艾灸阿是穴治疗寒湿型腰椎间盘突出症的临床观察

发布时间：2018-10-29 22:48

【摘要】：目的:观察艾灸阿是穴对于寒湿型腰椎间盘突出症的临床疗效差异;观察寒湿型腰椎间盘突出症冷感区的分布趋势,在选穴、探穴方面上进行探索;通过红外热成像技术,观察患肢冷感患者的冷感区温差变化,探索其与冷感症状严重程度之间的相关性。研究方法:1.纳入2016年1月至2017年2月期间于厦门市海沧医院康复医学科、骨科就诊的腰椎间盘突出症患者60例,随机分为阿是穴温灸组(治疗组)30例及药物口服组(对照组)30例;治疗组采用艾条悬灸患区阿是穴,对照组予药物口服,每日1次,5次为一个疗程,共两个疗程,疗程间间隔2天。治疗前后对两组患者进行JOA评分评定,患肢冷感评分标准及患肢冷感区温度评定,进行统计学分析,评价艾灸阿是穴治疗寒湿型腰椎间盘突出症临床疗效,并观察腰椎间盘突出症伴患肢冷感患者的患肢红外热像图,探索其冷感程度与健患侧温差变化的关系。结果:1.疗效比较:两组治疗前后JOA评分对比,经秩和检验,两组病情均有改善(P0.05)。两组各疗程进行组间比较,经秩和检验,两组治疗前JOA评分无显著性差异(P0.05),两组治疗后JOA评分有显著性差异(P0.05)。两组各个疗程治疗前后患肢冷感评分标准对比,经秩和检验,两组病情均有改善(P0.05)。两组各疗程进行组间对比,经秩和检验,治疗前患肢冷感评分标准评分无显著差异(P0.05),一疗程后患肢冷感评分标准评分有显著差异(P0.05),治疗后患肢冷感评分标准评分有显著差异(P0.05)。临床疗效比较:治疗组治愈6例,显效10例,好转8例,总有效率80%;对照组治愈2例,显效4例,好转11例,总有效率57%,经秩和检验,两组疗效有显著性差异(P0.05)。2、冷感区均分布于下肢的后、外侧,位于足太阳及足少阳经皮部上。3、患肢冷感程度、JOA评分与健患侧温差变化情况分析:对所有患者治疗前后的冷感程度评分与健患侧成像温差进行对比,经Pearson相关性分析,两组差值呈正相关;对治疗前后的JOA评分与健患侧成像温差进行对比,经Pearson相关性分析,两组差值无明显相关性。结论:1、采用循经取穴结合阿是取穴的取穴方法,进行艾灸治疗寒湿型腰椎间盘突出症,可以在较短的时间缓解患者的冷感症状,缓解腰椎间盘突出症的症状与体征。2、患者所描述冷感区均分布于患侧足太阳经与足少阳经的皮部上,通过红外热成像观察存在健患侧温差区,冷感区呈低温区。3、患肢冷感程度与健患侧温差密切相关。
[Abstract]:Objective: to observe the difference of clinical curative effect of moxibustion on cold and wet lumbar disc herniation, to observe the distribution trend of cold feeling area of cold wet type lumbar disc herniation, to explore points selection and probe points. Infrared thermal imaging was used to observe the temperature difference in the cold zone of patients with cold sensation and to explore the correlation between the temperature difference and the severity of cold sensation. Methods: 1. From January 2016 to February 2017, 60 patients with lumbar intervertebral disc herniation in orthopedic department of Haicang Hospital, Xiamen City, were randomly divided into two groups: 30 patients in the treatment group treated with warm moxibustion at Ashi point and 30 patients in the control group. The treatment group was treated with Ashi point of moxa suspension moxibustion, while the control group was given oral medication once a day, 5 times as a course of treatment, two courses of treatment, the interval between the two courses of treatment was 2 days. Before and after treatment, the patients in the two groups were assessed with JOA score, cold sensation score standard of affected limb and temperature of affected limb cold zone. The clinical effect of moxibustion on cold and wet lumbar intervertebral disc herniation was evaluated by statistical analysis. The infrared thermography of the affected limb in patients with lumbar disc herniation and cold sensation was observed to explore the relationship between the degree of cold sensation and the temperature difference of the affected side. The result is 1: 1. Comparison of curative effects: JOA scores were compared before and after treatment in both groups, and the two groups were improved by rank sum test (P0.05). By rank sum test, there was no significant difference in JOA score between the two groups before treatment (P0.05), and there was a significant difference in JOA score between the two groups after treatment (P0.05). Before and after the treatment of each course of treatment between the two groups, the cold sensation scores were compared, the two groups were improved by rank sum test (P0.05). By rank sum test, there was no significant difference in the score of cold sensation score between the two groups before treatment (P0.05), but there was significant difference in the score of cold sensation score after one course of treatment (P0.05). There was significant difference in cold sensation score after treatment (P0.05). Comparison of clinical efficacy: in the treatment group, 6 cases were cured, 10 cases were markedly effective, 8 cases were improved, and the total effective rate was 80%; In the control group, 2 cases were cured, 4 cases were markedly effective, 11 cases were improved. The total effective rate was 57%. By rank sum test, there was a significant difference between the two groups (P0.05). Located on the transcutaneous part of foot sun and foot Shaoyang, the degree of cold sensation of affected limb, JOA score and temperature difference of healthy side were analyzed. The cold sensitivity score of all patients before and after treatment was compared with that of healthy side imaging temperature difference, and the correlation analysis was made by Pearson. The difference between the two groups was positively correlated. The JOA score before and after treatment was compared with the imaging temperature difference of the healthy side. By Pearson correlation analysis, there was no significant correlation between the difference between the two groups. Conclusion: 1. Moxibustion treatment of cold and wet lumbar intervertebral disc herniation with acupoints along meridians combined with acupoint extraction along meridians can relieve cold symptoms and signs of lumbar intervertebral disc herniation in a short period of time. The cold regions described by the patients were all distributed on the skin of the sucromeria and the Shaoyang meridians of the affected foot. The difference of temperature in the affected side was observed by infrared thermal imaging. 3. 3. The degree of cold sensation of the affected limb was closely related to the difference of the temperature of the healthy side of the affected side.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.9

【参考文献】