易罐结合针刺治疗网球肘的临床研究及作用机制初探

发布时间：2017-12-27 03:28

本文关键词：易罐结合针刺治疗网球肘的临床研究及作用机制初探　出处：《广州中医药大学》2017年博士论文　论文类型：学位论文

【摘要】：网球肘(Tennis Elbow)又被称为肱骨外上髁炎、肘外侧疼痛综合征,多由于长期累积性的反复牵拉伸肌腱,导致前臂肌肉群及肌腱的微损伤,形成局部劳损,造成伸肌肌腱退变的一种肘外侧部的肌腱病(Lateral elbow tendinopathy,LET)。本病多见于需要长期反复用力伸腕的工作者或运动员,尤其是经常性地转动前臂者,如搅拌工、网球运动员、小提琴手、挖木工等,以40-50岁成人发病居多,男性网球运动员发生率高于女性,但在一般人群中男女患病比例基本相同。西医认为网球肘的主要致病机理是手腕伸展肌群过度使用,导致外上髁附着处的肌肉或肌腱微小创伤,长期积累而无法修复,肌腱退行性变,形成慢性无菌性炎症,并最终引起肘外侧部疼痛。网球肘是一种自身局限性的无菌炎症反应,90%的患者不经过治疗,依靠自身的修复可以痊愈。然而网球肘自身的修复时间周期比较长,疼痛难以忍受,复发率高,容易形成顽固性网球肘,增加治疗难度。临床治疗以保守疗法为主,包括疼痛缓解药物、局部类固醇注射、体外冲击波治疗、运动疗法、肘部护具等。中医认为网球肘是由于外伤、劳损,风寒湿邪闭阻导致肘关节气血凝滞不通,络脉淤阻,迁延日久,不通则痛;或素体亏虚,血不荣筋,筋骨长期得不到有效的润养,不荣则痛。中医治疗"肘痹"的历史比较悠久,已经形成了自己独特的理论及临床实践方案,在治疗网球肘的过程中,总体较西医的外科手术、激素疗法、冲击波疗法等副作用要小,复发率低,也无不良并发症,受到众多患者的青睐。因此,本研究主要从中医疗法治疗网球肘的临床效应入手。研究目的:由于针刺和易罐疗法在治疗网球肘方面具有独特的优势,两种疗法结合在临床治疗中取得了不错的临床效果。本课题研究拟结合针刺和易罐的治疗方法给予网球肘患者治疗,将单纯传统针刺疗法作为比较,进行临床随机对照试验,探讨其治疗网球肘的临床疗效及可能的作用机制,为临床医生治疗网球肘提供了优选治疗方案。研究方法:在香港荃湾区吴氏中医诊疗所招募到的符合试验纳入标准的60例网球肘患者作为研究对象。将研究对象按照随机对照分组的原则均分试验组和对照组各30例。试验组网球肘患者给予传统针刺结合易罐的疗法治疗。患者取正坐位,将患肢前臂平放于治疗桌上,常规消毒后,针刺阿是穴、曲池、外关、手三里、合谷、支沟、中渚穴,得气后施行平补平泻手法,留针30分钟。出针后进行易罐治疗,时间为10分钟。隔天治疗1次,10次为1疗程。对照组只进行以上所述的传统针刺治疗,治疗方法与疗程与试验组一致。在进行治疗前,先对纳入试验的所有病例包括试验组和对照组进行试验治疗前病情简单评价,评价项目包括JOA肘部功能评分、ADL日常生活活动能力评分、临床症状积分、简化McGill疼痛问卷、患肢痛点红外成像的最高温度五个项目指标,同时分析纳入对象的性别构成及年龄分布,以确保研究对象的基线具有一致性。在网球肘患者进行第一次治疗结束后15min,采用SF-MPQ量表中的VAS评分量表为评价标准及对患处进行红外热成像检测,进行即时止痛效果疗效评价,探索分析两种治疗方法的即时止痛效果。整个疗程10天的治疗结束后,对两组网球肘患者治疗后的JOA肘部功能评分、ADL日常生活活动能力评分、临床症状积分简化McGill疼痛问卷、患肢痛点红外成像的最高温度再进行一次评分测量,通过对比治疗前的基础指标,统计分析两种治疗方法的疗效。完成治疗后的1个月,以电话或面谈的方式对参与治疗的全部网球肘患者进行随访,随访记录日常生活活动能力,并采用ADL量表打分以评价远期治疗效果。研究结果:本次临床研究共60例网球肘患者纳入试验研究,治疗期间患者积极配合,整个试验过程中没有出现剔除或脱落的病例。根据临床试验的随机分组原则,试验组和治疗组各30例,对两组网球肘患者的性别构成及其年龄分布情况进行统计学分析,均无统计学差异(P0.05),说明试验组和治疗组的病人在性别构成、年龄分布上一致性较好。在进行试验治疗前,先对纳入试验研究的患者进行JOA肘功能评分,试验组和对照组治疗前评分相比较无统计学差异(P0.05),即可认为两组患者治疗前肘部受限活动程度较一致。ADL日常生活活动能力评分是评价患者肘部疾患对日常生活自理能力的影响。试验组和对照组治疗前评分相比较无统计学差异(P0.05),两组网球肘患者的日常生活自理能力较一致。临床症状积分是医生对患者进行体格检查所得到的较客观的病情量化评价积分。医者先对试验组和治疗组被纳入试验的研究对象进行临床症状检查并给予客观评价,试验组和对照组治疗前评分相比较无统计学差异(P0.05),可知治疗前两组患者的临床症状严重程度相近。SF-MPQ评分问卷包含三项内容,分别在疼痛等级、患者疼痛视觉评分、现时疼痛程度三个方面综合评价患者的疼痛感受。两组患者治疗前的PRI、VAS、PPI评分相比较无统计学差异(P0.05),说明两组患者的疼痛程度的一致性较好。红外成像仪测得的患者肘部痛点处最高温度,是疼痛局部炎症的较为直观的量化评价指标。两组患者治疗前的局部最高温度相比较无统计学差异(P0.05),说明两组患者治疗前疼痛局部皮温接近。接受治疗所有的网球肘患者,在接受第一次治疗结束后的15min,立即进行VAS评分,并进行统计学分析。第一次治疗结束后,试验组、对照组的治疗前后进行比较,均有显著统计学差异(P0.01),说明针刺加易罐疗法及单独针刺治疗都能改善患者的VAS评分。试验组和对照组相比VAS评分差值组间比较有显著统计学差异(P0.01),说明针刺加易罐疗法对网球肘患者VAS评分法的改善程度较单独针刺治疗组的改善程度要好。第一次治疗结束后痛点温度,试验组、对照组的治疗前后进行比较,均有显著统计学差异(P0.01),说明针刺加易罐疗法及单独针刺治疗都能使网球肘患者损伤局部皮温降低。试验组和对照组痛点温度改善程度组间比较,试验组痛点温度差改善更为明显,对比有统计学意义(P0.01),即针刺加易罐疗法对网球肘患者局部痛点温度改善程度较单纯针刺治疗要高。所有研究对象完成第一个疗程治疗结束后两组的JOA功能评分、日常生活活动能力ADL量表评分、临床症状积分、简化McGill疼痛问卷中各项的评分、痛点处最高温度,治疗后试验组及对照组均较治疗前的评分显著改善(P0.01),说明针刺加易罐疗法及单纯针刺治疗法都有不错的治疗效果。进一步统计分析疗程治疗后试验组和对照组组间的数据,试验组较对照组JOA量表评分差值改变程度更显著(P0.01);试验组ADL量表评分差值较对照组有改善(P0.05);试验组临床症状积分差改善程度与对照组的改善程度之间无统计学差异(P0.05);试验组简化McGill疼痛问卷中的PRI、VAS、PPI评分与对照组相比无统计学差异(P0.05);试验组治疗前后痛点最高温度差与对照组相比无统计学差异(P0.05)。随访ADL量表评分组间比较,试验组ADL评分较对照组评分高,且有统计学意义(P0.05)。试验组对比对照组,虽然在疗程疗效的临床症状积分、简化McGill疼痛问卷、红外成像的痛点温度等方面两组之间没有明显差别,但试验组的优势在于:对首次治疗结束后的VAS评分和红外成像的痛点温度的改善,疗程疗效的JOA肘功能量表和ADL量表的改善,还有远期疗效的ADL量表的改善。即试验组的疗法可以更好地产生即时的止痛效果,更好地促进治疗后肘部功能的恢复,以及对于治疗后和远期的日常生活活动能力的改善。研究结论:①单纯针刺治疗及针刺结合易罐疗法都能改善网球肘的JOA肘部功能评分、ADL 口常生活活动能力评分、临床症状积分、简化McGill疼痛问卷评分和痛点局部最高温度,治疗网球肘有效;②针刺结合易罐疗法的即时止痛效果及远期疗效均优于单纯针刺疗法。
[Abstract]:Tennis elbow (Tennis Elbow) is also known as lateral epicondylitis, lateral elbow pain syndrome, due to long-term accumulation of cyclic tensile tendons, resulting in forearm muscles and tendons micro damage, the formation of local strain, muscle tendon disease caused by degeneration of the extensor tendon of a lateral elbow Department (Lateral elbow tendinopathy LET). The disease is more common in long-term repeated hard wrist workers or athletes, especially frequently turn the forearm, such as mixer, tennis player, violinist, dig woodworking etc with 40-50 year old adult onset mostly male tennis players were higher than those in women, but in the general population prevalence ratio of men is basically the same. According to western medicine, the main pathogenesis of tennis elbow is the excessive use of extensor muscles of wrist, resulting in minor injuries of muscles or tendons at the attachment of external epicondyle, which can not be repaired for a long time, degenerative tendons, forming chronic aseptic inflammation, and eventually causing pain on the lateral elbow. Tennis elbow is a self limiting reaction of aseptic inflammation, and 90% of the patients are cured without treatment and can be cured by their own repair. However, the repair time of tennis elbow is long, the pain is unbearable, the recurrence rate is high, it is easy to form the stubborn tennis elbow and increase the difficulty of treatment. Clinical treatment is mainly conservative therapy, including pain relief drugs, local steroid injection, extracorporeal shock wave therapy, exercise therapy, elbow protector and so on. Chinese medicine believes that tennis elbow is due to injury and strain, the wind cold dampness stagnation caused elbow blood stagnation barrier, obstruction of collaterals, protracted, no pain; or ferrite deficiency, may B. and long-term lack of effective moistening, not glory pain. Chinese medicine treatment of "elbow Bi" has a long history, has formed its own unique theory and clinical practice, in the process of treating tennis elbow in general surgery compared with western medicine, hormone therapy, shock wave therapy and other side effects of small, low recurrence rate, no adverse complications, by many patients favor. Therefore, this study mainly starts with the clinical effect of traditional Chinese medicine therapy for tennis elbow. Research purposes: Acupuncture and cupping therapy have unique advantages in the treatment of tennis elbow. The two therapies have achieved good clinical results in clinical treatment. This research intends to acupuncture therapy and combined treatment with easy tank tennis elbow, simple traditional acupuncture therapy as compared to randomized clinical trials, to investigate the clinical curative effect for the treatment of tennis elbow and the possible mechanism, providing optimal treatment for clinical treatment of tennis elbow. Research methods: in Hongkong traditional Chinese medicine clinics in Tsuen Wan District Wu recruited to meet the 60 cases of patients with tennis elbow test standards as the research object. The subjects were divided into 30 cases in the test group and the control group according to the principle of the randomized controlled group. The experimental group of tennis elbow patients was treated with traditional acupuncture combined with easy canister therapy. Patients take seat, limb forearm flat on the treatment table, after routine disinfection, acupuncture point, Quchi, Waiguan, hand three years, Hegu, ditch, Zhongzhu point, after the gas as reinforcing reducing techniques, for 30 minutes. After the needle was released, the time was 10 minutes. 1 times a day, 10 times for 1 courses. The control group only carried out the traditional acupuncture treatment mentioned above, and the treatment method and the course of treatment were in accordance with the experimental group. In the treatment before, first of all test cases including experimental group and control group were tested before treatment simple evaluation, evaluation of the project include JOA ADL elbow function score, ADL score, clinical symptom score, simplified McGill pain questionnaire, limb pain point infrared imaging the highest temperature of the five items index. The analysis included gender and age distribution of the object, to ensure that the baseline is consistent with the research object. After the first treatment of tennis elbow patients, 15min used the VAS scale of SF-MPQ scale as the evaluation standard and the infrared thermography of the affected part to evaluate the effect of immediate analgesic effect, and explored the immediate analgesic effect of the two treatments. Over the entire course of treatment after 10 days of treatment in two group score, tennis elbow after elbow function JOA ADL ADL score, clinical symptoms of simplified McGill pain questionnaire, the highest temperature of phantom pain IR imaging to a score based index measurement, compared to before the treatment, statistical analysis of efficacy two treatment methods. 1 months after the completion of treatment, all tennis elbow patients who participated in the treatment were followed up by telephone or interview. Their activities of daily living were followed up, and the ADL scale was used to score the long-term effect. Results: a total of 60 tennis elbow patients were included in the experimental study. During the treatment period, the patients were actively coordinated, and no cases of rejection or falling out were found during the whole experiment. According to the principles of randomized clinical trials, experimental group and treatment group with 30 cases in each group, the statistical analysis on the gender and age distribution of two groups of patients with tennis elbow, there was no significant difference (P0.05), the experimental group and the treatment group of patients in the gender composition, age distribution, good consistency. Before the experimental treatment, the JOA elbow function score of the patients who were included in the experimental study was first scored. There was no significant difference in the score between the experimental group and the control group before treatment (P0.05). It could be considered that the elbow activity of the two groups was more consistent before treatment. The ADL daily living ability score is an evaluation of the effect of the elbow disease on the self-care ability of the daily life. There was no statistical difference between the test group and the control group before the treatment (P0.05). The daily life self-care ability of the two groups of tennis elbow patients was more consistent. The clinical symptom score is the doctor's physical examination of the patient
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R246.9

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