针刀疗法治疗跖筋膜炎的临床疗效观察

发布时间：2018-04-10 11:24

本文选题：封闭疗法 + 疗效　；参考：《北京中医药大学》2014年硕士论文

【摘要】：目的：跖筋膜炎是临床上常见的足部疾病,该病影响了患者的日常生活及工作。目前在临床上治疗跖筋膜炎的方法有中药口服／外洗、针灸、手法按摩以及非甾体类抗炎药、局部激素封闭、小腿三头肌或／和跖筋膜牵拉、夜间支具固定、体外超声波冲击、穿矫形鞋及手术等疗法。这些疗法均有一定的效果,但同时也存在诸多缺陷,如起效慢、复发率高、患者依从性差、费用高等。针刀疗法作为一种简单、有效的微创技术,越来越多的应用于本病的治疗。本研究通过对于望京医院门诊就诊的60例跖筋膜炎患者,分别进行针刀疗法和封闭疗法治疗,对比两种治疗方法疗效差异,对针刀治疗跖筋膜炎的疗效做出比较确切的评价。方法：共收集符合标准的跖筋膜炎患者60例,随机分为两组,其中试验组采用单纯针刀治疗,对照组采用封闭治疗,每组各30例。在针刀治疗组中,于患足压痛最明显处进针,行局部麻醉后,将刀口线与足长轴垂直,并垂直刺入。分别作横行及纵行切开剥离3-4次,当感觉针下有松动感时,即出针。封闭治疗组采用盐酸利多卡因(5m1:0.1g)+复方贝他米松1m1浑浊液,于压痛最明显处进针,直达骨面,做痛点及其周围封闭。术毕用无菌纱块按压片刻至伤口不出血为止,用创可贴固定创口,创口2天内不得沾水。两组均只治疗一次。于治疗前、治疗后1周、治疗后1月分别进行SF-MPQ及JOA评分以评价疗效,于治疗后2月进行复发率的观察。采用SPSS22.0进行数据的录入、管理和维护,并对患者基本资料及SF-MPQ、JOA积分进行统计分析。结果： 1、针刀治疗组总有效率(83.33%)虽然略低于封闭治疗组(86.67%),但并无统计学意义。在针刀治疗组中,各中医证型间疗效的差异无统计学意义(P=-0.736)。 2、治疗后2月,针刀组复发率为6.67%,封闭组复发率为16.67%,二者在统计学上具有显著性差异(P=0)。 3、两组患者SF-MPQ评分、JOA评分在治疗后1周、1月时均比治疗前有显著性差异(P=0)。 4、两组患者间SF-MPQ评分、JOA评分在治疗后1周、治疗后1月的差异均无统计学意义(1周时P1=0.680,P2=0.749,1月时P1=0.272,,P2＝0.994)。 5、在针刀治疗组中发现,SF-MPQ评分改善情况与患者年龄之间有显著性关联,二者之间的皮尔逊相关系数为-0.741,尸值为0.0000.01。结论： 1、两种治疗方法对跖筋膜炎均有较好的疗效,且疗效基本相同。针刀治疗组总有效率虽然略低于封闭治疗组,但并无统计学意义。 2、针刀疗法对不同中医证型患者的疗效相同。 3、针刀疗法治疗跖筋膜炎的复发率明显低于封闭疗法。 4、随着患者年龄的增长,针刀疗法的疗效降低。 5、两种疗法治疗跖筋膜炎均具有较高的安全性。
[Abstract]:Objective:Metatarsal fasciitis is a common foot disease, which affects the daily life and work of patients.The current clinical treatments for plantar fasciitis include oral / external washing of traditional Chinese medicine, acupuncture and moxibustion, manual massage and non-steroidal anti-inflammatory drugs, local hormone blocking, triceps or / and metatarsal fascia traction, nocturnal fixation, and external ultrasonic shock.Wear orthopaedic shoes and surgery.These treatments have certain effects, but there are also many defects, such as slow onset, high recurrence rate, poor compliance, high cost and so on.As a simple and effective minimally invasive technique, needle-knife therapy is more and more used in the treatment of this disease.In this study, 60 cases of metatarsal fasciitis treated in Wangjing Hospital were treated with needle knife therapy and block therapy respectively, and the curative effect of the two methods was compared, and the curative effect of needle knife on metatarsophalangeal fasciitis was evaluated more accurately.Methods:A total of 60 patients with plantar fasciitis were randomly divided into two groups: the experimental group was treated with simple needle knife and the control group was treated with block therapy, 30 cases in each group.In the acupuncture knife treatment group, the needle was inserted into the foot tenderness at the most obvious place. After local anesthesia, the cutting edge line was perpendicular to the long axis of the foot and punctured vertically.Transverse and longitudinal incision and stripping 3-4 times, when there is a sense of loosening under the needle, that is, the needle.The treatment group was treated with lidocaine hydrochloride (5m-1: 0.1g) compound betamethasone 1m1 turbidity liquid, the most obvious tenderness was injected into the bone surface, and the pain point and its surrounding sealing were done.At the end of the operation, use sterile gauze to press for a moment until the wound does not bleed. Fix the wound with a band-aid. Do not touch the wound with water for 2 days.Both groups were treated only once.SF-MPQ and JOA scores were evaluated before treatment, 1 week after treatment and 1 month after treatment, and the recurrence rate was observed at 2 months after treatment.The data input, management and maintenance were carried out by SPSS22.0, and the basic data of patients and the score of SF-MPQN JOA were statistically analyzed.Results:1. The total effective rate of acupuncture knife treatment group (83.33) was slightly lower than that of closed treatment group (86.67%), but there was no statistical significance.In the acupuncture knife treatment group, there was no significant difference in the curative effect between different TCM syndromes.2, 2 months after treatment, the recurrence rate of needle knife group was 6.67 and that of closed group was 16.67. There was significant statistical difference between the two groups.3, the SF-MPQ scores of the two groups were significantly different from those before treatment at 1 week and 1 month after treatment.(4) there was no significant difference in SF-MPQ score between the two groups at 1 week after treatment and 1 month after treatment. There was no significant difference between the two groups at 1 week after treatment (P 1: 0. 80 P 2 + 0. 749) and at 1 month after treatment (P 1 + 0. 272) and P 1 + 0. 272% P 2 + 0. 994%.5. There was a significant correlation between the improvement of SF-MPQ score and the age of the patients in the acupuncture knife treatment group. The Pearson correlation coefficient between them was -0.741and the cadaver value was 0.0000.01.Conclusion:1. Both methods have good curative effect on metatarsal fasciitis, and the curative effect is basically the same.The total effective rate of acupuncture-knife treatment group was slightly lower than that of closed treatment group, but there was no statistical significance.2. The effect of acupuncture-knife therapy on different TCM syndromes is the same.3. The recurrence rate of needle-knife therapy for metatarsal fasciitis was significantly lower than that of block therapy.4. With the age of the patients, the curative effect of needle knife therapy decreased.5, both treatments have high safety in the treatment of metatarsal fasciitis.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R246.9

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