推拿手法结合热疗治疗椎间盘源性下腰痛的临床疗效观察

发布时间：2018-06-24 19:50

本文选题：椎间盘源性下腰痛 + 推拿手法　；参考：《湖北中医药大学》2013年硕士论文

【摘要】：目的椎间盘源性下腰痛在近些年来逐渐被临床重视，其疼痛部位多位于下腰部中线附近，少有根性疼痛及干性疼痛，疼痛往往以患者主观感受为多而客观阳性体征较少。本病多慢性起病，且缓解与复发迁延不断，被临床医生认为是极为棘手的疾病之一。椎间盘源性下腰痛目前主要有手术治疗和非手术治疗两种方法。由于手术治疗的有创性与风险性、治疗费用的高昂性以及患者自身的恐惧心理，使得手术治疗的局限性逐渐被放大，而非手术治疗则成为了大多数患者的第一选择。因目前保守治疗中的传统疗法及物理疗法种类较多、方式多样，本文主要着重将传统疗法中的推拿治疗跟物理疗法中的热疗相结合，并与单纯的推拿治疗做对比，以此来探究推拿手法与热疗组合治疗的作用原理、实际疗效与临床价值。方法收集了自2011年8月-2013年3月就诊于湖北省中医院推拿科的椎间盘源性下腰痛的患者共80例，年龄为22-46岁,平均年龄为38.25岁，男性患者48例、女性患者32例，病程6月-3年,平均20.25月，符合本研究诊断标准、纳入标准及排除标准。采用随机数表将80人平均分为2组：观察组和对照组，每组40例。两组患者的性别、年龄、疗程经统计学分析，无显著性差异(p0.05)，具有可比性。对照组采用单纯推拿手法治疗，连续治疗5次为一疗程，一共3个疗程；观察组则采用推拿手法与热疗两种方法组合治疗，热疗在先，手法操作在后，手法操作同对照组，热疗为每日一次，连续治疗5次为一疗程，一共3个疗程。在治疗前和治疗后，对所有病例均应用VAS疼痛评分、Oswestry腰椎功能指数以及安静状态下持续坐立时间进行观察记录，数据采用SPSS17.0统计软件进行统计分析。结果观察组总有效率为95%，对照组总有效率为90%，差异无统计学意义（P0.05），说明单纯运用推拿手法和联合运用推拿热疗这两种方法均有效果；观察组一个疗程有效率为90%，对照组一个疗程有效率为72.5%，两者比较观察组优于对照组，差异有统计学意义（P0.05），说明观察组起效时间比对照组更快；两组病例治疗前VAS评分、持续坐立时间、Oswestry腰椎功能指数比较无显著性差异(P0.05)，具有可比性，两组病例治疗前后VAS评分、持续坐立时间、Oswestry腰椎功能指数的差值经t检验， P0.05，差异有统计学意义，说明观察组在对患者症状和体征的改善方面优于对照组。结论在治疗椎间盘源性下腰痛时，推拿手法和热疗组合运用比单纯使用推拿手法起效更快、疗效更好、改善预后方面更可靠，，值得临床应用与推广。
[Abstract]:Objective in recent years, discogenic low back pain has been paid more and more attention in clinic. Its pain location is located near the middle line of lower waist, and there is little root pain and dry pain. Pain is often more subjective than objective positive signs. Chronic onset, remission and recurrence are regarded by clinicians as one of the most intractable diseases. Disc-derived low back pain has two main methods: surgical treatment and non-operative treatment. Because of the invasiveness and risk of surgical treatment, the high cost of treatment and the fear of patients themselves, the limitation of surgical treatment is enlarged gradually, and non-operative treatment becomes the first choice of most patients. Because there are many kinds of traditional therapy and physical therapy in conservative treatment at present, this article mainly focuses on the combination of massage therapy in traditional therapy and hyperthermia in physical therapy, and makes a comparison with simple massage therapy. In order to explore the combination of massage manipulation and hyperthermia treatment of the principle of the actual effect and clinical value. Methods from August 2011 to March 2013, 80 patients with low back pain of intervertebral disc origin, aged 22-46 years, with an average age of 38.25 years, including 48 male patients and 32 female patients, were collected. The course of disease ranged from 6 months to 3 years, with an average of 20.25 months. 80 patients were randomly divided into two groups: observation group and control group with 40 cases in each group. There was no significant difference in sex, age and course of treatment between the two groups (p0.05). The control group was treated with simple massage manipulation for 5 consecutive courses of treatment for a course of treatment, and the observation group was treated with massage manipulation and hyperthermia. Hyperthermia once a day, continuous treatment for 5 times a course of treatment, a total of 3 courses. Before and after treatment, VAS pain score and Oswestry Lumbar function Index (Oswestry) were used to observe and record all the patients. SPSS 17.0 statistical software was used to analyze the data. Results the total effective rate of the observation group was 95%, the total effective rate of the control group was 90, the difference was not statistically significant (P0.05). The effective rate of one course of treatment in the observation group was 90 and that in the control group was 72.5. The comparison between the two groups was better than that in the control group, and the difference was statistically significant (P0.05), which indicated that the effective time of the observation group was faster than that of the control group; the VAS score of the two groups before treatment was better than that of the control group. There was no significant difference in the Oswestry lumbar functional index between the two groups (P0.05). The VAS scores before and after treatment and the Oswestry lumbar functional index difference between the two groups were statistically significant. The observation group was superior to the control group in improving the symptoms and signs of the patients. Conclusion in the treatment of low back pain caused by intervertebral disc, the combination of massage and hyperthermia is more effective, effective and reliable in improving the prognosis than that of simple massage. It is worthy of clinical application and popularization.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R244.1;R274.9

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