毫火针针刺结筋病灶点治疗肩周炎疗效观察

发布时间：2018-01-08 20:12

本文关键词：毫火针针刺结筋病灶点治疗肩周炎疗效观察　出处：《广州中医药大学》2016年博士论文　论文类型：学位论文

【摘要】：目的：通过与常规针刺治疗为对照组的比较,观察“毫火针针刺结筋病灶点为主”治疗肩周炎的总临床疗效,以及毫火针针刺结筋病灶点与常规针刺两种不同的疗法在不同时段的疗效指标的变化,初步探讨毫火针针刺结筋病灶点为主这种特色疗法在治疗肩周炎中的临床有效性和时效性,以及火针针刺结筋病灶点疗法治疗肩周炎的可能作用机理,说明“毫火针针刺结筋病灶点”治疗肩关节周围炎的临床价值及推广意义,为今后临床选择更有效的肩周炎治疗方法提供循证医学依据。方法：本研究课题病例主要是来自广东省中医院、广州中医药大学第一附属医院在2014年12月至2015年12月期间到门诊就诊的病人,根据本研究的病例选择标准纳入60例研究病例,将合格病例按照随机分配原则平均分配至治疗组(毫火针针刺结筋病灶点组)与对照组(常规针刺组),毫火针针刺结筋病灶点治疗组和常规针刺对照组的病例数分别都是三十例。治疗组参照《中国经筋学》的经筋查体方法在肩关节周围近端和远端查找结筋病灶点(规律性阿是穴)进行毫火针留针针刺治疗,对照组则参照王启才主编《针灸治疗学》中肩周炎的治疗处方选取相关穴位进行常规针刺。毫火针针刺结筋病灶点治疗组和常规针刺对照组的患者均接受隔天1次的针刺治疗,完成6次治疗为1个疗程,整个研究要求两组的肩周炎患者需完成2个疗程的治疗。本研究的临床总疗效标准参照《中医病证诊断疗效标准》中有关肩周炎的疗效标准,疗效指标为Constant - Murley score肩关节评定法(简称CMS评定),其中总临床疗效在两个疗程结束后评估,第一次治疗、两个疗程后、两个疗程结束后1个月的随访时三个时段对对毫火针针刺结筋病灶点组与常规针刺组的病例的疗效指标进行评估,运用SPSS20.0对研究的数据进行统计分析。结果：1.治疗前毫火针针刺结筋病灶点组与常规针刺组的病例两组间的基线资料的比较：两组患者无论在性别、年龄、病程、中医证型亦或是SCM评分量表总分和SCM评分量各成分积分方面经统计学统计分析比较可知差异无统计学意义(P0.05),提示两组肩关节周围炎患者治疗前的基线条件一致。2.总临床疗效的比较：毫火针针刺结筋病灶点治疗组与常规针刺对照组两组治疗后总临床疗效进行比较,数据经秩和检验提示两组治疗后总临床疗效差异有统计学意义(P0.05),具有可比性,治疗组的30例肩周炎患者中,达到痊愈水平的有4例,达到显效水平的肩周炎患者有多达16例,达到有效水平的肩周炎患者也有6例,只有4例无效,总有效率达86.67%,；对照组的30例肩周炎患者中,达到痊愈水平的有3例,达到显效水平的肩周炎患者有7例,多数患者(12例)疗效达到有效水平,8例患者为无效,所以该组的总有效率为73.33%。3.不同时段疗效指标的比较：分别将毫火针针刺结筋病灶点治疗组和常规针刺对照组两组的肩周炎患者在第一次治疗后,两个疗程后,两个疗程后一个月随访时的3个不同时段的CMS评分量表总分、CMS评分量表各成分积分(主要包括疼痛积分、日常生活活动水平积分、肩关节活动度积分、肌力积分)与治疗前的CMS评分量表总分、CMS评分量表各成分积分作组内比较；将毫火针针刺结筋病灶点治疗组和常规针刺对照组两组的两个疗程后一个月随访时的CMS评分量表总分、CMS评分量表各成分积分与随访前即两个疗程后的CMS评分量表总分、CMS评分量表各成分积分做组内比较；将毫火针针刺结筋病灶点治疗组和常规针刺对照组两组的患者在治疗后3个不同时段的CMS评分量表总分、CMS评分量表各成分积分作组间比较。毫火针针刺结筋病灶点治疗组的组内比较：统计结果表明毫火针针刺结筋病灶点治疗组在治疗后不同时段的CMS评分量表总分、CMS评分量表各成分积分(第一次治疗后的肌力积分除外)与治疗前的CMS评分量表总分、CMS评分量表各成分积分相比均升高,组内差异有统计学意义(P0.05),研究结果表明,经过治疗,毫火针针刺结筋病灶点疗法对提高CMS评分量表总分、缓解患侧的疼痛、改善日常生活活动水平、增加患侧肩关节的活动度、改善肩关节周围炎患者的患侧肌力方面均有效,且对提高CMS评分量表总分、缓解患侧的疼痛、改善日常生活活动水平、增加患侧肩关节的活动度这四项的疗效起效快速(第一次治疗后的评分结果较治疗前的评分结果升高,差异有统计学意义,P0.05),对改善肩关节周围炎患者的患侧肌力方面起效较慢(第一次治疗后的肌力积分与治疗前的肌力积分相比无统计学意义上的差别,P0.05)；毫火针针刺结筋病灶点治疗组随访时的CMS评分量表总分、CMS评分量表各成分积分与随访前的CMS评分量表总分、CMS评分量表各成分积分对比,统计结果表明,只有在改善日常生活活动水平方面,组内差异有统计学意义,P0.05,CMS评分量表总分和CMS评分量表其他的成分积分在随访时与随访前的结果无统计学意义上的差异,提示毫火针针刺结筋病灶点疗法对改善日常生活活动水平方面的远期疗效显着,对于CMS评分量表总分、缓解患侧的疼痛、增加患侧肩关节的活动度、改善肩关节周围炎患者的患侧肌力方面的远期疗效稳定。常规针刺对照组的组内比较：统计结果表明,常规针刺对照组在两个疗程后、两个疗程后一个月随访时的两个时段的CMS评分量表总分、CMS评分量表各成分积分与治疗前的CMS评分量表总分、CMS评分量表各成分积分相比均升高,组内差异有统计学意义,P0.05,研究结果表明常规针刺疗法对提高CMS评分量表总分、缓解患侧的疼痛、改善日常生活活动水平、增加患侧肩关节的活动度、改善肩关节周围炎患者的患侧肌力方面均有效,但起效较慢(第一次治疗后的CMS评分量表总分、CMS评分量表各成分积分与治疗前的CMS评分量表总分、CMS评分量表各成分积分相比无统计学意义上的差别,P0.05)；常规针刺对照组随访时的CMS评分量表总分、CMS评分量表各成分积分与随访前的CMS评分量表总分、CMS评分量表各成分积分对比,结果无统计学意义上的差异,提示常规针刺对照组的疗法对提高CMS评分量表总分、缓解患侧的疼痛、改善日常生活活动水平、增加患侧肩关节的活动度、改善肩关节周围炎患者的患侧肌力方面的远期疗效稳定。毫火针针刺结筋病灶点治疗组和常规针刺对照组两组的组间比较：毫火针针刺结筋病灶点治疗组和常规针刺对照组两组的CMS评分量表中的肌力积分在第一次治疗后,两个疗程后,两个疗程后一个月随访时的3个不同时段的组间差异经统计分析可知无统计学意义,P0.05,提示在改善肩周炎患者患侧肌力方面,毫火针针刺结筋病灶点治疗组与常规针刺对照组在治疗后三个不同时段的疗效相当。毫火针针刺结筋病灶点治疗组和常规针刺对照组两组的CMS评分量表总分、CMS评分量表中的疼痛积分、日常生活活动水平积分、肩关节活动度积分在治疗后的3个不同时段的组间差异有统计学意义,P0.05,经统计分析可知对提高CMS评分量表总分、缓解患侧的疼痛、改善日常生活活动水平、增加患侧肩关节的活动度这四方面,无论是第一次治疗后还是两个疗结束后,抑或是两个疗程结束后1个月的随访时三个不同时段,毫火针针刺结筋病灶点治疗组的疗效均优于常规针刺对照组。结论：毫火针针刺结筋病灶点治疗组和常规针刺对照组治疗肩周炎都有一定临床疗效,但和常规针刺对照组的疗法相比,毫火针针刺结筋病灶点组的疗法的总临床疗效更佳,在提高CMS评分量表总分、缓解患侧的疼痛、改善日常生活活动水平、增加患侧肩关节的活动度方面具有一定优势,毫火针针刺结筋病灶点疗法不仅起效快,在即时、近期、远期疗效均优于常规针刺疗法。毫火针针刺结筋病灶点治疗肩周炎的临床疗效显着,稳定持久,临床应用安全有效,值得推广应用和进行深入研究。
[Abstract]:Objective: To compare with the conventional acupuncture treatment as control group, to observe the clinical efficacy of acupuncture with filiform needle total tendon lesions mainly in the treatment of periarthritis of shoulder, and the change of rib lesions acupuncture filiform needle and conventional acupuncture therapy in two different therapeutic indexes in different periods, to explore milli fire needle rib lesions the main point of this special therapy in the treatment of scapulohumeral periarthritis in clinical effectiveness and timeliness, and fire needle rib lesions therapy for periarthritis of shoulder of the possible mechanism of action, that "the milli fire needle clinical value and application significance in treatment of shoulder joint inflammation around the rib lesion acupuncture point", provide evidence-based basis for future clinical selection a more effective method for treatment of scapulohumeral periarthritis. Methods: this research case is mainly from the Guangdong Province Traditional Chinese Medical Hospital, the First Affiliated Hospital of Guangzhou University of Chinese Medicine from December 2014 to 2015 In December 2005 to outpatient patients, according to the study of the selection criteria for the patients included 60 cases of cases, the qualified cases according to the average distribution of randomized to treatment group (milli fire needle rib lesion group) and control group (conventional acupuncture group), acupuncture filiform needle rib lesions and treatment group the number of cases of routine acupuncture group were thirty cases. The treatment group according to China by bar check < > in the method of reinforcement learning around the shoulder joint proximal and distal rib lesions (find the regularity of Ashi) for filiform needle acupuncture treatment, control group according to the prescriptions of acupuncture and moxibustion Wang Qicai. "Learn > in the treatment of periarthritis of shoulder acupoints selected routine acupuncture. Milli fire needle rib lesions treatment group and routine acupuncture group. The patients received 1 day acupuncture treatment, 6 treatment for 1 courses, the whole research Two groups of patients with scapulohumeral periarthritis is required to complete 2 courses of treatment. The total clinical efficacy criteria of this study refer to < efficacy standards related to periarthritis TCM syndrome diagnostic efficacy standards > in the index of Constant - Murley, the curative effect of shoulder joint score evaluation method (CMS test), of which the total clinical efficacy was assessed at the end of the two courses after the first treatment, after two courses of treatment, two months after follow-up of 1 months during the three periods of the therapeutic index milli fire needle rib lesions group and routine acupuncture group were evaluated using SPSS20.0 to study the data for statistical analysis. Results: compared with before treatment was 1. fire needle rib lesions group and conventional acupuncture group of patients between the two groups: baseline data of two groups of patients in terms of gender, age, course of disease, TCM syndrome type or SCM score and SCM score of the integral component The statistical analysis showed no significant difference (P0.05), suggesting that compared baseline condition two groups of patients before treatment of periarthritis of shoulder with.2. clinical curative effect: the milli fire needle rib lesion treatment group and routine acupuncture group and two in the control group after treatment the total clinical efficacy were compared by rank data test showed the differences between the two groups after treatment the total efficacy was statistically significant (P0.05), comparable, 30 patients in the treatment group, the level of cure in 4 cases, reaching significant levels of patients with periarthritis of shoulder in 16 cases, achieve the effective level of periarthritis patients also had 6 cases, only 4 invalid cases, the total effective rate was 86.67%; 30 patients in the control group, the level of cure in 3 cases, reaching significant levels of patients with periarthritis of shoulder in 7 cases, the majority of patients (12 cases) the curative effect reached to the effective level of 8 cases Invalid, so the group in the total efficiency of 73.33%.3. in different periods respectively: indicators of the effect of milli fire needle rib lesion treatment group and routine acupuncture control group, two groups of patients with scapulohumeral periarthritis in after the first treatment, after two courses, 3 different periods of one month follow-up of two courses after the CMS score, CMS score of each component score (including pain scores, activities of daily living level of integral, integral, integral of shoulder muscle) before treatment with the CMS score, CMS score of each component points within the group; the milli fire needle rib the focus of treatment group and routine acupuncture control group two courses of the two groups after one month follow-up, CMS score, CMS score and the integral before follow-up after two cycles of CMS score, CMS score of each component Integral comparison in the group; the milli fire needle rib lesion treatment group and routine acupuncture group of two groups of patients after treatment in 3 different periods of CMS score, CMS score of each component was compared between the groups. The integral milli fire needle rib lesion treatment group compared node group the statistical results show that: the milli fire needle treatment group node focus in the treatment of tendon in different periods after the CMS score, CMS score of each component (except the first integral integral strength after treatment) before treatment with the CMS score, CMS score of each component was increased compared with the integral. Significant differences in group (P0.05), the results showed that after treatment, milli fire needle rib lesions therapy to improve CMS score, alleviate ipsilateral pain, improve the activities of daily living level, increase the risk of shoulder joint activities and change The ipsilateral muscle in patients with periarthritis of shoulder were good and effective, and to improve the CMS score, alleviate ipsilateral pain, improve the activities of daily living level, increase the risk of shoulder joint activities of the four effect of rapid onset (for the first time after treatment score than before treatment score results increased, the difference was statistically significant, P0.05), to improve the ipsilateral muscle slow onset patients with periarthritis of shoulder (muscle strength score and treatment after the first treatment before the integral strength had no significant difference. The difference, P0.05); milli fire needle rib lesion treatment group follow-up CMS scores the total score, CMS score of each component integral with the follow-up before the CMS score, CMS score of each component integral comparison, the statistical results showed that only in the improvement of activities of daily living level, there were differences in each group Meaning, P0.05, CMS score and CMS score of other components integral in the follow-up and follow-up the results no statistically significant difference, suggesting that the long-term curative effect of node milli fire needle therapy on tendon lesions improve the activities of daily living level significantly, the CMS score, alleviate the suffering the side of pain, increase the risk of shoulder joint activities, improve the long-term efficacy of stable ipsilateral muscle of patients with periarthritis of shoulder. Compared with conventional acupuncture control group: the statistical results show that the conventional acupuncture in the control group after two month treatment, two hours a month follow-up of two courses after the CMS score, CMS score of each component score before treatment CMS score, CMS score of each component score was increased compared, statistically significant differences in group P0.05, the results showed that the conventional acupuncture Therapy to improve the CMS score, alleviate ipsilateral pain, improve the activities of daily living level, increase the risk of shoulder joint activities, improve the ipsilateral muscle strength in patients with periarthritis of shoulder were effective, but the effect is relatively slow (for the first time after treatment, CMS score, CMS score CMS, the integral scale CMS score of each component score before treatment compared with no significant difference, P0.05); routine acupuncture control group follow-up CMS score, CMS score of each component integral with the follow-up before the CMS score, CMS score the integral comparison results, no statistically significant difference in the control group, suggesting that the conventional acupuncture therapy to improve CMS score, alleviate ipsilateral pain, improve the activities of daily living level, increase the risk of shoulder joint activity, improve the shoulder off The long-term curative effect of stable ipsilateral muscle in patients with periarthritis of section. Milli fire needle rib lesion treatment group and routine acupuncture group and two in the control group between the two groups: milli fire needle rib lesion treatment group and routine acupuncture control group, two groups of CMS score in the first treatment in integral strength after two months after treatment, the differences of the 3 different periods of one month follow-up of treatment after the two groups by statistical analysis showed no statistical significance, P0.05, suggesting improvement in patients with scapulohumeral periarthritis ipsilateral muscle, milli fire needle treatment group node and conventional acupuncture point rib lesion control group after treatment efficacy three different periods of time. A milli fire needle rib lesion treatment group and routine acupuncture control group, two groups of CMS score, CMS pain score scale score, activities of daily living level points, activity of shoulder joint in integral There are statistically significant differences, 3 different periods of time after treatment of the group P0.05, with statistical analysis to improve the CMS score, alleviate ipsilateral pain, improve the activities of daily living level, increase the risk of shoulder joint activities of the four aspects, whether it is the first time after treatment or therapy over two later, or two months after 1 months of follow-up in three different time periods, filiform needle is superior to that of conventional acupuncture group acupuncture effect reinforcement treatment group lesions. Conclusion: the milli fire needle rib lesions treatment group and routine acupuncture group treatment of scapulohumeral periarthritis has certain clinical curative effect. But compared with the normal control group of acupuncture treatment, the total clinical efficacy of acupuncture filiform needle rib lesion group therapy, improve CMS score, alleviate ipsilateral pain, improve the activities of daily living level, increase the risk of shoulder joint Have the advantage of activity, milli fire needle rib lesions therapy is not only fast, in an instant, short-term, long-term efficacy was better than routine acupuncture therapy. The clinical efficacy of acupuncture with filiform needle for treatment of periarthritis of shoulder tendons lesions significantly, stable and durable, safe and effective in clinical use, is worthy of popularization and application and in-depth research.

【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】：2016
【分类号】：R246.9

【相似文献】