员利针疗法治疗不同突出类型腰椎间盘突出症的疗效比较

发布时间：2018-04-08 09:58

本文选题：员利针疗法　切入点：腰椎间盘突出症　出处：《中国中医科学院》2016年硕士论文

【摘要】：研究背景：腰椎间盘突出症是由椎间盘变性,纤维环破裂、髓核突出,刺激或压迫神经根、马尾神经所表现的一种综合征,是临床常见病和多发病；发病节段以腰4/5、腰5/骶1椎间隙发病率最高,临床以腰背痛、下肢放射痛为典型症状；多见于25-55岁的患者,且男性多于女性。腰椎间盘突出症的治疗分为保守治疗和手术治疗,以保守治疗为主,80-90%的患者可经过针灸、推拿、中药、物理疗法、神经阻滞等中医或西医保守方法得到缓解,有的甚至痊愈。在保守疗法中,针灸以其简、便、廉、效的特点,在临床上运用广泛。员利针为针灸中古九针演变而来,目前文献对于它治疗腰椎间盘突出症的报道较少,但因在临床中它以快速、有效、操作简单等优点脱颖而出,基于此,本研究以观察员利针疗法治疗不同突出类型腰椎间盘突出症的疗效,并比较外侧型和中央型的疗效,优化腰椎间盘突出症的治疗方案,以指导临床。研究目的：观察员利针疗法治疗腰椎间盘突出症的临床疗效及不同突出类型疗效相互比较(包括症状、疼痛程度、生活质量的改善),进一步明确临床适应症,以便临床推广应用。研究方法：1.将符合纳入排除标准的70例腰椎间盘突出症患者根据CT分型分为两组,外侧型组和中央型组分别35例。2.患者俯卧位,选取病变部位及上下节段腰夹脊穴、阿是穴,用75%酒精对皮肤常规消毒后用0.8x50mm的员利针,运用提插直刺傍刺法,针刺得气后不留针的方法,每日1次,5次为一个疗程。3.两组患者均选用JOA、VAS、SF-36量表,并对治疗前、后进行评分。4.疗效评价根据《中药新药临床研究指导原则》及国家中医药管理局制定的《中医病证诊断疗效标准》中治疗腰椎间盘突出症的疗效评定标准拟定。5.运用SPSS 16.0软件进行统计分析,计数资料用%表示,两组间差异比较用卡方检验；计量资料用x±s表示,两组间差异比较采用独立样本t检验,治疗前与治疗后比较采用配对t检验；两组间有效率差异比较采用卡方检验。P0.05为差异有统计学意义。研究结果：1.员利针对治疗外侧型和中央型腰椎间盘突出症均有疗效,但更适用于外侧型腰椎间盘突出症患者。2.VAS和临床疗效外侧型均优于中央型(P0.05)。3.JOA和SF-36比较结果显示,外侧型和中央型治疗均有效(P0.05),但差异不明显,无统计学意义(P0.05)。结论：员利针疗法对外侧型和中央型腰椎间盘突出症患者在改善症状、减轻疼痛、提高生活质量、临床疗效方面均有效；在减轻疼痛和临床疗效方面外侧型优于中央型。
[Abstract]:Background: lumbar disc herniation is a syndrome characterized by degeneration of intervertebral disc, rupture of fibrous ring, protrusion of nucleus pulposus, stimulation or compression of nerve root and cauda equina nerve.The incidence rate of lumbar 5 / sac1 intervertebral space was the highest. The typical symptoms were low back pain and lower extremity radialgia, which were more common in patients aged 25 to 55 years, and more in men than in women.The treatment of lumbar disc herniation can be divided into conservative treatment and surgical treatment. 80-90% of patients with lumbar disc herniation can be relieved by acupuncture, massage, Chinese medicine, physical therapy, nerve block and so on.In conservative therapy, acupuncture is widely used in clinic because of its simple, convenient, cheap and effective characteristics.Shenli Needle is the evolution of acupuncture and moxibustion. At present, there are few reports on the treatment of lumbar disc herniation in the literature, but it stands out because of its advantages in clinical practice, such as speed, effectiveness, simple operation, and so on.In this study, the therapeutic effects of different types of lumbar disc herniation were compared with those of lateral type and central type, and the treatment scheme of lumbar disc herniation was optimized to guide clinical practice.Objective: to evaluate the clinical efficacy of acupuncture therapy in the treatment of lumbar disc herniation and to compare the effects of different herniation types (including symptoms, pain degree, quality of life), and to determine the clinical indications.In order to promote clinical application.Research method: 1.According to CT classification, 70 patients with lumbar disc herniation were divided into two groups: the lateral type group and the central type group.In the prone position, the patients were selected the diseased position and upper and lower lumbar Jiaji points and Ashi points. After routine disinfection of the skin with 75% alcohol, the patients were treated with 0.8x50mm 's needling, and the method of lifting and inserting straight needling was used, and the method of not keeping the needle after acupuncture was used.Once a day, 5 times as a course of treatment. 3.JOAA VASS SF-36 scale was used in both groups, and the scores before and after treatment were. 4. 4.The evaluation of curative effect was made according to the guiding principles of Clinical Research on New drugs of traditional Chinese Medicine and the criteria for the diagnosis and treatment of Lumbar Intervertebral Disc Herniation made by the State Administration of traditional Chinese Medicine. 5.The statistical analysis was carried out by using SPSS 16.0 software. The counting data were expressed in%, the differences between the two groups were compared by chi-square test, the measurement data were expressed by x 卤s, and the differences between the two groups were compared by independent sample t test.Before and after treatment, paired t test was used; the difference of effective rate between the two groups was statistically significant by chi-square test.The result of the study was: 1.Both lateral and central types of lumbar disc herniation were treated by Shen Li, but it was more suitable for patients with lateral lumbar disc herniation. 2.VAS and clinical efficacy of lateral type were better than that of central type (P 0.05). 3. The results of JOA and SF-36 showed that the patients with lateral lumbar disc herniation were more effective than those with central type of lumbar disc herniation.There was no significant difference in the treatment of lateral type and central type (P 0.05), but there was no significant difference (P 0.05).Conclusion: Shenli acupuncture therapy is effective in improving symptoms, alleviating pain, improving quality of life and clinical curative effect in patients with lateral and central lumbar disc herniation, and lateral type is superior to central type in relieving pain and clinical effect.
【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.9

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