针刀治疗肩周炎的解剖与临床应用

发布时间：2018-04-26 09:13

本文选题：针刀 + 肩周炎　；参考：《广西中医药大学》2017年硕士论文

【摘要】：肩周炎是一种以肩痛、肩关节活动障碍为主要特征的筋伤,因该病多发生于50岁左右的患者,该年龄段处于工作的中间力量,目前肩周炎的早期诊断,早期治疗的研究己取得了巨大的进展,但诊疗标准尚有争议,我国人口众多,发病患者占骨科病人的1%,需要寻找一种简便廉效、易于推广的诊断治疗方法极为重要。针刀微创治疗肩周炎是一种理想的技术,需要把相关针刀入路进行分析,从理论和临床上进行合理的论证,以便更好的在接诊中运用。研究目的:全面综述肩周炎的中西医理论观点,以及当今各种治疗方案,分析针刀微创治疗的机理与临床应用。通过对人体标本进行针刀治疗的方案,并对相关标本部位的尺寸进行测量和研究,把相关的数据用来指导筛选确定针刀入路的临床应用,观察针刀微创治疗技术在肩周炎的临床症状包括VAS疼痛,活动角度及L‘Insalata评定的影响,通过规范标准化针刀治疗方案。评价针刀治疗技术对肩周炎治疗的安全入路风险与疗效,探讨针刀微创治疗的机理及临床规范。研究方法:实验研究以成人尸体上肢标本例进行局部解剖,观察肌肉、血管、神经分布走行以成人15具标本测量骨性标志,指导整理针刀治疗肩周炎的安全有效的入路。并结合临床60例患者分成两组,针灸组30人,针刀组30人,进行针刀治疗临床应用研究对比。临床采用随机方法分两组,即针刀组与针灸组,针刀组采用解剖数据确定安全的针刀松解疗法,每周治疗1次,4次为疗程,疗程结束后观察治疗结果。针灸组取穴,每日一次,5次一个疗程,间隔2日,进行4个疗程。对L‘Insalata肩关节功能评价量表、肩关节VAS疼痛分数、肩关节功能活动3个方面进行分析评价。结果:15具成人尸体标本提供了大量的图像和数据,并直观的展示了针刀进入人体后松解相关的神经与肌肉组织对肩部的影响,在此基础上,研究人员结合针刀理论整理出13个治疗肩周炎相对安全的针刀入路,在临床治疗运用,对60例患者进行针刀松解法与针灸治疗的对比,针刀组与针灸组的VAS评分组间比较在治疗1个月,3个月后的随访、6个月的随访,P指分别为0.019、0.036与0.001,针刀组明显优于针灸组;针刀组与针灸组的外展角度组间比较在治疗1个月,3个月后的随访、6个月的随访,P指分别为0.000、0.036与0.032,针刀组明显优于针灸组;针刀组与针灸组的前屈角度组间比较在治疗1个月,3个月后的随访、6个月的随访,P指分别为0.000,0.000与0.014,针刀组明显优于针灸组;针刀组与针灸组的内旋角度组间比较在治疗1个月,3个月后的随访、6个月的随访,P指分别为0.010,0.002与0.000,针刀组明显优于针灸组;针刀组与针灸组的外旋角度组间比较在治疗1个月,3个月后的随访、6个月的随访,P指分别为0.000,0.000与0.001,针刀组明显优于针灸组;针刀组与针灸组的L‘Insalata评价表评分组间比较在治疗1个月,3个月后的随访、6个月的随访,P指分别为0.002,0.003与0.030,针刀组明显优于针灸组。针刀组与针灸组治疗前后没有出现患者受伤的报道.针刀组治疗肩周在VAS评分,肩关节功能活动、L‘Insalata评价表各个方面均优于针灸组。
[Abstract]:Scapulohumeral periarthritis (scapulohumeral periarthritis) is a kind of muscle injury with the main characteristics of shoulder pain and shoulder joint activity disorder. Because the disease is mostly born in the patients about 50 years old, the age section is in the middle of the work, the early diagnosis of the periarthritis of shoulder, the early treatment research has made great progress, but the medical treatment standard is still controversial, our population is large and the patients are occupied. 1% of the patients in the Department of orthopedics need to find a simple and inexpensive and easy to spread diagnosis and treatment method. The needle knife minimally invasive treatment of scapulohumeral periarthritis is an ideal technique. It is necessary to analyze the related Acupotomy approach and make a reasonable argument in theory and clinic, so as to better use it in the reception. The theory of traditional Chinese and Western medicine, as well as the various treatment schemes today, analysis the mechanism and clinical application of the needle knife minimally invasive treatment. Through the needle knife treatment of the human specimens, and the measurement and study of the size of the related specimen, the related data are used to guide the clinical application of the needle knife approach and to observe the needle knife minimally invasive. The clinical symptoms of scapulohumeral periarthritis include VAS pain, activity angle and the influence of L 'Insalata assessment, standardized needle knife treatment plan. Evaluate the safe approach to the treatment of periarthritis of scapulohumeral periarthritis by needle knife treatment technology, explore the mechanism and clinical standard of needle knife minimally invasive treatment. Research method: Experimental Study on adult cadavers The body upper limb specimens were dissected to observe the muscle, blood vessel, and nerve distribution to measure bone markers in 15 adult specimens and guide the safe and effective approach of treating periarthritis of shoulder by needle knife. Combined with 60 clinical cases, 30 people and 30 needle knife groups were divided into two groups, and the clinical application of acupotomy was compared. The machine method was divided into two groups, namely needle knife group and acupuncture group, needle knife group using anatomical data to determine safe needle knife loosening therapy, 1 times a week, 4 times as a course of treatment, after the end of the course observation treatment results. Acupuncture group taking acupoint, 5 times a day, 2 days, 4 courses of treatment. L 'Insalata shoulder joint function evaluation scale, shoulder joint VAS Analysis and evaluation of 3 aspects of pain score and functional activity of shoulder joint. Results: 15 adult cadavers provided a large number of images and data, and intuitively demonstrated the influence of the Acupotomy into the human body and the influence of the related nerve and muscle tissue on the shoulder. On this basis, the researchers collate 13 scapulohumeral periarthritis in combination with the needle knife theory. Relatively safe needle knife approach, in clinical treatment, 60 patients were compared with acupuncture and acupuncture treatment. The comparison between the needle knife group and the VAS score group in the acupuncture group and the acupuncture group was 1 months, 3 months follow-up, 6 months follow-up, the P finger was 0.019,0.036 and 0.001, the needle knife group was obviously superior to the acupuncture group; the needle knife group and the acupuncture group were obviously better than the acupuncture group. The abduction angle group comparison between 1 months, 3 months follow-up, 6 months follow-up, P finger 0.000,0.036 and 0.032, needle knife group is obviously better than the acupuncture group, acupuncture group and acupuncture group of the anterior flexion angle group compared in the treatment 1 months, 3 months after the follow-up, 6 months with the visit, P finger respectively 0.000,0.000 and 0.014, needle knife group is obviously better than the group. Acupuncture group, acupuncture group and acupuncture group in the group of internal rotation angle comparison between 1 months, 3 months after follow-up, 6 months follow-up, P 0.010,0.002 and 0, needle knife group is obviously better than acupuncture group, needle knife group and acupuncture group of external rotation angle group comparison between 1 months, 3 months after the follow-up, 6 months follow-up, P finger is 0.000,0., respectively. 000 and 0.001, the needle knife group was obviously better than the acupuncture group; the L 'Insalata evaluation table between the needle knife group and the acupuncture group was compared in the treatment 1 months, 3 months follow-up, 6 months follow-up, the P finger was 0.002,0.003 and 0.030, the needle knife group was obviously superior to the acupuncture group. The shoulder circumference of the group was better than that of the acupuncture group in terms of VAS score, shoulder function activity and L 'Insalata evaluation table.

【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.9

【参考文献】