筋伤1号方治疗跟痛症患者临床观察

发布时间：2018-05-02 02:25

本文选题：跟痛症 + 筋伤1号方　；参考：《中国中医科学院》2017年硕士论文

【摘要】：研究背景跟痛症是骨科临床医学中一种常见的足部疾患。多为慢性发病,早期一般不易引起患者的重视。当疼痛已对患者正常生活造成一定影响时,方才会对该病引起重视。该病慢性起病,病程较长,且经治疗后时有反复。对患者的生活造成很大的不便。由于跟痛症常见于临床,故对该病的治疗已有了较为久远的历史。祖国医学经过成百上千年来对该病的治疗,各大医家也都采用不同的理念及方法力求改善患者足跟痛的症状,所得效果良莠不齐。现代医学依托于科技水平的不断发展,对跟痛症的发病机理和治疗方法也在逐步的深入。就目前来看,现代医学把跟痛症的发生归因于跖腱膜损伤、足跟垫病变、跟骨骨刺、神经性足跟痛及跟骨内高压等因素,在治疗上目前较为常见的方法是局部的物理治疗、足部的主动功能锻炼治疗以及被动的足部夜间夹板固定,以求减轻甚至消除足跟部局部炎症,以此来改善足跟部疼痛。近年来随着生物力学的发展,通过测量足部不同负重及非负重区的受力情况,并根据其所得结果所制作足部鞋垫以治疗跟痛症,取得了不错的效果,但因其价格较为昂贵,对科学技术的依赖较高,目前该治疗方案还没有广泛开展。局部封闭治疗作为一种骨科临床较为常用的治疗手段,止疼效果较为确切,可快速短期内解除患者疼痛。但因为糖皮质激素的应用,所带来的副作用也为广大临床医生所忌惮。目前最新的富含血小板血浆局部注射治疗还在探索过程中,已有了相关的临床治疗报道,不过目前缺乏更多样本病例的验证,目前还没有被进一步推广。针对一些保守治疗不能取得满意效果的跟痛症患者,手术治疗也不失为一种选择。通过分析患者病痛产生的原因,而采用不同的术式,通过去除病因而解除患者的疼痛。手术治疗的效果较为确切,不过因其治疗带有创伤性,且存在着一定感染的风险,并不能被所有患者所接受。研究目的我们通过对千百年来传统医学对跟痛症治疗过程中总结出的理论和实践经验的学习和提炼,按照传统经典理念自拟方剂,且经打粉后与凡士林混合制成筋伤1号方,外敷于患处,使治疗操作过程十分简便快捷,且成本低廉。本试验希望能通过筋伤1号方对跟痛症患者的临床疗效观察,以期能获得较为确切的疗效,为跟痛症的治疗提供一个较为便捷低廉且毒副作用较低的治疗方法。方法根据随机分组的临床试验原则,我们把符合纳入标准的60例跟痛症患者随机分成两组,治疗组采用筋伤1号方疼痛部位外敷,对照组采用扶他林膏剂疼痛部位外敷,每日2次。以视觉模拟评分法(visual analogue scale,VAS)及临床症状评分法为评价方法,观察其临床效果。以1周作为观察周期,持续观察3周。如提前达到痊愈标准,即停止治疗。结果1.临床总体疗效结果:治疗组30例患者中临床痊愈10例,显效11例,好转7例,无效2例,总有效率93.3%;对照组29例患者中(对照组脱落1例患者)临床痊愈4例,显效8例,好转13例,无效4例,总有效率86.2%。治疗组的总体有效率高于对照组。2.VAS评分变化结果:两组治疗前后VAS疼痛分值均有一定程度的下降(P0.05),说明两组对跟痛症的疗效具有统计学意义,且同时治疗组在VAS疼痛评分改善方面优于对照组。3.跟痛症症状分级量化评分积分:两组治疗前后临床症状积分均数明显下降,(P0.05),说明两组治疗方法对跟痛症的症状分级量化评分均有改善,且在压痛症状积分指标中,治疗组疗效要优于对照组(P0.05)。结论两组疗法对改善跟痛症的临床症状都是有效的,但应用筋伤1号方对跟痛症的治疗取得了更好的疗效。
[Abstract]:Background and pain syndrome is a common foot disease in Department of orthopedics clinical medicine. Most of them are chronic disease, which is usually not easy to cause attention in the early stage. When pain has had a certain influence on the normal life of the patient, it will pay attention to the disease. The disease is chronic and has a long course, and it has repeated treatment after treatment. The treatment of the disease has a long history because the pain is common in the clinic. After hundreds of thousands of years of medical treatment of the disease, the great doctors have adopted different ideas and methods to improve the symptoms of the heel pain of the patients. At present, the occurrence of heel pain is due to the injury of the plantar aponeurosis, the lesion of the heel pad, the calcaneus bone spur, the neurotic heel pain and the internal high pressure of the calcaneus, and the common methods are local physical therapy at present. In order to reduce or even eliminate local inflammation in the heel, the active functional exercise therapy and the passive foot nocturnal splint are used to improve the heel pain. In recent years, with the development of biomechanics, the stress of different weight and non weight bearing areas in the foot is measured, and the foot insole is made according to the results. Heel pain has achieved good results, but because of its high price and high dependence on science and technology, the treatment scheme has not been widely carried out at present. As a commonly used clinical treatment in Department of orthopedics, local closed therapy is more effective in pain relief, but it can quickly relieve the pain in the short term. However, it is due to glucocorticoid. The side effects of the most recent platelet rich plasma injection therapy are still being explored, and related clinical reports have been reported. However, there is no further validation of the sample cases and is not yet further promoted. Some conservative treatments can not achieve satisfactory results. It is an option to treat the patients with heel pain. By analyzing the causes of the patient's pain and using different surgical procedures to remove the pain of the patient by removing the cause of the disease. The effect of the operation is more accurate, but the treatment is traumatic and there is a risk of infection and can not be accepted by all patients. The purpose of this study is to study and refine the theoretical and practical experience summed up in the treatment of heel pain by traditional medicine for thousands of years. In accordance with the traditional classical concept, we make up a prescription for self preparation, and make a combination of 1 square tendons with Vaseline after powdered powder, and apply it to the affected area to make the treatment process very simple, quick and cheap. We hope to observe the clinical efficacy of the 1 Prescription of tendon injury to the patients with heel pain, in order to get a more accurate therapeutic effect, and to provide a more convenient and inexpensive treatment for the treatment of heel pain. Methods according to the principle of randomized clinical trials, we have followed the inclusion criteria of 60 patients with heel pain. The machine was divided into two groups. The treatment group was used for external application of the pain part of tendon injury No. 1 in the treatment group. The control group was applied with the external application of the pain area of the cream in the control group, 2 times a day. The visual analogue score (visual analogue scale, VAS) and the clinical symptom score were used as evaluation methods to observe the clinical effect. The observation period was taken as the observation period and continued to be observed for 3 weeks. For example, the effect was achieved early in advance. The more standard, that is, stop treatment. Results 1. clinical overall results: 30 patients in the treatment group were cured in 10 cases, 11 cases were markedly effective, 7 cases were improved, 2 cases were invalid, the total effective rate was 93.3%, 4 cases, 8 cases, good turn 13, invalid 4, total effective efficiency of 86.2%. treatment group were effective in 29 patients in the control group (the control group dropped 1 patients). Higher than the control group.2.VAS score change results: two groups of VAS pain scores before and after treatment have a certain degree of decrease (P0.05), indicating that the two groups have statistical significance for the effect of heel pain, and at the same time the treatment group in the improvement of VAS pain score is better than the control group of.3. and pain symptom grading score score score: two groups of clinical symptoms before and after treatment. The average number of integral declines, (P0.05), indicating that the two groups of treatment methods have improved the grading and quantifying score of the symptoms of heel pain, and the curative effect of the treatment group is better than the control group (P0.05). Conclusion the treatment group is effective in improving the clinical symptoms of heel pain, but the application of tendon injury 1 to the treatment of heel pain is taken. Got a better 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】：2017
【分类号】：R274.9

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