清宫正骨手法治疗枕大神经痛的临床疗效观察

发布时间：2018-05-15 11:44

本文选题：封闭治疗 + 清宫正骨手法　；参考：《北京中医药大学》2017年硕士论文

【摘要】：研究背景枕大神经痛系枕大神经分布区域的神经、肌肉、血管等软组织非特异性炎症、卡压或损伤引起的阵发性或持续性呈刀割样、抽搐样、电击样、钝痛样疼痛,可放射至头顶、乳突、外耳部及以枕大神经出口处有压痛或者与其相对应的皮肤节段有感觉过敏或者感觉减退为主要临床表现的一种非遗传神经疾病。该病具有发病率高、发病人群广的特点,多见于中老年人,是一种临床常见病、多发病。尤其是随着现在生活方式的改变,人们的工作过多的趋向于坐位及低头姿势,直接导致屈颈活动的增多,颈椎局部活动的减少,导致了枕大神经痛的发病率的日趋增高。各地区枕大神经痛的流行病学调查结果不一,不同性别、不同年龄段、不同职业和地区的发病存在差异,患病率呈逐年升高和年轻化趋势,严重影响患者的生活质量及工作学习效率。目前该病的治疗主要以中西医结合保守治疗为主,手术治疗相对较少。中医治疗目前主要包括中药治疗、针灸治疗、穴位注射、推拿手法及小针刀松解治疗等。针灸治疗相对运用较多,其中又细分为针刺、艾灸、温针灸、火针、刺血、电针治疗等多种治疗方法。西医治疗目前主要包括非甾体类止痛抗炎药、物理方法、神经阻滞术、手术治疗为主,还有心理疗法较为新颖,物理治疗又可细分为激光治疗和射频治疗。上述治疗方法在临床研究报道中均取得了一定的治疗效果,至于哪种治疗方法更佳,以及每种治疗方法的适应症的选择,目前尚无定论。有时甚至导致患者病情的延误,导致病情的缠绵难愈和反复。清宫正骨手法治疗该病,在治疗的过程中通过重点施术于"筋结"部位。以放松理筋手法调和气血、活血化瘀、舒缓痉挛,紧张的肌肉,消除颈部局部异常应力的作用。同时又依据中医骨伤"筋骨"理论,运用颈部不定点旋转手法,纠正"筋出槽"与"骨错缝",解除颈枕部枕大神经周围小关节及软组织的嵌压,恢复颈椎关节的正常序列,达到恢复颈椎功能,起到治疗的目的。最后又以善后手法缓解紧张情绪,释放心理压力,达到舒筋活络,贯通筋脉气血,增加局部软组织的血液供应,从而达到治疗的目的。目的:探讨清宫正骨手法治疗枕大神经痛的作用机理,观察清宫正骨手法对于该病治疗的临床疗效。方法:按照纳入排除标准收集本次研究所需的60例病例。均为2014年10月至2017年1月在北京中医药大学第三附属医院骨科门诊及病房就诊的患者。随机分为清宫正骨手法试验组和封闭治疗对照组各30例。按照已制定的治疗及随访方案分析两组治疗前、治疗后2周及治疗后3个月VAS减分率、VAS及NDI评分,进行疗效分析。结果:①治疗后2周VAS评分减分率:试验组痊愈率13.33%、显效率50.00%、有效率30.00%、无效率6.67%、总有效率93.33%;对照组痊愈率3.33%、显效率53.33%、有效率36.67%、无效率6.67%、总有效率93.33%。②治疗后3个月VAS评分减分率:试验组痊愈率6.67%、显效率53.33%、有效率33.33%、无效率6.67%、总有效率93.33%;对照组痊愈率0、显效率10.00%、有效率73.33%、无效率16.67%、总有效率83.33%。③非参数检验分析治疗前后VAS评分,试验组治疗前均值为:6.10±0.92,治疗后均值为:2.10± 1.15。Z=-4.802,P=0.0000.05;对照组治疗前均值为:5.96±0.76,治疗后均值为:2.33±1.03。Z=-4.809,P=0.0000.05。④非参数检验分析治疗前后NDI评分,试验组治疗前均值为:33.20±2.77,治疗后均值为:10.23±2.28。Z=-4.794,P=0.0000.05;对照组治疗前均值为:34.83±1.89,治疗后均值为:11.37±3.26。Z=-4.789,P=0.0000.05。⑤非参数检验,分析两组治疗后VAS、NDI评分,VAS评分Z=-0.672,P=0.5020.05;NDI 评分 Z=-1.118,P=0.2630.05。⑥非参数检验,两组治疗3个月随访VAS、NDI评分,VAS评分Z=-4.411,P=0.0000.05;NDI 评分 Z=-3.334,P=0.0010.05。结论:清宫正骨手法和封闭治疗对于枕大神经痛患者疼痛及颈椎功能改善上都有显著的疗效。近期疗效两种治疗方法没有明显的差异。中长期疗效,清宫正骨手法治疗该病的效果优于封闭治疗。
[Abstract]:Background of the occipital great neuralgia of the occipital neuralgia of the occipital nerve. The soft tissues such as the nerve, muscle, blood vessel, and other soft tissues are nonspecific. The paroxysmal or continuous knife cuts, convulsions, electric shocks, and dull pain like pain caused by pressure or injury can radiate to the head, the mastoid, the external ear, and the pain of the exportation of the large occipital nerve or corresponding to it. A non genetic neuropathy with hypersensitivity or hypersensitivity as the main clinical manifestation of the skin segment. The disease is characterized by high incidence and a wide range of patients. It is often seen in the middle and old age. It is a common clinical disease and frequently occurring disease. In particular, with the change of lifestyle now, people tend to work too much to sit and bow. The incidence of occipital neuralgia is increasing. The incidence of occipital neuralgia is increasing. There are different epidemiological investigation results in various areas, different sex, different age groups, different occupational and regional differences, the prevalence rate is increasing year by year and young trend, serious. At present, the treatment of the disease is mainly based on the conservative treatment of traditional Chinese and Western medicine, and the surgical treatment is relatively less. The treatment of traditional Chinese medicine mainly includes the treatment of Chinese medicine, acupuncture and moxibustion, acupoint injection, manipulation of massage and the treatment of small needle knife and so on. A variety of treatment methods such as acupuncture, moxibustion, warm acupuncture, fire needle, blood pricking, electroacupuncture treatment. Western medicine mainly includes non steroidal analgesics, physical methods, nerve block, surgical treatment, psychological therapy more novel, physical therapy can be subdivided into laser therapy and radiofrequency therapy. The above treatment methods are reported in clinical research report. There is a certain therapeutic effect in the course. As for the better treatment and the selection of the indications for each treatment, there is no final conclusion. Sometimes it even leads to the delay of the patient's condition, which leads to the difficulty and repetition of the disease. At the same time, according to the theory of "muscle and bone" of the bone injury of the traditional Chinese medicine, using the unfixed rotation of the neck to correct the inlay of the small joint and soft tissue around the great nerve of the occipital nerve of the neck and pillow, and restore the compression of the small joints and soft tissues around the occipital nerve of the neck and pillow, and restore the compression of the small joints and soft tissues around the occipital nerve of the neck and pillow, and restore the compression of the small joints and soft tissues around the occipital nerve of the neck and pillow, and restore the pressure of the small joints and soft tissues around the occipital nerve of the neck and pillow, and restore the pressure of the small joints and soft tissues around the neck and pillow part of the nerve. The normal sequence of the cervical vertebra joint to restore the function of the cervical vertebra and play the purpose of treatment. At last, the aim of treatment is to relieve the tension, release the psychological pressure, reach the relaxing and activating circulation, through the veins and blood, and increase the blood supply of the local soft tissue. The mechanism was used to observe the clinical effect of the bone manipulation of the Qing Palace on the treatment of the disease. Methods: according to the inclusion of the exclusion criteria, 60 cases were collected from the Department of orthopedics, the Department of orthopedics, the Department of orthopedics, the Affiliated Hospital of Beijing University of Chinese Medicine, from October 2014 to January 2017. In the treatment control group, 30 cases were treated, and the results were analyzed in two groups before treatment, 2 weeks after treatment and 3 months' VAS score, VAS and NDI score. Results: (1) the reduction rate of VAS score in 2 weeks after treatment was 13.33%, the effective rate was 50%, the effective rate was 30%, the invalid rate was 6.67%, and the total effective rate was 93.33%; The recovery rate of the control group was 3.33%, the effective rate was 53.33%, the effective rate was 36.67%, the inefficiency was 6.67%. The total effective rate of 93.33%. was 3 months after the treatment. The rate of VAS score reduction was 6.67%, the effective rate was 53.33%, the effective rate was 33.33%, the invalid rate was 6.67%, the total effective rate was 93.33%, the control group recovered rate 0, significant efficiency 10%, efficiency 73.33%, inefficient 16.67%, total effective rate 3.33%. (6.10 + 0.92) before and after treatment, the mean value of the test group was 2.10 + 1.15.Z=-4.802, P=0.0000.05, the mean value before treatment was 5.96 + 0.76, the average after treatment was 2.33 + 1.03.Z=-4.809, and the NDI score before and after treatment was analyzed by the non parametric test of P=0.0000.05.; the test group was treated before treatment. The mean value was 33.20 + 2.77, the mean value after treatment was 10.23 + 2.28.Z=-4.794, P=0.0000.05, the mean value before treatment in the control group was 34.83 + 1.89, the average after treatment was 11.37 + 3.26.Z=-4.789, P=0.0000.05. 5 non parameter test, VAS, NDI score after the two groups of treatment, Z= -0.672, P=0.5020.05; NDI score Z=-1.118, non parametric test. The two groups were followed up for 3 months of follow-up VAS, NDI score, VAS score Z=-4.411, P=0.0000.05; NDI score Z=-3.334, P=0.0010.05. conclusion: there is a significant effect on the pain and the function improvement of the cervical vertebra in the patients with big neuralgia and the improvement of the function of the cervical vertebra. There is no obvious difference between the two treatment methods in the short term effect. The effect of bone setting manipulation on the disease is better than that of closed therapy.

【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R244.1

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