“T”形针刀整体松解术治疗颈椎病的术式设计原理及临床研究

发布时间：2018-06-18 19:48

本文选题：针刀 + 颈椎病　；参考：《湖北中医药大学》2017年硕士论文

【摘要】：研究目的:通过运用针刀医学基础理论来研究颈椎病发病机制及其病理构架,以此为依据研究设定了“T”形针刀整体松解术。观察该方法治疗颈椎病的疗效,以评价“T”形针刀整体松解术的临床应用价值。研究方法:1.基于针刀医学基础理论人体弓弦力学解剖系统及力学病理构架“网眼理论”,模仿弓箭组成结构和受力模式,将生物力学和人体解剖学相结合,重新构建颈段弓弦力学解剖系统的运动模型,从而分析颈椎病的发病机制及病理构架,并以此为依据研究“T”形针刀整体松解术。2.对湖北中医大黄家湖医院针刀科2014年9月—2016年12月收治的的60名颈椎病患者,采用随机数字表,按照1:1的比例随机分为压痛点组(30例)和术式组(30例)。压痛点组以压痛点为针刀治疗部位,术式组采用“T”形针刀整体松解术治疗。分别于术前、术后2周、术后3个月观察两组的临床疗效,并采用颈椎病临床评价量表(CASCS)和简化Mc Gi LL疼痛量表(SF-MPQ)作为评价指标,基于SPSS20.0软件进行数据统计,评估两组的近期和远期疗效。研究结果:1.颈段弓弦力学解剖系统模型。弓:枕骨、颈椎骨、肩胛骨。弦:附着于弓上的软组织。(1)肌肉:斜方肌;肩胛提肌;菱形肌;竖脊肌;椎枕肌;夹肌;半棘肌;颈部多裂肌;颈部回旋肌;棘间肌;横突间肌;胸锁乳突肌;斜角肌。(2)韧带:项韧带;棘上韧带;棘间韧带;黄韧带;横突间韧带;关节囊韧带;前纵韧带和后纵韧带。(3)筋膜:颈固有筋膜;脏器筋膜和颈血管鞘。(4)辅助装置:颈部神经、血管。2.颈椎病的立体网络状病理构架,首先是颈段弓弦力学解剖系统中浅层的项韧带、棘间韧带、斜方肌等软组织,由于长期不良姿态等原因造成的慢性损伤,导致软组织受力异常。若人体得不到及时修复,损伤日久,次序由浅入深,引起周围与之有连接的深层软组织,如斜方肌;夹肌;椎枕肌群;肩胛提肌等软组织的联合损伤。最终形成以各软组织起始部位(弓弦结合部)为点;各软组织走形路径的交叉部位(弦应力集中部位)为线;各软组织覆盖层次为面的立体网络状病理构架。3.“T”形针刀整体松解术的研究,是以颈段弓弦力学解剖系统模型为物质基础,依据上述内容分析的本病立体网络状病理构架来确定针刀治疗具体部位。“T”的横线为5个点,在枕骨下缘上项线处,中点为枕外隆突,在依此线略成的弧形平面上,距离枕外隆突向左、右旁开2.5cm和5cm定4个点;竖线为6个点,分别为C2~C7棘突顶点。将横线5个点和竖线6个点连起来,形似字母“T”。所以称之为“T”形针刀整体松解术。4.通过对两组患者术后3个月的随访,术式组愈显率80.00%,总有效率96.67%,明显高于压痛点组,且差异具有统计学意义(Ρ0.05)。两组患者术前、术后2周和术后3个月SF-MPQ积分比较,压痛点组术后2周与术前SF-MPQ积分比较明显下降(Ρ0.05),差异有统计学意义;术后3个月与术后2周比较,Ρ0.05,差异有统计学意义。术式组术后2周与术前比较,差异有统计学意义(Ρ0.05);术后3个月与术后2周比较,差异有统计学意义(Ρ0.05)。同时,经过术后2周、术后3个月的随访,术式组与压痛点组的组间SF-MPQ积分比较,Ρ0.05,差异有统计学意义。通过术前、术后2周及术后3个月的随访和对比,压痛点组与术式组,术后2周、术后3个月与术前比较,CASCS总积分均有明显的改善(Ρ0.05),且术式组的术后2周、术后3个月积分改善程度明显好于压痛点组(Ρ0.05)。但是,CASCS的主观症状积分中,压痛点组术后3个月与术后2周比较,Ρ0.05,差异无统计学意义;而术式组的术后3个月与术后2周比较,Ρ0.05,差异有统计学意义。研究结论:1.颈椎病形成的主要因素是颈段弓弦力学解剖系统力平衡失调。其病理过程首先是颈部周围软组织(肌肉、韧带、筋膜、关节囊)由于姿势不正、慢性劳损等各种因素,导致软组织受力异常,且损伤次序由浅入深,并引起周围与之有连接的深层软组织的联合损伤。损伤的软组织通过粘连、瘢痕、挛缩和堵塞进行自我代偿和自我调节。如果代偿失败,人体会启动第二套代偿系统即硬化、钙化和骨化,这也就是X片上的骨质增生或骨刺。如果仍然不能代偿弦的异常应力,就会形成以各软组织起始部位(弓弦结合部)为点;各软组织的走形路径为线;各软组织覆盖层次为面的三维立体状网络病理构架。最终导致颈段弓弦力学解剖系统的力平衡失调,引起软组织疼痛、僵硬及血管、神经束卡压等系列临床表现和体征。并且,据此病理构架我们可以得出颈椎病压痛点的分布规律,从而制定规范化的临床基础术式,以促进针刀医学的现代化、科学化和规范化的发展。2.根据颈段弓弦力学解剖系统及颈椎病的立体网络状病理构架分析,颈椎病的早期可以归属为慢性软组织损伤类疾病的范畴。因此,在颈椎病的早期治疗上,必须要遵循慢性软组织损伤类疾病的发生、发展规律,采用慢性软组织损伤类疾病的治疗方法。在颈椎病的进展期,人体启动第二套代偿系统即硬化、钙化和骨化来进一步对异常应力进行代偿时,即影像学上出现骨质增生阶段,也必须先从恢复颈段弓弦力学解剖系统的软组织力平衡入手。由此可以初步窥探针刀医学关于颈椎病的分型诊疗研究,其科学术式的研究和临床操作的规范,将有待进一步的研究。3.通过压痛点组和术式组的临床资料分析,两种治疗方法对改善颈椎病的临床症状均有明显的疗效。从临床疗效、CASCS总积分和MPQ积分的评价分析,“T”形针刀整体松解术无论是在近期还是远期疗效上,都明显优于压痛点组,且术式组的远期效果好于近期疗效;压痛点组虽然远期疗效也优于近期疗效,但是从CASCS主观症状积分来看,患者对远期和近期疗效的主观判断并无改变,提示我们针对颈椎病的治疗,不能过于依赖客观检查和临床体征,而要更加的重视患者本人的主观症状改善程度。
[Abstract]:Objective: To study the pathogenesis and pathological framework of cervical spondylosis by using the basic theory of acupotomy, based on which "T" shaped Acupotomy was set up to observe the therapeutic effect of this method in the treatment of cervical spondylosis, and to evaluate the clinical application value of "T" shaped Acupotomy as a whole. 1. The basic theory of the anatomy system of human body and the mechanics pathological frame "mesh theory", imitate the structure and the force mode of the bow and arrow, combine the biomechanics and the human anatomy, reconstruct the motion model of the mechanical anatomy system of the neck segment, and analyze the pathogenesis and pathological frame of the cervical spondylosis, and Study on this basis. 60 patients with cervical spondylosis treated by "T" shaped Acupotomy (.2.) were randomly divided into 60 cases of cervical spondylosis treated in the Department of needle knife department from September 2014 to December 2016. According to the proportion of 1:1, they were randomly divided into the pain point group (30 cases) and the operation group (30 cases). The pain point group was treated with the Acupotomy point in the pain point group, and the operation group adopted the "T" shaped needle. The clinical efficacy of the two groups was observed before the operation, 2 weeks after the operation and 3 months after the operation. The clinical evaluation scale of the cervical spondylosis (CASCS) and the simplified Mc Gi LL pain scale (SF-MPQ) were used as evaluation indexes. The results of the short-term and long-term effects of the two groups were evaluated based on the data of the software, and the results of the study: 1. neck segment force. Anatomical system model. Arch: occipital bone, cervical spine, scapula. Chord: strings attached to the arch of soft tissue. (1) muscle: trapezius muscle; scapula muscle; rhombus muscle; erector muscle; vertebral occipital muscle; cervical spinous muscle; cervical spinous muscle; interspinous muscle; intertransverse muscle; sternocleidomastoid; 2) ligament; ligament; interspinous ligament; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; interspinous ligaments; interspinous ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; interspinous ligaments; interspinous ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; interspinous ligaments; interspinous ligaments; ligaments; yellowish toughened ligaments Band; intertransverse ligaments; articular capsule ligaments; anterior longitudinal ligaments and posterior longitudinal ligaments. (3) fascia: cervical inherent fascia; visceral fascia and cervical vascular sheath. (4) auxiliary device: cervical nerve,.2. cervical spondylosis of the neck; first of all, the superficial ligament, interspinous ligament, trapezius muscle, and other soft tissues of the cervical spine mechanical anatomy system, because of the soft tissue such as the interspinous ligament, the trapezius muscle, and so on. Chronic injury caused by long-term bad posture and other causes leads to abnormal stress of soft tissue. If the human body can not be repaired in time, the damage is long and the order of deep soft tissue, such as the trapezius muscle, the splinters, the occipital muscle group, the muscle of the scapula, and other soft tissues, is finally formed in the beginning of the soft tissues. The cross section of the bow string is a point; the cross section of the walking path of the soft tissues (the central part of the chord stress) is a line; the study of the holistic loosening of the.3. "T" shaped Acupotomy of the three-dimensional network like pathological framework of the soft tissues is the material basis of the mechanical anatomy system model of the cervical segment of the bow string and the three-dimensional network of the disease based on the above content. To determine the specific site of acupotomy, the transverse line of "T" is 5 points, on the lower edge of the occipital border, the middle point of the occipital protuberance, the outer occipital protuberance to the left, the right side of the occipital protuberance to the left, the right side open 2.5cm and 5cm on the right side, the vertical line of 6 points, and the apex of the C2~C7 spinous process. The 5 points and the vertical lines of the transverse line are connected by 6 points. It is similar to the letter "T". Therefore, it is called "T" shaped Acupotomy for the overall release of.4. through the follow-up of two groups of patients 3 months after operation, the healing rate is 80%, the total effective rate is 96.67%, obviously higher than the pressure pain point group, and the difference has statistical significance (0.05). Two groups of patients, 2 weeks after the operation, and 3 months after the Surgery score comparison, pressure pain. The difference was statistically significant between the 2 weeks after the operation and the preoperative SF-MPQ score (0.05). The difference was statistically significant between 3 months after the operation and 2 weeks after the operation. The difference was statistically significant (0.05) at 2 weeks after the operation (0.05) and 3 months after the operation and 2 weeks after the operation (0.05). At the same time, the difference was statistically significant. 2 weeks after the operation and 3 months after the operation, the SF-MPQ score of the group was compared with the group of pressure pain, and the difference was 0.05. The difference was statistically significant. The total score of CASCS was obviously improved (0.05), and the total score of the group was significantly improved (0.05) after the operation, after the operation and 3 months after the operation, and in the 3 months after the operation (0.05). 2 weeks after operation, the improvement degree of the 3 months after operation was better than that of the pressure pain point group (0.05). But, in the subjective symptom score of CASCS, the score of the pain point group was 3 months after the operation and 2 weeks after the operation. The difference was not statistically significant, but the difference was statistically significant 3 months after the operation of the operation group and 2 weeks after the operation, and the difference was statistically significant. The conclusion of the study: 1. cervical spondylosis. The main factor is the imbalance of force balance in the mechanical anatomy system of the cervical segment. The pathological process is first of all the soft tissues around the neck (muscles, ligaments, fascia, joint capsule) due to various factors such as incorrect posture, chronic strain, and so on. Joint injury. The damaged soft tissue is self compensatory and self regulating through adhesion, scar, contracture, and clogging. If compensation fails, the body starts second sets of compensatory systems, that is, hardening, calcification, and ossification. This is the osteogeny or bone spur on the X slices. If the abnormal stress of the chord is still not compensable, it will form a soft tissue. The starting position (the joint of the bow string) is a point; the walking path of each soft tissue is a line; the soft tissue is covered with a three-dimensional three-dimensional network pathological framework. Finally, it leads to the imbalance of the force balance of the mechanical anatomy system of the cervical segment, causing the pain, stiffness and blood vessels of the soft tissue, the compression of the nerves, and other clinical manifestations and signs. We can obtain the distribution of the pressure and pain points of the cervical spondylosis, so as to formulate a standardized clinical basic operation to promote the modernization of needle knife medicine, scientific and standardized development of.2. based on the anatomy system of the cervical segment and the three-dimensional network of cervical spondylosis. The early stage of cervical spondylosis can be classified as chronic soft. Therefore, in the early treatment of cervical spondylosis, it is necessary to follow the occurrence of chronic soft tissue injury, the law of development, and the treatment of chronic soft tissue injury. In the development period of cervical spondylosis, the human body starts second sets of compensatory systems, that is, hardening, calcification and ossification to further the abnormal stress. When it is compensatory, that is, the appearance of hyperosteogeny in imaging, it is also necessary to start with the restoration of the soft tissue force balance of the mechanical anatomy system of the cervical segment. Thus, the study of the classification of the cervical spondylosis by Acupotomy can be preliminarily explored. The academic research and the standard of clinical operation in the Department of acupuncture will be further studied by.3. through the pressure pain. The clinical data of the point group and the operation group were analyzed. The two treatments had obvious effect on improving the clinical symptoms of cervical spondylosis. From the clinical effect, the total score of CASCS and the evaluation of the MPQ integral, the "T" shape Acupotomy was obviously superior to the pressure pain point group in both the short term and the long term effect, and the long-term effect of the operation group was better. It is better than the short-term effect. Although the pain point group is better than the short-term effect, the subjective judgment of the long-term and recent curative effect is not changed from the CASCS subjective symptom score. It suggests that we should not rely too much on the objective examination and clinical signs for the treatment of cervical spondylosis, but we should pay more attention to the subjective symptoms of the patient. The degree of improvement.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.9

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