针刺商丘穴治疗桡骨茎突狭窄性腱鞘炎的临床研究
发布时间：2019-06-28 15:59
【摘要】：目的：桡骨茎突狭窄性腱鞘炎是临床常见的慢性劳损性骨伤科病变,手工劳动者,尤以妇女好发本病,比如抱婴者,清洁工等群体,腱鞘炎患病率高且易复发,虽然不会有直接致命的风险,但是却会带给患者生活工作带来诸多不便和极度痛苦,仍是不可忽视的严重病症。开展本临床试验研究,探索桡骨茎突狭窄性腱鞘炎的治疗方法,拓宽临床治疗思路,为治疗该病提供更多的临床和试验依据。方法：以本人在所执业新北市新店区易丰中医诊所、与固定支持门诊的基隆市忠生中医诊所,新北市中和区的三大中医诊所、新北市中和区的世安中医诊所,以及桃园市大溪区的安泰中医诊所的门诊病患为本课题病例来源。必须以连续以本病症门诊连续治疗2个疗程,而且每个疗程连续治疗6次为限的患者,方为有效病例样本。把60例符合纳入和排除标准的病例按照统计学要求分成2个组,每组有30例患者,局部取穴位和远部取穴加以结合,分为2个疗程,选用中国大陆国家中医药管理局《中医病证诊断疗效标准》(2002年)制定疗效判定标准以及王文华、王恒斌等的《运用的临床症状及体征分级记分标准》等成绩判定标准评价疗效。评价内容包括休息痛、患侧肿胀、压痛、握拳尺偏试验疼痛等4个项目做判定,并设定、制作桡骨茎突狭窄性腱鞘炎的疗效评价表,并且统计治疗效果。结果：实验组和对照组两组患者在性别、年龄、年龄构成比、以及二者患病因素、病情严重分级上根据统计学检测,结果表明无统计学差异(P0.05),具有可比性。治疗疗程结束后,两种治疗方法在对患者症状改善上二者无统计学差异,但是在实验组30个病例中：治愈1例,显效10例,有效19例,无效0例；而对照组30个病例中：治愈0例,显效2例,有效24例,无效4例。治疗前休息痛评分组间差异比较经独立样本t检验,P=0.451,P0.05,两组患者治疗前休息痛比较差异无统计意义,具有可比性；治疗后评分组间比较不符合方差齐性检验(F检验),采用非参数Kolmogorov-Smirnov检验,P=0.236,P0.05,表明两组患者治疗后休息痛评分差异无统计学意义。组内差异比较,治疗前后差异经配对样本t检验,P=0.00,P0.05,表明治疗前后休息痛评分具有统计学意义。治疗前患侧肿胀评分组间差异比较经独立样本t检验,P=0.608,P0.05,两组患者治疗前患侧肿胀比较差异无统计意义,具有可比性；治疗后评分组间比较不符合方差齐性检验(F检验),采用非参数Kolmogorov-Smirnov检验,P=0.998,P0.05,表明两组患者治疗后患侧肿胀评分差异无统计学意义。组内差异比较,治疗前后差异经配对样本t检验,P=0.00,P0.05,表明治疗前后患侧肿胀评分具有统计学意义。治疗前压痛评分组间差异比较经独立样本t检验,P=0.321,P0.05,两组患者治疗前压痛比较差异无统计意义,具有可比性；治疗后评分组间比较不符合方差齐性检验(F检验),采用非参数Kolmogorov-Smirnov检验,P=0.388,P0.05,表明两组患者治疗后压痛评分差异无统计学意义。组内差异比较,治疗前后差异经配对样本t检验,P=0.00,P0.05,表明治疗前后压痛评分具有统计学意义。治疗前握拳尺偏试验评分组间差异比较经独立样本t检验,P=0.608,P0.05,两组患者治疗前握拳尺偏试验比较差异无统计意义,具有可比性；治疗后评分组间比较不符合方差齐性检验(F检验),采用非参数Kolmogorov-Smirnov检验,P=0.586,P0.05,表明两组患者治疗后握拳尺侧偏压试验评分差异无统计学意义。组内差异比较,治疗前后差异经配对样本t检验,P=0.00,P0.05,表明治疗前后握拳尺偏试验验评分具有统计学意义。治疗前总积分评分组间差异比较经独立样本t检验,P=0.477,P0.05,两组患者治疗前总积分比较差异无统计意义,具有可比性；治疗后评分组间比较符合方差齐性检验(F检验),经独立样本t检验,P=0.063,P0.05,两组患者治疗后总积分比较差异无统计意义。组内差异比较,治疗前后差异经配对样本t检验,P=0.00,P0.05,表明治疗前后总积分评分具有统计学意义。通过对两组功能的整体评估,实验组治疗前总积分为279分,治疗后总积分为116分,下降的总积分为163分,总平均由治疗前的9.300,在两个疗程后则降至3.800分,平均总差距是5.500分；对照组治疗前总积分为268分,治疗后总积分为154分,下降的总积分为114分,总平均由治疗前的8.933分,在两个疗程后则降至5.267分,平均总差距是3.666分。在视觉模拟评分法(VAS)治疗前后的评分差距：在休息痛方面,实验组是1.600±0.498)分,对照组是(1.100±0.305)分；在患侧肿胀方面,实验组是1.067±0.254)分,对照组是(0.800±0.484)分；在压痛方面,实验组是(1.500±0.507分,对照组是(1.067±0.254)分；在握拳尺偏试验方面,实验组是1.267±0.450分,对照组是(0.833±0.379)分；而以上四项的总和差距,实验组是5.433±1.194分,对照组是(3.800±0.925)分。在疗效方面：实验组样本30例,其中痊愈1例,占3.33%,显效10例,占33.33%,有效19例,占63.33%,无效0例,占0%,总有效率100%；而组样本30例,其中痊愈0例,0%,显效2例,占6.67%,有效24例,占80%,无效4例,占13.33%,总有效率86.67%发现治疗后两组的各项积分和治疗前相比,皆有明显的下降但是实验组下降的积分以及平均分数皆明显多于对照组,差异有统计学意义(P0.05)。提示针刺商丘穴远道取穴针刺法与局部取穴针刺法更能缓解患处腕关节休息痛、患侧肿胀、压痛、握拳尺偏试验疼痛。结论：两种治疗都是治疗桡骨茎突狭窄性腱鞘炎的有效方式,无论在改善患处腕关节休息痛、患侧肿胀、压痛、握拳尺偏试验方面,皆可见到效果,但是实验组的总体疗效更佳,一定程度而言,商丘穴针刺这种远处用穴位比单纯的手腕局部针刺的方法疗效更好。
[Abstract]:Objective: The osteopathyous tendinous tendonitis is a common chronic strain of the bone injury of the chronic strain. The manual worker, especially the women's disease, such as the infant, the cleaner and other groups, the prevalence of the tendinous aponeurosis is high and the recurrence is easy, although there is no direct and fatal risk, But it will bring the patient's life to work with many inconveniences and extreme pain, and it is still a serious condition that can't be ignored. The clinical trial was carried out to explore the treatment of the stenoses of the stenoses of the stem of the bone and to broaden the thinking of clinical treatment and to provide more clinical and experimental basis for the treatment of the disease. Method: I am in the Yi Feng Chinese Medicine Clinic in Xindian District, Xinbei City, and the three traditional Chinese medicine clinics in the middle and middle areas of Xinbei City and the Shian Traditional Chinese Medicine Clinic in the middle and middle areas of Xinbei City. And the outpatient department of the Antai Traditional Chinese Medicine Clinic in the Daxi District of Taoyuan City is the source of the subject. It is necessary to continuously treat 2 courses of treatment in the outpatient clinic in a continuous condition, and each treatment course will be treated continuously for 6 times with a limited number of patients, which is an effective case sample. The cases with the inclusion and exclusion criteria were divided into two groups according to the statistical requirements. The evaluation criteria for clinical symptoms and signs, such as Wang Wenhua, Wang Hengbin, etc., and the criteria for grading and scoring of clinical symptoms and signs, such as Wang Wenhua and Wang Hengbin and the like, were selected and evaluated according to the criteria for clinical symptoms and physical signs and scores of clinical symptoms and signs in the Chinese mainland China National Center for Traditional Chinese Medicine (TCM). The evaluation contents included four items, such as rest pain, swelling of the affected side, tenderness, and test pain of the hand, and set up the evaluation table of the curative effect of the osteopathytis of the stem of the bone, and the effect of the treatment was statistically analyzed. Results: There was no statistical difference between the two groups in the experimental group and the control group (P <0.05). After the treatment course was over, there was no statistical difference between the two treatment methods in the improvement of the symptoms of the patient, but in the 30 cases of the experimental group,1 case was cured,10 cases were effective,19 cases were effective,0 cases were not valid, and 30 cases of the control group:0 cases were cured,2 cases were effective, and 24 cases were effective. Invalid 4 cases. The difference between the pre-treatment and the rest pain scores was compared with the independent sample t test, P = 0.451, P0.05, the difference of the rest pain in the two groups was not statistically significant, and it was comparable; the comparison between the post-treatment score groups did not accord with the non-parametric test (F test), and the non-parametric Kolmogorov-Smirnov test was used, P = 0.236, P0.05, There was no significant difference in the scores of the rest pain scores after the treatment of the two groups. The difference of the intra-group and the before-and-after-treatment difference was tested by the paired sample t, P = 0.00, P <0.05, indicating that the score of the rest pain before and after treatment was of statistical significance. The difference between the two groups was compared with that of the independent sample t, P = 0.608, P <0.05, the difference between the two groups was not statistically significant, and the difference between the two groups was not statistically significant. The non-parametric Kolmogorov-Smirnov test, P = 0.998, was used to test the difference between the two groups. The results showed that there was no statistical significance between the two groups of patients with the side swelling scores after treatment. The difference in the group was compared with that of the paired samples t before and after treatment, P = 0.00, P <0.05, indicating the statistical significance of the side swelling scores after treatment. The difference between the pre-treatment scoring groups was compared with the independent sample t test, P = 0.321, P0.05, the difference of the pre-treatment pressure pain of the two groups was not statistically significant, and it was comparable; the comparison between the post-treatment score groups did not accord with the non-parametric test (F test), and the non-parametric Kolmogorov-Smirnov test was used, P = 0.388, P0.05, It was shown that there was no statistical significance between the two groups of patients after treatment. The difference of the intra-group and the before-and-after-treatment difference was tested by the paired samples t, P = 0.00, P <0.05, indicating the statistical significance of the pre-and post-treatment pressure pain scores. The difference between the pre-treatment score and the pre-treatment score group was compared with the independent sample t test, P = 0.608, P0.05, and the difference between the two groups in the pre-treatment group was not statistically significant, and it was comparable; the comparison between the post-treatment score groups did not accord with the self-alignment test (F test). The non-parametric Kolmogorov-Smirnov test, P = 0.586, P 0.05, showed no statistical significance in the difference of the test scores between the two groups. In group, the difference of pre-treatment and post-treatment was tested by paired sample t, P = 0.00, P <0.05, indicating that the pre-and post-treatment pre-and post-treatment scores were of statistical significance. The difference between the pre-treatment total score scores was compared with the independent sample t test, P = 0.477, P0.05, the difference of the total score of the two groups was not statistically significant, and the difference between the two groups was comparable; the comparison of the post-treatment score groups was in accordance with the homogeneity test (F test), and tested by the independent sample t, P = 0.063, P0.05, The difference of total score of the two groups was not statistically significant. The difference of the intra-group and the post-treatment difference was tested by the paired samples t, P = 0.00, P <0.05, indicating the statistical significance of the total score before and after treatment. The total score of the two groups was 279, the total score of the total score was 116, the total score of the decrease was 163, the total score was 9.300 before the treatment, and the total score of the decrease was 3.800, the average total difference was 5.500, and the total score before treatment in the control group was 268. After the treatment, the total score was 154 points, the total score of the reduction was 114 points, the total average was 8.933 points before treatment, and the total score decreased to 5.267 points after the two treatment courses, and the average total difference was 3.666 points. The scoring gap before and after the treatment of visual analogue scale (VAS): in the aspect of rest pain, the experimental group was 1.600 (0.498), and the control group was (1.100, 0.305); in the aspect of swelling of the affected side, the experimental group was 1.067 (0.254), and the control group was (0.800-0.484); in the aspect of tenderness, The experimental group was (1.500-0.507), the control group was (1.067-0.254), and the experimental group was 1.267-0.450, the control group was (0.833-0.379), and the total difference of the above four groups was 5.433-1.194 and the control group was (3.800-0.925). In the treatment group,30 cases were cured,1 case recovered, 3.33%,10 cases markedly effective, 33.33%, effective 19 cases, 63.33%, invalid 0 cases,0%, total effective rate 100%, and 30 cases of group samples, including 0,0%,2 cases, 6.67%, effective 24 cases. The total effective rate was 86.67%, the total effective rate was 86.67%, and the scores of the two groups were significantly lower than that of the control group (P <0.05). It is suggested that the acupuncture method and the local point-taking acupuncture method can relieve the rest pain of the wrist joint of the affected part, the swelling of the affected side, the pain of the affected part and the pain of the hand-holding device. Conclusion: The two kinds of treatment are effective in the treatment of the narrow tendinous tendinous tendinous inflammation, and the effect can be seen in the aspects of improving the rest pain of the wrist joint of the affected part, the swelling of the affected side, the tenderness of the affected part and the test of the exercise of the fist, but the overall curative effect of the experimental group is better, and in a certain degree, The point of acupuncture at the Shangqiu point is better than that of the simple wrist local acupuncture.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R246.9
本文编号：2507430
[Abstract]:Objective: The osteopathyous tendinous tendonitis is a common chronic strain of the bone injury of the chronic strain. The manual worker, especially the women's disease, such as the infant, the cleaner and other groups, the prevalence of the tendinous aponeurosis is high and the recurrence is easy, although there is no direct and fatal risk, But it will bring the patient's life to work with many inconveniences and extreme pain, and it is still a serious condition that can't be ignored. The clinical trial was carried out to explore the treatment of the stenoses of the stenoses of the stem of the bone and to broaden the thinking of clinical treatment and to provide more clinical and experimental basis for the treatment of the disease. Method: I am in the Yi Feng Chinese Medicine Clinic in Xindian District, Xinbei City, and the three traditional Chinese medicine clinics in the middle and middle areas of Xinbei City and the Shian Traditional Chinese Medicine Clinic in the middle and middle areas of Xinbei City. And the outpatient department of the Antai Traditional Chinese Medicine Clinic in the Daxi District of Taoyuan City is the source of the subject. It is necessary to continuously treat 2 courses of treatment in the outpatient clinic in a continuous condition, and each treatment course will be treated continuously for 6 times with a limited number of patients, which is an effective case sample. The cases with the inclusion and exclusion criteria were divided into two groups according to the statistical requirements. The evaluation criteria for clinical symptoms and signs, such as Wang Wenhua, Wang Hengbin, etc., and the criteria for grading and scoring of clinical symptoms and signs, such as Wang Wenhua and Wang Hengbin and the like, were selected and evaluated according to the criteria for clinical symptoms and physical signs and scores of clinical symptoms and signs in the Chinese mainland China National Center for Traditional Chinese Medicine (TCM). The evaluation contents included four items, such as rest pain, swelling of the affected side, tenderness, and test pain of the hand, and set up the evaluation table of the curative effect of the osteopathytis of the stem of the bone, and the effect of the treatment was statistically analyzed. Results: There was no statistical difference between the two groups in the experimental group and the control group (P <0.05). After the treatment course was over, there was no statistical difference between the two treatment methods in the improvement of the symptoms of the patient, but in the 30 cases of the experimental group,1 case was cured,10 cases were effective,19 cases were effective,0 cases were not valid, and 30 cases of the control group:0 cases were cured,2 cases were effective, and 24 cases were effective. Invalid 4 cases. The difference between the pre-treatment and the rest pain scores was compared with the independent sample t test, P = 0.451, P0.05, the difference of the rest pain in the two groups was not statistically significant, and it was comparable; the comparison between the post-treatment score groups did not accord with the non-parametric test (F test), and the non-parametric Kolmogorov-Smirnov test was used, P = 0.236, P0.05, There was no significant difference in the scores of the rest pain scores after the treatment of the two groups. The difference of the intra-group and the before-and-after-treatment difference was tested by the paired sample t, P = 0.00, P <0.05, indicating that the score of the rest pain before and after treatment was of statistical significance. The difference between the two groups was compared with that of the independent sample t, P = 0.608, P <0.05, the difference between the two groups was not statistically significant, and the difference between the two groups was not statistically significant. The non-parametric Kolmogorov-Smirnov test, P = 0.998, was used to test the difference between the two groups. The results showed that there was no statistical significance between the two groups of patients with the side swelling scores after treatment. The difference in the group was compared with that of the paired samples t before and after treatment, P = 0.00, P <0.05, indicating the statistical significance of the side swelling scores after treatment. The difference between the pre-treatment scoring groups was compared with the independent sample t test, P = 0.321, P0.05, the difference of the pre-treatment pressure pain of the two groups was not statistically significant, and it was comparable; the comparison between the post-treatment score groups did not accord with the non-parametric test (F test), and the non-parametric Kolmogorov-Smirnov test was used, P = 0.388, P0.05, It was shown that there was no statistical significance between the two groups of patients after treatment. The difference of the intra-group and the before-and-after-treatment difference was tested by the paired samples t, P = 0.00, P <0.05, indicating the statistical significance of the pre-and post-treatment pressure pain scores. The difference between the pre-treatment score and the pre-treatment score group was compared with the independent sample t test, P = 0.608, P0.05, and the difference between the two groups in the pre-treatment group was not statistically significant, and it was comparable; the comparison between the post-treatment score groups did not accord with the self-alignment test (F test). The non-parametric Kolmogorov-Smirnov test, P = 0.586, P 0.05, showed no statistical significance in the difference of the test scores between the two groups. In group, the difference of pre-treatment and post-treatment was tested by paired sample t, P = 0.00, P <0.05, indicating that the pre-and post-treatment pre-and post-treatment scores were of statistical significance. The difference between the pre-treatment total score scores was compared with the independent sample t test, P = 0.477, P0.05, the difference of the total score of the two groups was not statistically significant, and the difference between the two groups was comparable; the comparison of the post-treatment score groups was in accordance with the homogeneity test (F test), and tested by the independent sample t, P = 0.063, P0.05, The difference of total score of the two groups was not statistically significant. The difference of the intra-group and the post-treatment difference was tested by the paired samples t, P = 0.00, P <0.05, indicating the statistical significance of the total score before and after treatment. The total score of the two groups was 279, the total score of the total score was 116, the total score of the decrease was 163, the total score was 9.300 before the treatment, and the total score of the decrease was 3.800, the average total difference was 5.500, and the total score before treatment in the control group was 268. After the treatment, the total score was 154 points, the total score of the reduction was 114 points, the total average was 8.933 points before treatment, and the total score decreased to 5.267 points after the two treatment courses, and the average total difference was 3.666 points. The scoring gap before and after the treatment of visual analogue scale (VAS): in the aspect of rest pain, the experimental group was 1.600 (0.498), and the control group was (1.100, 0.305); in the aspect of swelling of the affected side, the experimental group was 1.067 (0.254), and the control group was (0.800-0.484); in the aspect of tenderness, The experimental group was (1.500-0.507), the control group was (1.067-0.254), and the experimental group was 1.267-0.450, the control group was (0.833-0.379), and the total difference of the above four groups was 5.433-1.194 and the control group was (3.800-0.925). In the treatment group,30 cases were cured,1 case recovered, 3.33%,10 cases markedly effective, 33.33%, effective 19 cases, 63.33%, invalid 0 cases,0%, total effective rate 100%, and 30 cases of group samples, including 0,0%,2 cases, 6.67%, effective 24 cases. The total effective rate was 86.67%, the total effective rate was 86.67%, and the scores of the two groups were significantly lower than that of the control group (P <0.05). It is suggested that the acupuncture method and the local point-taking acupuncture method can relieve the rest pain of the wrist joint of the affected part, the swelling of the affected side, the pain of the affected part and the pain of the hand-holding device. Conclusion: The two kinds of treatment are effective in the treatment of the narrow tendinous tendinous tendinous inflammation, and the effect can be seen in the aspects of improving the rest pain of the wrist joint of the affected part, the swelling of the affected side, the tenderness of the affected part and the test of the exercise of the fist, but the overall curative effect of the experimental group is better, and in a certain degree, The point of acupuncture at the Shangqiu point is better than that of the simple wrist local acupuncture.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R246.9
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