弹拨法治疗肱骨外上髁炎的临床研究
|
摘要
肱骨外上髁炎又称网球肘，是肘部中最常见的疾病最初是在1873年由Major描述并于1883年首先提出并命名，一直被认为是肌腱劳损。随着患者数的增加和诊断治疗的不断深入，人们对此病的了解也越来越深。虽然此病的治疗方法多种多样，但此病在治疗后往往容易反复发作，却不容忽视，部分还容易转化为顽固性网球肘。随着国内外循证医学的全面开展，肱骨外上髁炎如何获得最佳的治疗效果，仍是临床医师需要反复思考的问题。
目的：通过单盲随机分组的方法观察弹拨法和TDP神灯照射治疗肱骨外上髁炎的疗效差异并探讨其机理。
方法：将2010年12月至2012年04月长春中医药大学附属医院就诊的患者共观察60例，采用单盲随机分组设计的方法随机分为治疗组（30例）和对照组（30例）。通过统计学分析，得出治疗前两组患者性别、年龄、病程及临床症状和体征总积分均未见明显差异；比较两组治疗2个疗程，20天的疗效，并对治疗后的症状体征进行评分，通过统计方法分析前后的差异。
结果：治疗后肘关节症状、体征总积分，经Τ检验，Τ=-3.905，P=0.000，P<0.01，两组间有极显著性差异，说明两组在改善肱骨外上髁炎的症状与体征上不同。治疗组与对照组患者病情经秩和检验，Z=-3.682，P=0.000，P<0.001，治疗组和对照组间有极显著性差异，说明治疗组和对照组在治疗疾病上疗效完全不同，治疗组疗效明显优于对照组。
结论：本文研究结果发现，治疗组及对照组在治疗后患者症状、体征总积分均有不同程度降低。通过对两组治疗结果的统计学分析，P<0.05，均有统计学意义；提示弹拨法治疗肱骨外上髁炎的临床疗效确切，具有简、便、廉的特点，值得临床推广。
Humeral condyle inflammation and says tennis elbow, the elbow is the most common form of the disease was first described in1873by Major in1883and first put forward and named, was thought to be a hamstring strain. Along with the increase of the number of patients with the diagnosis and treatment of further, people understand the disease is more and more deep. Although the disease treatment varied, but the disease after treatment often easily repeated attacks, but cannot be ignored, part is easy to translate into intractable tennis elbow. As foreign and domestic evidence-based medicine in an all-round way, humeral condyle inflammation how to get the best treatment effect, is still clinicians requires repeated thinking of problem.
Purpose: It through randomized method of single blind observation plucked method and the TDP absolute being light radiation therapy the humerus epicondylitis of differences and discuss the mechanism.
Method: There will be December2010-2012over the month changchun university of Chinese medicine affiliated hospital of the patients were observed60patients, the single blind randomized methods of the design of divided into the treatment group (30cases) and the control group (30cases). Through the statistics and analysis of two groups of patients before treatment gender, age, duration view, and clinical signs and symptoms are not total score was found differences; Compare two treatment group2treatment, the curative effect of20days, and the treatment of the symptoms and signs after rating, through the analysis of the differences and statistical method.
Result: After treatment, symptoms, physical signs elbow total score, the T inspection, T=-3.905, P=0.000, P<0.01, between the two groups have significantly difference, explain two groups in improve symptoms and signs on different points. The treatment group and control group of patients had a rank and the inspection, Z=-3.682, P=0.000, P<0.001, between treatment group and control group have significantly difference that treatment group and control group in the treatment of disease curative effect, the treatment group entirely different had better effects than control group.
Conclusion: This paper the research result shows that the treatment group and control group in the treatment of patients after total score symptoms and signs are different degree is reduced,. Through to the two groups of the results of the treatment statistics analysis, P<0.05, all have statistical significance; Tip plucked treatments for humerus condyle inflammation the clinical curative effect of the exact, with Jane, then, the characteristics of the cream, worth clinical promotion..
目的：通过单盲随机分组的方法观察弹拨法和TDP神灯照射治疗肱骨外上髁炎的疗效差异并探讨其机理。
方法：将2010年12月至2012年04月长春中医药大学附属医院就诊的患者共观察60例，采用单盲随机分组设计的方法随机分为治疗组（30例）和对照组（30例）。通过统计学分析，得出治疗前两组患者性别、年龄、病程及临床症状和体征总积分均未见明显差异；比较两组治疗2个疗程，20天的疗效，并对治疗后的症状体征进行评分，通过统计方法分析前后的差异。
结果：治疗后肘关节症状、体征总积分，经Τ检验，Τ=-3.905，P=0.000，P<0.01，两组间有极显著性差异，说明两组在改善肱骨外上髁炎的症状与体征上不同。治疗组与对照组患者病情经秩和检验，Z=-3.682，P=0.000，P<0.001，治疗组和对照组间有极显著性差异，说明治疗组和对照组在治疗疾病上疗效完全不同，治疗组疗效明显优于对照组。
结论：本文研究结果发现，治疗组及对照组在治疗后患者症状、体征总积分均有不同程度降低。通过对两组治疗结果的统计学分析，P<0.05，均有统计学意义；提示弹拨法治疗肱骨外上髁炎的临床疗效确切，具有简、便、廉的特点，值得临床推广。
Humeral condyle inflammation and says tennis elbow, the elbow is the most common form of the disease was first described in1873by Major in1883and first put forward and named, was thought to be a hamstring strain. Along with the increase of the number of patients with the diagnosis and treatment of further, people understand the disease is more and more deep. Although the disease treatment varied, but the disease after treatment often easily repeated attacks, but cannot be ignored, part is easy to translate into intractable tennis elbow. As foreign and domestic evidence-based medicine in an all-round way, humeral condyle inflammation how to get the best treatment effect, is still clinicians requires repeated thinking of problem.
Purpose: It through randomized method of single blind observation plucked method and the TDP absolute being light radiation therapy the humerus epicondylitis of differences and discuss the mechanism.
Method: There will be December2010-2012over the month changchun university of Chinese medicine affiliated hospital of the patients were observed60patients, the single blind randomized methods of the design of divided into the treatment group (30cases) and the control group (30cases). Through the statistics and analysis of two groups of patients before treatment gender, age, duration view, and clinical signs and symptoms are not total score was found differences; Compare two treatment group2treatment, the curative effect of20days, and the treatment of the symptoms and signs after rating, through the analysis of the differences and statistical method.
Result: After treatment, symptoms, physical signs elbow total score, the T inspection, T=-3.905, P=0.000, P<0.01, between the two groups have significantly difference, explain two groups in improve symptoms and signs on different points. The treatment group and control group of patients had a rank and the inspection, Z=-3.682, P=0.000, P<0.001, between treatment group and control group have significantly difference that treatment group and control group in the treatment of disease curative effect, the treatment group entirely different had better effects than control group.
Conclusion: This paper the research result shows that the treatment group and control group in the treatment of patients after total score symptoms and signs are different degree is reduced,. Through to the two groups of the results of the treatment statistics analysis, P<0.05, all have statistical significance; Tip plucked treatments for humerus condyle inflammation the clinical curative effect of the exact, with Jane, then, the characteristics of the cream, worth clinical promotion..
引文
[1]孙树椿等,中医筋伤学(第二版)[M],人民卫生出版社,2006,7;81一82.
[2]李庆泰等,手外科诊断学[M],人民卫生出版社,2009,10;71-72.
[3]尹律平,筋痛散外敷治疗网球肘32例[J],实用中医药杂志.2011,10;27（4）:720—721
[4]朱诚,止痛膏外敷治疗网球肘98例疗效观察[J],中医外治杂志.2004;（2）
[5]吴铁男,郭宏社,汪汉民,归马散外敷治疗网球肘300例[J],河南中医,2002;22（4）:36
[6]庞志英,治疗网球肘三法[J],河南中医药学刊2001;16(4):25
[7]赵相洪,肱骨外上髁炎的的分型辨治[J],安徽中医临床杂志,2003;15(2):143
[8]刘莹莹,温针灸结合电针治疗网球肘[J],中医民间疗法,2011;（1）
[9]张万蓉,针灸加激光治疗网球肘,医学信息(中旬刊)[J],2010;（3）:494.
[10]王占国,针后加灸治疗网球肘60例[J],甘肃针灸,2010;23（9）:23
[11]姜占成,针刺与远红外线治疗网球肘28例[J],中医外治杂志,2011,2;20（1）:39）
[12]李天昱,针药并行论治顽固性网球肘[J],辽宁医学杂志,2011;25(2):69—70.
[13]杨军雄,针推加TDP治疗网球肘的临床研究[J],铜仁职业技术学院学报2003;1（2）:33—34.
[14]王康,针刺与推拿治疗网球肘30例疗效观察[J],中外医学研究,2011,3;9（8）:85.
[15]李海龙,单穴针联合过伸牵抖法治疗网球肘49例[J],实用中医内科杂志,2011;25（8）:94.
[16]张钊,火针治疗网球肘60例[J],河北中医,2012,2;32（2）:219.
[17]林志建,火针加拔罐治疗网球肘124例[J],中国民间疗法,2008;3:21
[18]赵永祥火针治疗网球肘32例[J],云南中医药杂志,2009;30（12）:89）
[19]黄健琳,傍针刺法结合烧针柄法治疗网球肘32例[J],陕西中医,2008;29（4）:480
[20]符仲华.浮针疗法[M].北京:人民军医出版社,2000:17-20.
[21]刘志良,浮针疗法治疗网球肘疗效观察[J],上海针灸杂志,2011,10;30（10）:693.
[22]高凤云,浮针配合围刺法治疗网球肘56例[J],中华中医药杂志,2011,8;26（8）:1893
[23]路则显,局部针刀松解治疗顽固性网球肘80例[J],中国民间疗法,2004;（3）.
[24]毛伟欢,小针刀结合火针疗法治疗网球肘45例[J],浙江中医杂志,2010,3;45（3）:208
[25]刘云军小针刀治疗网球肘186例[J],中国中医急症,2008,4;17（4）:495
[26]付祥龙,采用小针刀联合封闭治疗网球肘６８例[J],中医民间疗法,2011,9;19（9）:29
[27]吕宁,针刀为主配合药物治疗网球肘80例[J],长春中医药大学学报,2009,12;32（12）:885
[28]吴珍,针刀配合手法治疗网球肘238例临床报告[J],光明中医,2011,02;26（2）:310
[29]姚益龙,针刀疗法结合药物注射治疗网球肘43例[J],陕西中医,2009;30（3）:338
[30]王丽萍,针刀联合手法治疗网球肘７８例[J],人民军医,2012,1,1;55（1）:5
[31]杨阳,小针刀松解配合康复治疗网球肘87例[J],实用中医内科杂志,2012;26（1）:105.
[32]罗仁瀚,小针刀治疗网球肘30例临床观察[J],云南中医学院学报,2008,4;31（2）:48—49.
[33]容斌,点按剥离法治疗网球肘60例[J],江西中医药,2009;40（3）:51.
[34]王维臣,手法点穴治疗网球肘疗效观察[J],中国社区医师（医学专业半月刊）2008;10（20）:124—125.
[35]陶缨,颈肘联合手法治疗运动员顽固性网球肘[J],中国康复,2009;（01）.
[36]刘文新,按摩手法治疗网球肘64例临床观察[J],中国民康医学,2009,21（20）:2516.
[37]吴兆明等,手法治疗网球肘162例总结[J],中医药导报,2008,3;14（3）:52—53.
[38]汤凤平,指压灵骨、尺泽穴配手法治疗网球肘37例[J],中国疗养医学,2011;20（9）:783
[39]范国林,推筋导络治疗网球肘[J],中华养生保健,2010;7:16
[40]刘维屏,推拿整复治疗网球肘80例[J],现代中西医结合杂志,2008,6;17（21）:3314
[41]江浩,推拿手法配合温针治疗网球肘40例,陕西中医,2010;3（31）:348.
[42]蔡琴、陈继春,手法治疗肱骨外上髁炎68例的体会[J],按摩与导引.2000;8(16):41
[43]冯俊卿,推拿治疗肱骨外上髁炎72例[J],中国民间疗法.2000;3(8):19
[44]郑卫国,点穴推拿治疗肱骨外上髁炎[J],中国正骨.2004;6(16):6
[45]陈建萍,口服非甾体抗炎药联合局部注射糖皮质激素及局麻药治疗网球肘的疗效观察[J],中国实用医药,2010,10;5（30）:157—158
[46]彭京.顽固性网球肘封闭治疗失败2例分析[J].中医正骨,1996;8(4):42.
[47]姜金成,中国老年保健医学[J],2010;8（3）:29—30
[48]马腾,曲安奈德注射结合针刀治疗难治性网球肘的临床研究[J],菏泽医学专科学校学报,2011;23（3）:32
[49]马建民等,护具配合封闭治疗顽固性网球肘60例疗效观察[J],宁夏医学杂志,2010,12;32（12）:1188）.
[50]王育庆,半导体激光并推拿理伤手法治疗网球肘的临床观察[J],激光杂志,2008;29（5）:85.
[51]王丽,电磁波治疗仪在网球肘治疗中的应用[J],山东中医药,2008;48（26）:100—101.
[52]郭一鸣,应用微波治疗网球肘的临床观察[J],中国康复理论与实践,2009;8;15（8）:784—785
[53]缪定国,依托芬那酯超声透入治疗网球肘疗效观察[J],中国康复,2011,2;26（1）:73
[54]刘振光,小切口手术治疗顽固性网球肘22例临床疗效观察[J],中国中医骨伤科杂志,2007;1.
[55]卢美源,顽固性网球肘的手术治疗[J],山东医药,1994;(6)
[2]李庆泰等,手外科诊断学[M],人民卫生出版社,2009,10;71-72.
[3]尹律平,筋痛散外敷治疗网球肘32例[J],实用中医药杂志.2011,10;27（4）:720—721
[4]朱诚,止痛膏外敷治疗网球肘98例疗效观察[J],中医外治杂志.2004;（2）
[5]吴铁男,郭宏社,汪汉民,归马散外敷治疗网球肘300例[J],河南中医,2002;22（4）:36
[6]庞志英,治疗网球肘三法[J],河南中医药学刊2001;16(4):25
[7]赵相洪,肱骨外上髁炎的的分型辨治[J],安徽中医临床杂志,2003;15(2):143
[8]刘莹莹,温针灸结合电针治疗网球肘[J],中医民间疗法,2011;（1）
[9]张万蓉,针灸加激光治疗网球肘,医学信息(中旬刊)[J],2010;（3）:494.
[10]王占国,针后加灸治疗网球肘60例[J],甘肃针灸,2010;23（9）:23
[11]姜占成,针刺与远红外线治疗网球肘28例[J],中医外治杂志,2011,2;20（1）:39）
[12]李天昱,针药并行论治顽固性网球肘[J],辽宁医学杂志,2011;25(2):69—70.
[13]杨军雄,针推加TDP治疗网球肘的临床研究[J],铜仁职业技术学院学报2003;1（2）:33—34.
[14]王康,针刺与推拿治疗网球肘30例疗效观察[J],中外医学研究,2011,3;9（8）:85.
[15]李海龙,单穴针联合过伸牵抖法治疗网球肘49例[J],实用中医内科杂志,2011;25（8）:94.
[16]张钊,火针治疗网球肘60例[J],河北中医,2012,2;32（2）:219.
[17]林志建,火针加拔罐治疗网球肘124例[J],中国民间疗法,2008;3:21
[18]赵永祥火针治疗网球肘32例[J],云南中医药杂志,2009;30（12）:89）
[19]黄健琳,傍针刺法结合烧针柄法治疗网球肘32例[J],陕西中医,2008;29（4）:480
[20]符仲华.浮针疗法[M].北京:人民军医出版社,2000:17-20.
[21]刘志良,浮针疗法治疗网球肘疗效观察[J],上海针灸杂志,2011,10;30（10）:693.
[22]高凤云,浮针配合围刺法治疗网球肘56例[J],中华中医药杂志,2011,8;26（8）:1893
[23]路则显,局部针刀松解治疗顽固性网球肘80例[J],中国民间疗法,2004;（3）.
[24]毛伟欢,小针刀结合火针疗法治疗网球肘45例[J],浙江中医杂志,2010,3;45（3）:208
[25]刘云军小针刀治疗网球肘186例[J],中国中医急症,2008,4;17（4）:495
[26]付祥龙,采用小针刀联合封闭治疗网球肘６８例[J],中医民间疗法,2011,9;19（9）:29
[27]吕宁,针刀为主配合药物治疗网球肘80例[J],长春中医药大学学报,2009,12;32（12）:885
[28]吴珍,针刀配合手法治疗网球肘238例临床报告[J],光明中医,2011,02;26（2）:310
[29]姚益龙,针刀疗法结合药物注射治疗网球肘43例[J],陕西中医,2009;30（3）:338
[30]王丽萍,针刀联合手法治疗网球肘７８例[J],人民军医,2012,1,1;55（1）:5
[31]杨阳,小针刀松解配合康复治疗网球肘87例[J],实用中医内科杂志,2012;26（1）:105.
[32]罗仁瀚,小针刀治疗网球肘30例临床观察[J],云南中医学院学报,2008,4;31（2）:48—49.
[33]容斌,点按剥离法治疗网球肘60例[J],江西中医药,2009;40（3）:51.
[34]王维臣,手法点穴治疗网球肘疗效观察[J],中国社区医师（医学专业半月刊）2008;10（20）:124—125.
[35]陶缨,颈肘联合手法治疗运动员顽固性网球肘[J],中国康复,2009;（01）.
[36]刘文新,按摩手法治疗网球肘64例临床观察[J],中国民康医学,2009,21（20）:2516.
[37]吴兆明等,手法治疗网球肘162例总结[J],中医药导报,2008,3;14（3）:52—53.
[38]汤凤平,指压灵骨、尺泽穴配手法治疗网球肘37例[J],中国疗养医学,2011;20（9）:783
[39]范国林,推筋导络治疗网球肘[J],中华养生保健,2010;7:16
[40]刘维屏,推拿整复治疗网球肘80例[J],现代中西医结合杂志,2008,6;17（21）:3314
[41]江浩,推拿手法配合温针治疗网球肘40例,陕西中医,2010;3（31）:348.
[42]蔡琴、陈继春,手法治疗肱骨外上髁炎68例的体会[J],按摩与导引.2000;8(16):41
[43]冯俊卿,推拿治疗肱骨外上髁炎72例[J],中国民间疗法.2000;3(8):19
[44]郑卫国,点穴推拿治疗肱骨外上髁炎[J],中国正骨.2004;6(16):6
[45]陈建萍,口服非甾体抗炎药联合局部注射糖皮质激素及局麻药治疗网球肘的疗效观察[J],中国实用医药,2010,10;5（30）:157—158
[46]彭京.顽固性网球肘封闭治疗失败2例分析[J].中医正骨,1996;8(4):42.
[47]姜金成,中国老年保健医学[J],2010;8（3）:29—30
[48]马腾,曲安奈德注射结合针刀治疗难治性网球肘的临床研究[J],菏泽医学专科学校学报,2011;23（3）:32
[49]马建民等,护具配合封闭治疗顽固性网球肘60例疗效观察[J],宁夏医学杂志,2010,12;32（12）:1188）.
[50]王育庆,半导体激光并推拿理伤手法治疗网球肘的临床观察[J],激光杂志,2008;29（5）:85.
[51]王丽,电磁波治疗仪在网球肘治疗中的应用[J],山东中医药,2008;48（26）:100—101.
[52]郭一鸣,应用微波治疗网球肘的临床观察[J],中国康复理论与实践,2009;8;15（8）:784—785
[53]缪定国,依托芬那酯超声透入治疗网球肘疗效观察[J],中国康复,2011,2;26（1）:73
[54]刘振光,小切口手术治疗顽固性网球肘22例临床疗效观察[J],中国中医骨伤科杂志,2007;1.
[55]卢美源,顽固性网球肘的手术治疗[J],山东医药,1994;(6)