针刺补泻手法对腰椎间盘突出症疗效影响研究
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摘要
目的：通过比较靳三针+手法组与单纯靳三针针刺组治疗腰椎间盘突出症(LIDH)的疗效,验证二者在腰椎间盘突出症治疗中的疗效如何,并比较两组间疗效差异,探索靳三针治疗腰椎间盘突出症更加有效的操作方法。旨在通过探讨传统手法在治疗腰椎间盘突出症过程中所起的作用,引起针灸研究者对传统补泻手法的重视。
方法：①通过国内外的文献研究,探讨腰椎间盘突出症的中西医发病机制,中西医的治疗研究概况以及针灸治疗腰椎间盘突出症的研究进展。②选择72例符合诊断标准、排除标准的腰椎间盘突出症患者,采用随机分组方法分到两组中,按照脱落标准排除后,手法组、留针组各剩30例。③两组均以腰三针(肾俞、大肠俞、委中)坐骨针(坐骨点、委中、昆仑)为基本处方,配以辩证取穴,予以针刺治疗,留针30分钟。期间,手法组每10分钟于下肢远端五输穴上行补泻手法一次,每次行针1分钟。留针组不予其他操作。每天治疗1次,10次1个疗程,治疗期间停用其他方法。④1疗程后及1个月后随访,评价两组病例的临床疗效,填写量表,建立数据库,运用SPSS17.0进行统计分析。
结果：①将两组的一般资料(包括年龄、性别、病期、病程、中医证型及治疗前生活质量和体征评分)进行基线比较,经统计学处理,差异均无统计学意义(p>0.05)。②两组总疗效比较：手法组总有效率93.33%,对照组总有效率83.33%,两组比较,经秩和检验,差异具有统计学意义(P<0.05)。③组内定量疗效比较：将两组各自治疗前JOA、PRI、VAS评分分别与治疗后及随访时的这三个评分比较,经配对t检验,两组JOA、PRI、VAS评分变化均有统计学意义(P<0.05)。④组间定量疗效比较：将治疗后及1个月后随访的J0A、PRI、VAS评分及改善率两组之间进行比较,经统计学分析,治疗后两组之间的评分及改善率差异具有统计学意义(P<0.05),而随访1个月的评分及改善率无差异无统计学意义(p>0.05)。⑤两组治疗过程中所有患者经临床观察未发现任何不良反应。
结论：①两组资料基线比较无显著差异,两组一般资料具有可比性。②两组治疗腰椎间盘突出症的总治疗效果皆较好,手法组总体治疗效果明显高于留针组。③两组在改善腰椎间盘突出症患者的生活质量及临床症状方面均有效,且均具有远期疗效。④手法组的近期疗效优于留针组,但远期疗效二者无显著差别。⑤针灸操作时,如果严格按照操作规范操作,安全性相对较高。
Purpose:In the project thesis, all cases of Lumbar Intervertebral Disc Protrusion (LIDH) are divided into two groups, that one is the group of acupuncture with reinforcing and reducing techniques and another is the group of mere acupuncture. Through comparing the curative effects on treatment of LIDH between the two groups, the effects of the two methods will be verified and the differences of the two will be discovered, to exploring the more effective operational method of Jin'3-Needle Technique on treatment of LIDH. The purpose of the paper is to probe into the effects of reinforcing and reducing techniques on treatment of LIDH and to attach the acupuncture researchers'importance to the techniques.
Methods:Firstly, they were researched via interior and foreign document study, that the pathogenesis and overview of the treatment of LIDH in Traditional Chinese(TCM) and Western medicine and research progress on treating LIDH by acupuncture. Secondly,72 cases of LIDH in accordance with the diagnostic standards, inclusion criteria and exclusion criteria were selected and distributed to the two groups randomly; after some cases were dropped out according with the shedding standards, the technique group and the retaining needle group both remained 30 cases. Thirdly, both group was treated with acupuncture on "the 3-Lumbar Points"(Shenshu, Dachangshu, Weizhong) and "the 3-Sciatic Points"(Jin's Zuogudian, Weizhong, Kunlun) essentially; At the same time, another auxiliary points were used basing on overall analysis of symptoms and signs; all retained needles for 30 minutes; during the process, the reinforcing and reducing methods for a minute were used on the 5-Shu acupoints every 10 minutes in the technique group, but noting was done in the ohter; every patient was gave one period of treatment following the methods mentioned before, with 10 times for a period of treatment. Finally, every was evaluated the clinical effect by filling in the scales after a period treatment and at the time of follow-up visit in a month, then the datum were collected and analysed with the statistical software of spssl7.0.
Results:First, there was no statistical significance(p>0.05) in the general datum(including age, sex, period, TCM different syndrome types, and quality of life and signs before treatment) between the two groups. Next, compare of the total curative effect between the two groups:the total effective rate of the technique group was 93.33%, while the other group was 83.33%; there was statistical significance (p<0.05) of their total curative effects after statistical analysis with Wilcoxon Rank Sum Test. What's more, compare of the quantitative curative effects in both group:They were compared, that all of the scores(JOA scores, PRI scores, VAS scores) before treatment with those after treatment and at the time of follow-up visit; there were statistical significance (p<0.05) between all the pairs by means of statistical analysis with Pair T Test,. In addition, compare of the quantitative curative effects between the two group:all the scores(JOA scores, PRI scores, VAS scores) and the improvement rates were compared between the two group with Wilcoxon Rank Sum Test after treatment and at the time of follow-up visit in a month; there was statistical significance(p<0.05) after treatment in the scores and improvement rates between them, but there weren't statistical significance in those between them at the time of follow-up visit(p>0.05). In the end, all the patients of the two groups weren't been found any adverse reactions during clinical observation.
Conclusions:First, the general datum of the two groups was comparable, because there was no significant difference(p>0.05) between them in the baseline. Second, total curative effect on treatment of LIDH were good with both methods mentioned in the two groups, but the technique group was more effective than the retaining needle group in total curative effect obviously. Third, both of the two groups was valid in improving the quality of life and the clinical symptoms of the patients suffering from LIDH and both had lateresults. Fourth, the technique group was superior to the retaining needle group in short-term curative effect, but there was no significant differences between their long-term outcome. Last, if the operation standards was accorded with strictly, the safety of acupuncture was high relatively.
方法：①通过国内外的文献研究,探讨腰椎间盘突出症的中西医发病机制,中西医的治疗研究概况以及针灸治疗腰椎间盘突出症的研究进展。②选择72例符合诊断标准、排除标准的腰椎间盘突出症患者,采用随机分组方法分到两组中,按照脱落标准排除后,手法组、留针组各剩30例。③两组均以腰三针(肾俞、大肠俞、委中)坐骨针(坐骨点、委中、昆仑)为基本处方,配以辩证取穴,予以针刺治疗,留针30分钟。期间,手法组每10分钟于下肢远端五输穴上行补泻手法一次,每次行针1分钟。留针组不予其他操作。每天治疗1次,10次1个疗程,治疗期间停用其他方法。④1疗程后及1个月后随访,评价两组病例的临床疗效,填写量表,建立数据库,运用SPSS17.0进行统计分析。
结果：①将两组的一般资料(包括年龄、性别、病期、病程、中医证型及治疗前生活质量和体征评分)进行基线比较,经统计学处理,差异均无统计学意义(p>0.05)。②两组总疗效比较：手法组总有效率93.33%,对照组总有效率83.33%,两组比较,经秩和检验,差异具有统计学意义(P<0.05)。③组内定量疗效比较：将两组各自治疗前JOA、PRI、VAS评分分别与治疗后及随访时的这三个评分比较,经配对t检验,两组JOA、PRI、VAS评分变化均有统计学意义(P<0.05)。④组间定量疗效比较：将治疗后及1个月后随访的J0A、PRI、VAS评分及改善率两组之间进行比较,经统计学分析,治疗后两组之间的评分及改善率差异具有统计学意义(P<0.05),而随访1个月的评分及改善率无差异无统计学意义(p>0.05)。⑤两组治疗过程中所有患者经临床观察未发现任何不良反应。
结论：①两组资料基线比较无显著差异,两组一般资料具有可比性。②两组治疗腰椎间盘突出症的总治疗效果皆较好,手法组总体治疗效果明显高于留针组。③两组在改善腰椎间盘突出症患者的生活质量及临床症状方面均有效,且均具有远期疗效。④手法组的近期疗效优于留针组,但远期疗效二者无显著差别。⑤针灸操作时,如果严格按照操作规范操作,安全性相对较高。
Purpose:In the project thesis, all cases of Lumbar Intervertebral Disc Protrusion (LIDH) are divided into two groups, that one is the group of acupuncture with reinforcing and reducing techniques and another is the group of mere acupuncture. Through comparing the curative effects on treatment of LIDH between the two groups, the effects of the two methods will be verified and the differences of the two will be discovered, to exploring the more effective operational method of Jin'3-Needle Technique on treatment of LIDH. The purpose of the paper is to probe into the effects of reinforcing and reducing techniques on treatment of LIDH and to attach the acupuncture researchers'importance to the techniques.
Methods:Firstly, they were researched via interior and foreign document study, that the pathogenesis and overview of the treatment of LIDH in Traditional Chinese(TCM) and Western medicine and research progress on treating LIDH by acupuncture. Secondly,72 cases of LIDH in accordance with the diagnostic standards, inclusion criteria and exclusion criteria were selected and distributed to the two groups randomly; after some cases were dropped out according with the shedding standards, the technique group and the retaining needle group both remained 30 cases. Thirdly, both group was treated with acupuncture on "the 3-Lumbar Points"(Shenshu, Dachangshu, Weizhong) and "the 3-Sciatic Points"(Jin's Zuogudian, Weizhong, Kunlun) essentially; At the same time, another auxiliary points were used basing on overall analysis of symptoms and signs; all retained needles for 30 minutes; during the process, the reinforcing and reducing methods for a minute were used on the 5-Shu acupoints every 10 minutes in the technique group, but noting was done in the ohter; every patient was gave one period of treatment following the methods mentioned before, with 10 times for a period of treatment. Finally, every was evaluated the clinical effect by filling in the scales after a period treatment and at the time of follow-up visit in a month, then the datum were collected and analysed with the statistical software of spssl7.0.
Results:First, there was no statistical significance(p>0.05) in the general datum(including age, sex, period, TCM different syndrome types, and quality of life and signs before treatment) between the two groups. Next, compare of the total curative effect between the two groups:the total effective rate of the technique group was 93.33%, while the other group was 83.33%; there was statistical significance (p<0.05) of their total curative effects after statistical analysis with Wilcoxon Rank Sum Test. What's more, compare of the quantitative curative effects in both group:They were compared, that all of the scores(JOA scores, PRI scores, VAS scores) before treatment with those after treatment and at the time of follow-up visit; there were statistical significance (p<0.05) between all the pairs by means of statistical analysis with Pair T Test,. In addition, compare of the quantitative curative effects between the two group:all the scores(JOA scores, PRI scores, VAS scores) and the improvement rates were compared between the two group with Wilcoxon Rank Sum Test after treatment and at the time of follow-up visit in a month; there was statistical significance(p<0.05) after treatment in the scores and improvement rates between them, but there weren't statistical significance in those between them at the time of follow-up visit(p>0.05). In the end, all the patients of the two groups weren't been found any adverse reactions during clinical observation.
Conclusions:First, the general datum of the two groups was comparable, because there was no significant difference(p>0.05) between them in the baseline. Second, total curative effect on treatment of LIDH were good with both methods mentioned in the two groups, but the technique group was more effective than the retaining needle group in total curative effect obviously. Third, both of the two groups was valid in improving the quality of life and the clinical symptoms of the patients suffering from LIDH and both had lateresults. Fourth, the technique group was superior to the retaining needle group in short-term curative effect, but there was no significant differences between their long-term outcome. Last, if the operation standards was accorded with strictly, the safety of acupuncture was high relatively.
引文
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[3]王福权,员公怡.老年人腰椎间盘突出症的手术治疗[J].中华老年医学杂志,1997,15(3)：132.
[4]张双喜.老年人腰椎间盘突出症7例分析[J].骨与关节损伤杂志,1995,10(5)：56.
[5]伊智雄.中西医结合治疗腰椎间盘突出症[M].北京：人民卫生出版社,2008：84-86,184-220.
[6]周秉文.腰背痛[M].北京：人民卫生出版社,1994：115.
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