夹脊穴透刺搓针法治疗腰椎间盘突出症的临床研究
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摘要
腰椎间盘突出症(Lumber Disc Herniation,简称LDH)属于中医学“腰痛”、“痹证”范畴。指腰部感受外邪,或因劳伤,或由肾虚而引起气血运行失调,脉络绌急,腰府失养所致的以腰部一侧或两侧疼痛为主要症状的一类病证。其主要表现为阵发性或持续性窜痛,夜间尤为明显,疼痛部位多自臀部向大腿后侧、小腿后外侧及足背外侧放射。每遇咳嗽、打喷嚏等易使腹压升高的动作时,疼痛加剧,严重影响患者的工作和生活质量,现代医学对于腰椎间盘突出症从定义、流行病学、病因、病理、临床分型、症状等多方面进行了大量的讨论。针刺治疗是目前治疗腰椎间盘突出症非手术疗法中的主流方法,近年来在临床上广泛应用,取得了一定得效果,本研究在这些认识的基础上从夹脊穴透刺搓针法入手,探讨其对治疗腰椎间盘突出症的临床疗效。
研究目的
观察夹脊穴透刺搓针法治疗腰椎间盘突出症的疗效,为本病提供临床高效的针刺治疗方法。
研究方法
临床上将135例符合纳入标准的患者采用随机对照法分成夹脊穴透刺搓针法组、常规针刺组和电针组,采用随机方法,将患者按照1:1:1的比例随机分配到夹脊穴透刺搓针法组、常规针刺组和电针组,总数为135例,夹脊穴透刺搓针法组45例,常规针刺组45例,电针组45例。夹脊穴透刺搓针法组以腰椎夹脊穴,在病变椎体的上一个椎体的夹脊穴至病变椎体的下一个椎体的夹脊穴。采用3寸毫针根据患者形体的胖瘦分别向下以30度角度透至下两椎,如腰3椎体突出者则取腰2椎夹脊穴向下透刺至腰4椎夹脊穴。依此类推。针刺得气后每隔5分钟行针1次。留针30分钟。常规针刺及电针组均采用临床常规治疗,三组均每天治疗一次,每周针刺5天后休息两天,共针刺4周为一疗程。治疗后3个月后随访一次。分别在治疗前,治疗后,3个月后采用视觉模拟评分(VAS,visual analog scale)、行为评分法(BRS-6,behavioral rating scale)和Fairbank.Jc腰痛病情计分表评价。
研究结果
1.经过一个疗程的治疗后评价,三组总的临床疗效相当,但夹脊穴透刺搓针法组治疗腰椎间盘突出症的复发率明显低于常规针刺组和电针组。
2.临床疗效与性别关系:经研究发现夹脊穴透刺搓针法组治疗男性腰椎间盘突出症的总有效率明显优于常规针刺组与电针组;女性组间比较无显著性差异,说明夹脊穴透刺搓针法组、常规针刺组、电针组治疗女性腰椎间盘突出症的临床疗效无差异。复发率比较显示,夹脊穴透刺搓针法组治疗腰椎间盘突出症的患者复发率明显低于常规针刺组与电针组。
3.临床疗效与病程:总的临床疗效与病程关系研究显示病程越短的患者总的临床疗效越好;复发率比较,总的临床复发率研究发现患者的病程越久,其复发率越高;三组组间比较,所有研究的患者,电针组及常规针刺组的复发率明显高于夹脊穴透刺搓针法组。
4.临床疗效与中医证型:夹脊穴透刺搓针法组治疗寒湿型及瘀血型腰椎间盘突出症的临床疗效明显优于肾虚型;电针组治疗肾虚型腰椎间盘突出症疗效最佳,其次瘀血型,寒湿型疗效相对较差;央脊穴透刺搓针法组治疗寒湿型及瘀血型腰椎间盘突出症优于常规针刺组及电针组;电针组治疗肾虚型腰椎间盘突出症优于夹脊穴透刺搓针法组及常规针刺组。
5.VAS疼痛评分量表评价夹脊穴透刺搓针法组在改善患者疼痛的缓解程度明显优于常规针刺组与电针组。
6.BRS-6行为量表评价夹脊穴透刺搓针法组在改善患者腰痛症状明显优于常规针刺组和电针组。
7.Fairbank JC量表评价夹脊穴透刺搓针法组在改善患者疼痛及日常生活活动能力方面临床疗效显著,且明显优于常规针刺组及电针组。
结论
夹脊穴透刺搓针法治疗腰椎间盘突出症的临床疗效确切,且复发率率低,在临床值得推广。
Objective
Lumbar disc herniation(Lumbar Disc Herniation),referred to as LDH,is a certified clinical diseases.With the current social development and to accelerate the pace of people's lives,the using of the increasing frequency of transport in recent years have increased the incidence trend.The main performance for the channeling of paroxysmal or persistent pain,especially at night is more than pain from the buttocks to the posterior thigh, posterolateral calf and lateral dorsum radiation.Moment,when coughing, sneezing,increased abdominal pressure,such as easy to make the move,the pain intensified,severely affected by the work of patients and quality of life.The author from clamps the keel hole to pass punctures the law to obtain, to pass punctures the law stems from Song Dynasty horse Danyang "Miscellaneous Diseases song".Jin Dynasty·Dou Hanqin" needle guide by through barbed" reference to law.Yuan Dynasty·Wang Guorui"Que acupuncture Yulong God Song "will pay more attention to law through the application of thorns," the first wind modification difficult medical......along the backward-through rate of percutaneous Valley."Ming Dynasty·Yang Jizhou"acupuncture Dacheng"a thorn Fengchi ventilate House,gill side must cross through it." "Plain Questions·Spurs need to talk":"floating disease,gill have deep,each to its rationale, no off the Road,off of the internal injuries,which is less than the outside of Health obstruct,stop up the evil from them." The acupuncture has dredges the channels and collaterals,transfers to a new post the vitality,Shu Jinli the festival,to make up empty really flows swiftly,the straight sickness institute,but passes punctures also has the original opening after to be mad the effect,therefore every chronic long illness,sinking sickness stubborn illness and part difficult various illnesses urgently need the effectiveness. Therefore this topic from clamps the keel hole to pass punctures the law to obtain,treatment waist intervertebral disc prominent sickness.
Methods
135 cases will meet the clinical inclusion criteria of patients divided into the use of randomized controlled penetration Jiaji Law Group, conventional acupuncture and electro-acupuncture group,using random methods, in accordance with the 1:1:1 ratio in patients randomly assigned to Jiaji stabbed through the group,acupuncture group and the conventional electro-acupuncture group,a total of 135 cases,penetration Jiaji group 45 cases,45 cases of conventional acupuncture group,45 cases of electro-acupuncture group.Jiaji penetration lumbar Jiaji group,in the lesions of the vertebrae of a vertebral body Jiaji to the next vertebral body lesions of the vertebral body Jiaji.Filiform needle using 3-inch body according to the patients,respectively,of down to 30 degrees angle to the next through the two vertebrae,such as lumbar vertebra 3 lumbar prominent while taking down two vertebral penetration Jiaji to Jiaji lumbar vertebra 4.And so on.Acupuncture after a gas line every five minutes the needle 1. 30 minutes left needle.Conventional acupuncture and electro-acupuncture group treatment of clinical practice are used;three groups were treated once a day, 5 days a week to rest for two days of acupuncture,a total of four weeks of acupuncture as a treatment.6 months after treatment follow-up time, Respectively,before treatment,after treatment,6 months after the use of visual analogue score(VAS,visual analog scale),behavior score(BRS-6, behavioral rating scale) and low back pain patients Fairbank.Jc evaluation scorecard.
Results
1.After a course of treatment efficacy criteria were assessed by Ridit analysis,P＞0.05,the effect of the total between the two groups no significant difference,but the relapse rate by,by Ridit analysis,P＜0.05,folder Ridge Point penetration was significantly superior to conventional acupuncture group.2.Clinical efficacy and gender relations:(1) three groups within each group comparison,the overall efficiency and no significant gender differences P＞0.05;penetration Jiaji lumbar disc herniation treatment of female patients with recurrent rate was significantly lower than male P＜0.05,with statistical significance;conventional acupuncture and electro-acupuncture law and gender between the relapse rate was no significant difference P＞0.05.(2) three sets of inter-group comparison,Jiaji penetration men treatment of lumbar disc herniation The total effective rate was superior to conventional acupuncture with electric acupuncture,P＜0.05;female group showed no significant difference,Note Jiaji penetration method,the conventional acupuncture, electro-acupuncture treatment of women in the clinical effect of lumbar disc herniation rather,P＞0.05;the relapse rate compared three groups of groups, penetration Jiaji treatment of lumbar disc herniation were men,women,the recurrence rate was significantly lower than that of conventional acupuncture and electro-acupuncture method on penetration Jiaji treatment of lumbar disc herniation in patients with the relapse rate was significantly lower than that of conventional acupuncture and electro-acupuncture method P＜0.01.3.Clinical efficacy and course of disease:After a course of treatment the clinical effects of three groups and course of the relationship between the analysis by Ridit as follows:(1) three groups within each group comparison,the overall efficiency and gender was not significant between difference P＞0.05; penetration Jiaji lumbar disc herniation treatment of female patients with the relapse rate was significantly lower than male P＜0.05,with statistical significance;conventional acupuncture and electro-acupuncture law and gender between the relapse rate was no significant difference P＞0.05.Three different course by the effect of differences is in the distribution of chi-square test with statistical significance(P＜0.01),duration of effect that significantly affected.The longer the duration,the worse treatment is.
4.The clinical efficacy and TCM syndrome:different effect of TCM-based comparison,by chi-square test results showed the following:(1) the total efficiency of the three groups were compared groups:①Jiaji treatment penetration cold type and the blood of lumbar disc herniation clinical efficacy was superior to kidney deficiency type,P＜0.01;Jiaji cold treatment penetration and blood type lumbar disc herniation clinical efficacy was not significant,P＞0.05;②Cold conventional acupuncture treatment type,blood type,kidney vacuity lumbar disc herniation clinical efficacy,with statistical analysis,no significant differences in type,a considerable effect P＞0.05;electro-acupuncture treatment of kidney deficiency treatment lumbar Clinical efficacy of lumbar intervertebral disc is superior to blood type,P＜0.01;blood type is superior to cold-type P＜0.01;that electro-acupuncture group treatment of lumbar disc herniation Kidney best efficacy,followed by blood type,the relatively poor efficacy of cold type;③electro-acupuncture treatment of lumbar disc herniation group of kidney deficiency type more effective than blood type,blood Cold is better than blood type,by the statistical processing of P＜0.01.(2) Comparison of three sets of groups:①Jiaji cold treatment penetration and blood type lumbar disc herniation is superior to conventional acupuncture and electrical acupuncture group,P＜0.01;②Electroacupuncture treatment of kidney deficiency type group lumbar disc herniation than Jiaji penetration acupuncture group and the conventional group,with statistical analysis P＜0.01.5.VAS pain score scale rating:(1) treatment of the first three groups by the t test,P＞0.05,that three sets of data from the same samples comparable.(2) three groups before and after treatment by t test,P＜0.01,with a significant difference, suggesting that penetration Jiaji group,conventional acupuncture group, electro-acupuncture group may improve pain in patients with lumbar disc herniation;(3) three sets of inter-group comparison after treatment by t test Jiaji penetration was significantly superior to conventional acupuncture with electric acupuncture(P＜0.05);electro-acupuncture method and routine acupuncture treatment by the statistical analysis between the two was not significant P＞0.05.6.BRS-6 behavior rating scale:(1) treatment of the first three groups by the t test,P＞0.05,that three sets of data from the same samples comparable.(2) three groups before and after treatment by t test, P＜0.01,significant difference with that group Jiaji penetration, conventional acupuncture group,electro-acupuncture group may improve symptoms in patients with lumbar disc herniation;(3) cgroup after treatment compared groups by t test,P＜0.05,suggesting that penetration Jiaji group more effective than conventional acupuncture and electro-acupuncture group.
7.Fairbank JC rating scale:(1) treatment of the first three groups by the t test,P＞0.05,that three sets of data from the same sample of comparable; (2) three groups before and after treatment by t test,P＜0.01,significant difference with that group Jiaji penetration,conventional acupuncture group, electro-acupuncture group may improve symptoms in patients with lumbar disc herniation;(3) three sets of inter-group comparison after treatment by t test, P＜0.05,suggesting that penetration Jiaji group more effective than conventional acupuncture and electro-acupuncture group.
Conclusion
Acupuncture Jiaji through treatment of lumbar disc herniation precise clinical efficacy and low relapse rate in the clinical worth promoting.
研究目的
观察夹脊穴透刺搓针法治疗腰椎间盘突出症的疗效,为本病提供临床高效的针刺治疗方法。
研究方法
临床上将135例符合纳入标准的患者采用随机对照法分成夹脊穴透刺搓针法组、常规针刺组和电针组,采用随机方法,将患者按照1:1:1的比例随机分配到夹脊穴透刺搓针法组、常规针刺组和电针组,总数为135例,夹脊穴透刺搓针法组45例,常规针刺组45例,电针组45例。夹脊穴透刺搓针法组以腰椎夹脊穴,在病变椎体的上一个椎体的夹脊穴至病变椎体的下一个椎体的夹脊穴。采用3寸毫针根据患者形体的胖瘦分别向下以30度角度透至下两椎,如腰3椎体突出者则取腰2椎夹脊穴向下透刺至腰4椎夹脊穴。依此类推。针刺得气后每隔5分钟行针1次。留针30分钟。常规针刺及电针组均采用临床常规治疗,三组均每天治疗一次,每周针刺5天后休息两天,共针刺4周为一疗程。治疗后3个月后随访一次。分别在治疗前,治疗后,3个月后采用视觉模拟评分(VAS,visual analog scale)、行为评分法(BRS-6,behavioral rating scale)和Fairbank.Jc腰痛病情计分表评价。
研究结果
1.经过一个疗程的治疗后评价,三组总的临床疗效相当,但夹脊穴透刺搓针法组治疗腰椎间盘突出症的复发率明显低于常规针刺组和电针组。
2.临床疗效与性别关系:经研究发现夹脊穴透刺搓针法组治疗男性腰椎间盘突出症的总有效率明显优于常规针刺组与电针组;女性组间比较无显著性差异,说明夹脊穴透刺搓针法组、常规针刺组、电针组治疗女性腰椎间盘突出症的临床疗效无差异。复发率比较显示,夹脊穴透刺搓针法组治疗腰椎间盘突出症的患者复发率明显低于常规针刺组与电针组。
3.临床疗效与病程:总的临床疗效与病程关系研究显示病程越短的患者总的临床疗效越好;复发率比较,总的临床复发率研究发现患者的病程越久,其复发率越高;三组组间比较,所有研究的患者,电针组及常规针刺组的复发率明显高于夹脊穴透刺搓针法组。
4.临床疗效与中医证型:夹脊穴透刺搓针法组治疗寒湿型及瘀血型腰椎间盘突出症的临床疗效明显优于肾虚型;电针组治疗肾虚型腰椎间盘突出症疗效最佳,其次瘀血型,寒湿型疗效相对较差;央脊穴透刺搓针法组治疗寒湿型及瘀血型腰椎间盘突出症优于常规针刺组及电针组;电针组治疗肾虚型腰椎间盘突出症优于夹脊穴透刺搓针法组及常规针刺组。
5.VAS疼痛评分量表评价夹脊穴透刺搓针法组在改善患者疼痛的缓解程度明显优于常规针刺组与电针组。
6.BRS-6行为量表评价夹脊穴透刺搓针法组在改善患者腰痛症状明显优于常规针刺组和电针组。
7.Fairbank JC量表评价夹脊穴透刺搓针法组在改善患者疼痛及日常生活活动能力方面临床疗效显著,且明显优于常规针刺组及电针组。
结论
夹脊穴透刺搓针法治疗腰椎间盘突出症的临床疗效确切,且复发率率低,在临床值得推广。
Objective
Lumbar disc herniation(Lumbar Disc Herniation),referred to as LDH,is a certified clinical diseases.With the current social development and to accelerate the pace of people's lives,the using of the increasing frequency of transport in recent years have increased the incidence trend.The main performance for the channeling of paroxysmal or persistent pain,especially at night is more than pain from the buttocks to the posterior thigh, posterolateral calf and lateral dorsum radiation.Moment,when coughing, sneezing,increased abdominal pressure,such as easy to make the move,the pain intensified,severely affected by the work of patients and quality of life.The author from clamps the keel hole to pass punctures the law to obtain, to pass punctures the law stems from Song Dynasty horse Danyang "Miscellaneous Diseases song".Jin Dynasty·Dou Hanqin" needle guide by through barbed" reference to law.Yuan Dynasty·Wang Guorui"Que acupuncture Yulong God Song "will pay more attention to law through the application of thorns," the first wind modification difficult medical......along the backward-through rate of percutaneous Valley."Ming Dynasty·Yang Jizhou"acupuncture Dacheng"a thorn Fengchi ventilate House,gill side must cross through it." "Plain Questions·Spurs need to talk":"floating disease,gill have deep,each to its rationale, no off the Road,off of the internal injuries,which is less than the outside of Health obstruct,stop up the evil from them." The acupuncture has dredges the channels and collaterals,transfers to a new post the vitality,Shu Jinli the festival,to make up empty really flows swiftly,the straight sickness institute,but passes punctures also has the original opening after to be mad the effect,therefore every chronic long illness,sinking sickness stubborn illness and part difficult various illnesses urgently need the effectiveness. Therefore this topic from clamps the keel hole to pass punctures the law to obtain,treatment waist intervertebral disc prominent sickness.
Methods
135 cases will meet the clinical inclusion criteria of patients divided into the use of randomized controlled penetration Jiaji Law Group, conventional acupuncture and electro-acupuncture group,using random methods, in accordance with the 1:1:1 ratio in patients randomly assigned to Jiaji stabbed through the group,acupuncture group and the conventional electro-acupuncture group,a total of 135 cases,penetration Jiaji group 45 cases,45 cases of conventional acupuncture group,45 cases of electro-acupuncture group.Jiaji penetration lumbar Jiaji group,in the lesions of the vertebrae of a vertebral body Jiaji to the next vertebral body lesions of the vertebral body Jiaji.Filiform needle using 3-inch body according to the patients,respectively,of down to 30 degrees angle to the next through the two vertebrae,such as lumbar vertebra 3 lumbar prominent while taking down two vertebral penetration Jiaji to Jiaji lumbar vertebra 4.And so on.Acupuncture after a gas line every five minutes the needle 1. 30 minutes left needle.Conventional acupuncture and electro-acupuncture group treatment of clinical practice are used;three groups were treated once a day, 5 days a week to rest for two days of acupuncture,a total of four weeks of acupuncture as a treatment.6 months after treatment follow-up time, Respectively,before treatment,after treatment,6 months after the use of visual analogue score(VAS,visual analog scale),behavior score(BRS-6, behavioral rating scale) and low back pain patients Fairbank.Jc evaluation scorecard.
Results
1.After a course of treatment efficacy criteria were assessed by Ridit analysis,P＞0.05,the effect of the total between the two groups no significant difference,but the relapse rate by,by Ridit analysis,P＜0.05,folder Ridge Point penetration was significantly superior to conventional acupuncture group.2.Clinical efficacy and gender relations:(1) three groups within each group comparison,the overall efficiency and no significant gender differences P＞0.05;penetration Jiaji lumbar disc herniation treatment of female patients with recurrent rate was significantly lower than male P＜0.05,with statistical significance;conventional acupuncture and electro-acupuncture law and gender between the relapse rate was no significant difference P＞0.05.(2) three sets of inter-group comparison,Jiaji penetration men treatment of lumbar disc herniation The total effective rate was superior to conventional acupuncture with electric acupuncture,P＜0.05;female group showed no significant difference,Note Jiaji penetration method,the conventional acupuncture, electro-acupuncture treatment of women in the clinical effect of lumbar disc herniation rather,P＞0.05;the relapse rate compared three groups of groups, penetration Jiaji treatment of lumbar disc herniation were men,women,the recurrence rate was significantly lower than that of conventional acupuncture and electro-acupuncture method on penetration Jiaji treatment of lumbar disc herniation in patients with the relapse rate was significantly lower than that of conventional acupuncture and electro-acupuncture method P＜0.01.3.Clinical efficacy and course of disease:After a course of treatment the clinical effects of three groups and course of the relationship between the analysis by Ridit as follows:(1) three groups within each group comparison,the overall efficiency and gender was not significant between difference P＞0.05; penetration Jiaji lumbar disc herniation treatment of female patients with the relapse rate was significantly lower than male P＜0.05,with statistical significance;conventional acupuncture and electro-acupuncture law and gender between the relapse rate was no significant difference P＞0.05.Three different course by the effect of differences is in the distribution of chi-square test with statistical significance(P＜0.01),duration of effect that significantly affected.The longer the duration,the worse treatment is.
4.The clinical efficacy and TCM syndrome:different effect of TCM-based comparison,by chi-square test results showed the following:(1) the total efficiency of the three groups were compared groups:①Jiaji treatment penetration cold type and the blood of lumbar disc herniation clinical efficacy was superior to kidney deficiency type,P＜0.01;Jiaji cold treatment penetration and blood type lumbar disc herniation clinical efficacy was not significant,P＞0.05;②Cold conventional acupuncture treatment type,blood type,kidney vacuity lumbar disc herniation clinical efficacy,with statistical analysis,no significant differences in type,a considerable effect P＞0.05;electro-acupuncture treatment of kidney deficiency treatment lumbar Clinical efficacy of lumbar intervertebral disc is superior to blood type,P＜0.01;blood type is superior to cold-type P＜0.01;that electro-acupuncture group treatment of lumbar disc herniation Kidney best efficacy,followed by blood type,the relatively poor efficacy of cold type;③electro-acupuncture treatment of lumbar disc herniation group of kidney deficiency type more effective than blood type,blood Cold is better than blood type,by the statistical processing of P＜0.01.(2) Comparison of three sets of groups:①Jiaji cold treatment penetration and blood type lumbar disc herniation is superior to conventional acupuncture and electrical acupuncture group,P＜0.01;②Electroacupuncture treatment of kidney deficiency type group lumbar disc herniation than Jiaji penetration acupuncture group and the conventional group,with statistical analysis P＜0.01.5.VAS pain score scale rating:(1) treatment of the first three groups by the t test,P＞0.05,that three sets of data from the same samples comparable.(2) three groups before and after treatment by t test,P＜0.01,with a significant difference, suggesting that penetration Jiaji group,conventional acupuncture group, electro-acupuncture group may improve pain in patients with lumbar disc herniation;(3) three sets of inter-group comparison after treatment by t test Jiaji penetration was significantly superior to conventional acupuncture with electric acupuncture(P＜0.05);electro-acupuncture method and routine acupuncture treatment by the statistical analysis between the two was not significant P＞0.05.6.BRS-6 behavior rating scale:(1) treatment of the first three groups by the t test,P＞0.05,that three sets of data from the same samples comparable.(2) three groups before and after treatment by t test, P＜0.01,significant difference with that group Jiaji penetration, conventional acupuncture group,electro-acupuncture group may improve symptoms in patients with lumbar disc herniation;(3) cgroup after treatment compared groups by t test,P＜0.05,suggesting that penetration Jiaji group more effective than conventional acupuncture and electro-acupuncture group.
7.Fairbank JC rating scale:(1) treatment of the first three groups by the t test,P＞0.05,that three sets of data from the same sample of comparable; (2) three groups before and after treatment by t test,P＜0.01,significant difference with that group Jiaji penetration,conventional acupuncture group, electro-acupuncture group may improve symptoms in patients with lumbar disc herniation;(3) three sets of inter-group comparison after treatment by t test, P＜0.05,suggesting that penetration Jiaji group more effective than conventional acupuncture and electro-acupuncture group.
Conclusion
Acupuncture Jiaji through treatment of lumbar disc herniation precise clinical efficacy and low relapse rate in the clinical worth promoting.
引文
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