本文關(guān)鍵詞：消髓化核湯結(jié)合針刺治療破裂型腰椎間盤突出癥的臨床研究　出處：《南京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 破裂型腰椎間盤突出癥 消髓化核湯 針刺治療 JOA評分 MRI影像學(xué)改變 重吸收

【摘要】：目的:通過臨床研究,觀察消髓化核湯結(jié)合針刺治療破裂型腰椎間盤突出癥的臨床療效及椎間盤重吸收程度,并與單獨服用消髓化核湯和單獨使用針刺治療對比。探討中藥結(jié)合針刺治療腰椎間盤突出癥是否可以提高臨床療效,并分析中醫(yī)體系中這兩大方面的傳統(tǒng)保守治療對于破裂型腰椎間盤突出癥的優(yōu)勢與不足。方法:將2015年5月至2016年11月期間,在蘇州市中醫(yī)醫(yī)院和新加坡仁大中醫(yī)診所被診斷為破裂型腰椎間盤突出癥的病人,通過納入及排除標(biāo)準(zhǔn),選出60例患者,根據(jù)其個人意愿,分為消髓化核湯為主的中藥組(20例)、針刺組(20例)和消髓化核湯結(jié)合針刺的中藥結(jié)合針刺組(20例),采取隨訪的形式,根據(jù)患者治療前和治療2個月后的自身情況,根據(jù)J0A評分和MRI影像學(xué)改變?nèi)鐚嵱涗洈?shù)據(jù),進(jìn)行統(tǒng)計學(xué)處理。結(jié)果:(1)中藥組、針刺組和中藥結(jié)合針刺組治療均可顯著提高患者的J0A評分(P0.05),而中藥結(jié)合針刺組J0A評分的改善率高于其余兩組(P0.05)。根據(jù)J0A評分的療效評估,中藥組療效優(yōu)良7例,總的優(yōu)良率為35%(7/20);針刺組療效優(yōu)良2例,總的優(yōu)良率為10%(2/20);中藥結(jié)合針刺組療效優(yōu)良9例,總的優(yōu)良率為45%(9/20)。(2)中藥組、針刺組和中藥結(jié)合針刺組治療均可使突出物縮小(P0.05),而中藥結(jié)合針刺組突出物的吸收率高于其余兩組(P0.05)。根據(jù)吸收程度,中藥組完全吸收1例,明顯吸收1例,部分吸收15例,幾乎不變1例,突出體積增大2例,總的吸收率為85%(17/20);針刺組完全吸收0例,明顯吸收4例,部分吸收12例,幾乎不變1例,突出體積增大3例,總的吸收率為80%(16/20);中藥結(jié)合針刺組完全吸收2例,明顯吸收5例,部分吸收11例,幾乎不變0例,突出體積增大2例,總的吸收率為90%(18/20)。結(jié)論:(1)治療后3組患者的J0A評分較治療前均明顯提高;腰椎間盤突出程度較治療前均縮小。說明通過保守治療,腰椎間盤突出癥的臨床癥狀及椎間盤突出程度均能夠取得良好的轉(zhuǎn)歸。(2)中藥結(jié)合針刺組J0A評分提高比例及突出物縮小程度最大;中藥組次之,稍微弱于中藥結(jié)合針刺組;而針刺組最低。說明中藥和針刺治療腰椎間盤突出癥均能取得良好療效,但兩者結(jié)合能協(xié)同增加療效。
[Abstract]:Objective: to observe the clinical effect of Xiaomuanhuahe decoction combined with acupuncture in treating ruptured lumbar disc herniation and the degree of disc reabsorption. And compared with the treatment of Xiaoliaohuanhe decoction alone and acupuncture alone, to explore whether the combination of traditional Chinese medicine and acupuncture can improve the clinical efficacy of lumbar disc herniation. And analyze the advantages and disadvantages of traditional conservative treatment in these two aspects of traditional Chinese medicine system for ruptured lumbar disc herniation. Methods: from May 2015 to November 2016. Patients diagnosed as ruptured lumbar disc herniation in Suzhou traditional Chinese Medicine Hospital and Singapore Renda TCM Clinic selected 60 patients according to their personal wishes through inclusion and exclusion criteria. The patients were divided into two groups: the traditional Chinese medicine group (20 cases) and the acupuncture group (20 cases) and the group (20 cases) and the group (20 cases) were followed up. According to the patient's condition before treatment and 2 months after treatment, according to J0A score and MRI imaging changes, the data were recorded truthfully and statistically. Results: 1) Chinese medicine group. The treatment of acupuncture group and Chinese medicine combined with acupuncture group can significantly improve the J0A score of patients (P0.05). The improvement rate of J0A score in the TCM combined with acupuncture group was higher than that in the other two groups (P 0.05). According to the evaluation of J0A score, 7 cases of the TCM group were good, and the total excellent and good rate was 35% / 20%. In the acupuncture group, the curative effect was good in 2 cases, and the total excellent and good rate was 10% 20%. There were 9 cases of excellent curative effect in Chinese medicine combined with acupuncture group. The total excellent and good rate was 45% 20 / 20. 2) Chinese medicine group, acupuncture group and traditional Chinese medicine combined with acupuncture group could reduce the protrusions (P0.05). However, the absorptivity of protrusions in TCM combined with acupuncture group was higher than that in the other two groups. According to the degree of absorption, 1 case was completely absorbed, 1 case was obviously absorbed, 15 cases were partially absorbed, and 1 case was almost unchanged. The volume of protrusion increased in 2 cases, and the total absorptivity was 85 / 20%. In the acupuncture group, there were 0 cases of complete absorption, 4 cases of obvious absorption, 12 cases of partial absorption, almost 1 case of no change, and 3 cases of enlarged protrusion volume. The total absorption rate was 80% 16 / 20%. In the combination of Chinese medicine and acupuncture group, 2 cases were completely absorbed, 5 cases were obviously absorbed, 11 cases were partially absorbed, almost 0 cases were unchanged, and 2 cases were enlarged protruding volume. The total absorptivity was 90 / 20. Conclusion the J0A score of the three groups after treatment was significantly higher than that before treatment. The degree of lumbar disc herniation was smaller than that before treatment. The clinical symptoms of lumbar disc herniation and the degree of disc herniation can achieve good outcome. The Chinese medicine group was the second, slightly weaker than the traditional Chinese medicine combined with acupuncture group; The acupuncture group is the lowest. It shows that both Chinese medicine and acupuncture can achieve good curative effect on lumbar disc herniation, but the combination of both can increase the curative effect synergistically.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R274.9

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