本文選題：封閉療法 + 療效　； 參考：《北京中醫(yī)藥大學(xué)》2014年碩士論文

【摘要】：目的： 跖筋膜炎是臨床上常見的足部疾病,該病影響了患者的日常生活及工作。目前在臨床上治療跖筋膜炎的方法有中藥口服／外洗、針灸、手法按摩以及非甾體類抗炎藥、局部激素封閉、小腿三頭肌或／和跖筋膜牽拉、夜間支具固定、體外超聲波沖擊、穿矯形鞋及手術(shù)等療法。這些療法均有一定的效果,但同時(shí)也存在諸多缺陷,如起效慢、復(fù)發(fā)率高、患者依從性差、費(fèi)用高等。針刀療法作為一種簡(jiǎn)單、有效的微創(chuàng)技術(shù),越來越多的應(yīng)用于本病的治療。本研究通過對(duì)于望京醫(yī)院門診就診的60例跖筋膜炎患者,分別進(jìn)行針刀療法和封閉療法治療,對(duì)比兩種治療方法療效差異,對(duì)針刀治療跖筋膜炎的療效做出比較確切的評(píng)價(jià)。 方法： 共收集符合標(biāo)準(zhǔn)的跖筋膜炎患者60例,隨機(jī)分為兩組,其中試驗(yàn)組采用單純針刀治療,對(duì)照組采用封閉治療,每組各30例。在針刀治療組中,于患足壓痛最明顯處進(jìn)針,行局部麻醉后,將刀口線與足長(zhǎng)軸垂直,并垂直刺入。分別作橫行及縱行切開剝離3-4次,當(dāng)感覺針下有松動(dòng)感時(shí),即出針。封閉治療組采用鹽酸利多卡因(5m1:0.1g)+復(fù)方貝他米松1m1渾濁液,于壓痛最明顯處進(jìn)針,直達(dá)骨面,做痛點(diǎn)及其周圍封閉。術(shù)畢用無菌紗塊按壓片刻至傷口不出血為止,用創(chuàng)可貼固定創(chuàng)口,創(chuàng)口2天內(nèi)不得沾水。兩組均只治療一次。于治療前、治療后1周、治療后1月分別進(jìn)行SF-MPQ及JOA評(píng)分以評(píng)價(jià)療效,于治療后2月進(jìn)行復(fù)發(fā)率的觀察。采用SPSS22.0進(jìn)行數(shù)據(jù)的錄入、管理和維護(hù),并對(duì)患者基本資料及SF-MPQ、JOA積分進(jìn)行統(tǒng)計(jì)分析。 結(jié)果： 1、針刀治療組總有效率(83.33%)雖然略低于封閉治療組(86.67%),但并無統(tǒng)計(jì)學(xué)意義。在針刀治療組中,各中醫(yī)證型間療效的差異無統(tǒng)計(jì)學(xué)意義(P=-0.736)。 2、治療后2月,針刀組復(fù)發(fā)率為6.67%,封閉組復(fù)發(fā)率為16.67%,二者在統(tǒng)計(jì)學(xué)上具有顯著性差異(P=0)。 3、兩組患者SF-MPQ評(píng)分、JOA評(píng)分在治療后1周、1月時(shí)均比治療前有顯著性差異(P=0)。 4、兩組患者間SF-MPQ評(píng)分、JOA評(píng)分在治療后1周、治療后1月的差異均無統(tǒng)計(jì)學(xué)意義(1周時(shí)P1=0.680,P2=0.749,1月時(shí)P1=0.272,,P2＝0.994)。 5、在針刀治療組中發(fā)現(xiàn),SF-MPQ評(píng)分改善情況與患者年齡之間有顯著性關(guān)聯(lián),二者之間的皮爾遜相關(guān)系數(shù)為-0.741,尸值為0.0000.01。 結(jié)論： 1、兩種治療方法對(duì)跖筋膜炎均有較好的療效,且療效基本相同。針刀治療組總有效率雖然略低于封閉治療組,但并無統(tǒng)計(jì)學(xué)意義。 2、針刀療法對(duì)不同中醫(yī)證型患者的療效相同。 3、針刀療法治療跖筋膜炎的復(fù)發(fā)率明顯低于封閉療法。 4、隨著患者年齡的增長(zhǎng),針刀療法的療效降低。 5、兩種療法治療跖筋膜炎均具有較高的安全性。
[Abstract]:Objective:Metatarsal fasciitis is a common foot disease, which affects the daily life and work of patients.The current clinical treatments for plantar fasciitis include oral / external washing of traditional Chinese medicine, acupuncture and moxibustion, manual massage and non-steroidal anti-inflammatory drugs, local hormone blocking, triceps or / and metatarsal fascia traction, nocturnal fixation, and external ultrasonic shock.Wear orthopaedic shoes and surgery.These treatments have certain effects, but there are also many defects, such as slow onset, high recurrence rate, poor compliance, high cost and so on.As a simple and effective minimally invasive technique, needle-knife therapy is more and more used in the treatment of this disease.In this study, 60 cases of metatarsal fasciitis treated in Wangjing Hospital were treated with needle knife therapy and block therapy respectively, and the curative effect of the two methods was compared, and the curative effect of needle knife on metatarsophalangeal fasciitis was evaluated more accurately.Methods:A total of 60 patients with plantar fasciitis were randomly divided into two groups: the experimental group was treated with simple needle knife and the control group was treated with block therapy, 30 cases in each group.In the acupuncture knife treatment group, the needle was inserted into the foot tenderness at the most obvious place. After local anesthesia, the cutting edge line was perpendicular to the long axis of the foot and punctured vertically.Transverse and longitudinal incision and stripping 3-4 times, when there is a sense of loosening under the needle, that is, the needle.The treatment group was treated with lidocaine hydrochloride (5m-1: 0.1g) compound betamethasone 1m1 turbidity liquid, the most obvious tenderness was injected into the bone surface, and the pain point and its surrounding sealing were done.At the end of the operation, use sterile gauze to press for a moment until the wound does not bleed. Fix the wound with a band-aid. Do not touch the wound with water for 2 days.Both groups were treated only once.SF-MPQ and JOA scores were evaluated before treatment, 1 week after treatment and 1 month after treatment, and the recurrence rate was observed at 2 months after treatment.The data input, management and maintenance were carried out by SPSS22.0, and the basic data of patients and the score of SF-MPQN JOA were statistically analyzed.Results:1. The total effective rate of acupuncture knife treatment group (83.33) was slightly lower than that of closed treatment group (86.67%), but there was no statistical significance.In the acupuncture knife treatment group, there was no significant difference in the curative effect between different TCM syndromes.2, 2 months after treatment, the recurrence rate of needle knife group was 6.67 and that of closed group was 16.67. There was significant statistical difference between the two groups.3, the SF-MPQ scores of the two groups were significantly different from those before treatment at 1 week and 1 month after treatment.(4) there was no significant difference in SF-MPQ score between the two groups at 1 week after treatment and 1 month after treatment. There was no significant difference between the two groups at 1 week after treatment (P 1: 0. 80 P 2 + 0. 749) and at 1 month after treatment (P 1 + 0. 272) and P 1 + 0. 272% P 2 + 0. 994%.5. There was a significant correlation between the improvement of SF-MPQ score and the age of the patients in the acupuncture knife treatment group. The Pearson correlation coefficient between them was -0.741and the cadaver value was 0.0000.01.Conclusion:1. Both methods have good curative effect on metatarsal fasciitis, and the curative effect is basically the same.The total effective rate of acupuncture-knife treatment group was slightly lower than that of closed treatment group, but there was no statistical significance.2. The effect of acupuncture-knife therapy on different TCM syndromes is the same.3. The recurrence rate of needle-knife therapy for metatarsal fasciitis was significantly lower than that of block therapy.4. With the age of the patients, the curative effect of needle knife therapy decreased.5, both treatments have high safety in the treatment of metatarsal fasciitis.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R246.9

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