本文選題：頸型頸椎病 + 澳式手法　； 參考：《廣州中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:本研究采用本體感覺反射療法與澳式手法治療頸型頸椎病,通過比較分析治療前后表面肌電信號,觀察頸部肌肉疲勞與表面肌電信號特征的相關(guān)性,探討表面肌電圖檢測是否可以作為檢測手法有效性的一種客觀的、可量化的有效的觀察指標(biāo)。方法:本實驗采用隨機(jī)對照研究,利用計算機(jī)隨機(jī)數(shù)字表法產(chǎn)生隨機(jī)數(shù)字,從2016年3月至2016年12月在廣東省中醫(yī)院康復(fù)科門診接受診治的患者中,選取符合本研究納入標(biāo)準(zhǔn)的60例頸型頸椎病患者,隨機(jī)分組對照組和觀察組,兩組各30例,總共收集病例63例,其中脫落3例例,其它患者均順利完成實驗,收集到有效病例60例。對照組接受澳式手法治療,觀察組接受本體感覺反射療法治療,每組均接受3次治療,每次治療前后均進(jìn)行簡化McGill疼痛詢問量表(MPQ)評估、痛域測定、表面肌電圖檢測。兩組患者在治療結(jié)束2周后接受1次隨訪。數(shù)據(jù)采集完成后,對數(shù)據(jù)先進(jìn)行基線分析,計數(shù)數(shù)據(jù)組與組之間比較時采用卡方檢驗,符合正態(tài)分布以及方差齊性的特點的計量數(shù)據(jù)組與組之間比較時,采用t檢驗。不符合正態(tài)分布或者方差齊性的特點時,采用秩和檢驗進(jìn)行分析;實驗結(jié)果采用重復(fù)測量的方差分析。結(jié)果:本研究納入的60例患者,對照組男12例,女18例,平均年齡(歲)28.80±6.07,平均病程(天)28.00±24.82;觀察組男10例,女20例,平均年齡(歲)27.13±4.53,平均病程(天)33.23±37.00;兩組患者的基本情況包括年齡、性別、病程、治療前MPQ評分、治療前痛域、治療前胸鎖乳突肌肌電值、頸豎脊肌屈曲放松比組間進(jìn)行比較,差異無統(tǒng)計學(xué)意義(P0.05),具有可比性。治療后,整體分析顯示各項指標(biāo)在時間點主效應(yīng)上均有統(tǒng)計學(xué)意義,而在處理主效應(yīng)上僅在痛域測定中左、右側(cè)耐痛域和胸鎖乳突肌左旋左側(cè)RMS、右旋右側(cè)RMS指標(biāo)有統(tǒng)計學(xué)差異外,其余各項均無統(tǒng)計學(xué)意義;另外,疼痛問卷量表中S和Total處理效應(yīng)與時間的交互作用均有統(tǒng)計學(xué)意義,胸鎖乳突肌左右前屈AEMG和RMS處理效應(yīng)與時間效應(yīng)也存在交互作用。進(jìn)一步對時間點進(jìn)行分析,組間比較:兩組簡化McGill疼痛詢問量表(MPQ)僅在第1次治療后疼痛強(qiáng)度(PPI)方面比較有顯著性差異(P0.05);痛域測定方面,兩組第1次治療后左側(cè)耐痛域和第2次治療后左、右耐痛域比較差異有顯著性意義(P0.05);豎脊肌屈曲放松比:第1次治療后,頸豎脊肌兩組左側(cè)屈曲放松比比較差異有顯著性意義(P0.05)。胸鎖乳突肌肌電值:第1次治療后,胸鎖乳突肌兩組右旋右側(cè)時RMS比較差異有顯著性意義(P0.05),第2次治療后,胸鎖乳突肌兩組左旋左側(cè)、右旋右側(cè)時RMS比較差異均有顯著性意義(P0.05),第3次治療后,兩組右旋時右側(cè)胸鎖乳突肌RMS比較有顯著性差異(P0.05)。結(jié)論:對照組與觀察組均能有效改善頸型頸椎病患者主觀感覺、肩中俞痛域,在肌電活動方面,兩種手法對頸部屈曲放松比、頸前屈時胸鎖乳突肌的肌電活動影響是沒有明顯差異的,但對照組手法對旋轉(zhuǎn)時胸鎖乳突肌的肌電活動影響較觀察組好。
[Abstract]:Objective: This study used proprioceptive reflex therapy and Australian manipulation to treat cervical spondylosis. By comparing and analyzing the surface electromyography (EMG) before and after treatment, the correlation between cervical muscle fatigue and surface myoelectric signal characteristics was observed. It was discussed whether the surface electromyography detection could be an objective and quantifiable method to detect the effectiveness of the manipulation. Methods: the randomized controlled study was used in this experiment. Random numbers were used to produce random numbers. From March 2016 to December 2016, 60 patients with cervical spondylosis were selected in the patients who were treated in the clinic of Rehabilitation Department of Guangdong Province Traditional Chinese Medical Hospital, which were randomly divided into control group and observation group, two In the group of 30 cases, a total of 63 cases were collected, of which 3 cases were exfoliated. All the other patients completed the experiment successfully and collected 60 cases of effective cases. The control group received Australian manipulation treatment, the observation group received proprioceptive reflex therapy, each group received 3 treatment, and each treatment was evaluated by simplified McGill pain questionnaire (MPQ) before and after each treatment, and the pain domain was evaluated before and after each treatment. Two groups of patients were followed up for 1 times after 2 weeks of treatment. After the data collection was completed, the data were first baseline analyzed, the count data group and the group were compared with the chi square test. The t test was adopted when the measurement number of the normal distribution and the homogeneity of variance was compared between the group and the group. In the characteristics of state distribution or homogeneity of variance, the rank sum test was used to analyze the results, and the experimental results were analyzed by repeated measurements. Results: 60 patients were included in this study, 12 in the control group and 18 in women, with the average age of 28.80 + 6.07 and the average course (day) 28 + 24.82; the average age was 27.13 + 27.13 + 4.53, the average age was 27.13 + 4.53, and the average age was 27.13 +. The course of the disease (day) was 33.23 + 37. The basic conditions of the two groups were age, sex, course of disease, pre treatment MPQ score, pre treatment pain domain, treatment of the electromyography of the sternocleidomastoid muscle and the flexion relaxation of the cervical spine muscle. There was no statistical difference (P0.05). The overall analysis showed that the indexes were in the time point. There were statistical significance in the effect, but in the treatment of the main effect only in the pain domain, the right pain domain and the left left RMS of the sternocleidomastoid muscle and the right right-hand right RMS index had statistical difference, and the other items were not statistically significant. In addition, the interaction of S and Total treatment effect and time in the pain questionnaire was statistically significant. There was also interaction between the AEMG and RMS treatment effects of the left and right papillomastoid myomomastoid flexion and the time effect of the sternocleidomastoid muscle. Further analysis of the time point was carried out. The two groups of simplified McGill pain questionnaire (MPQ) had significant difference (P0.05) in the pain intensity (PPI) only after first times of treatment (P0.05); the pain domain was measured, and the two groups were treated left after the treatment. There was significant difference in the left and right pain tolerance regions of the lateral pain domain and the second treatment (P0.05); the flexion and relaxation ratio of the erection muscle was significant (P0.05) after the treatment of the first times. The electromyography of the sternocleidomastoid muscle: after the first treatment, the RMS difference was compared between the two groups of the right side of the sternocleidomastoid muscle and the right side of the sternocleidomastoid muscle. There was significant significance (P0.05). After the second treatment, there were significant differences in the RMS difference between the left side left side of the sternocleidomastoid muscle group and the right side on the right side (P0.05). After the third treatment, the RMS of the right sternocleidomastoid muscle in the two groups was significantly different (P0.05). Conclusion: the control group and the observation group can effectively improve the subjective of cervical spondylosis patients. It is felt that there is no significant difference between the two manipulations on the flexion and relaxation ratio of the neck and the electromyoelectric activity of the sternocleidomastoid muscle during the cervical flexion, but the control group has a better effect on the electromyography of the sternocleidomastoid muscle than the observation group.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R681.55

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