本文選題：電針 + 腰椎間盤突出癥　； 參考：《福建中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:觀察電針治療腰椎間盤突出癥(Lumbar Disc Herniation,LDH)椎間孔鏡術(shù)后殘余痛的臨床療效,初步探討電針治療的可能機(jī)制,為傳統(tǒng)中醫(yī)方法治療椎間孔鏡術(shù)后殘余痛提供新的可能。方法:選擇于2015年6月至2016年12月我院骨科診斷明確,并在符合手術(shù)指征及征得患者同意的前提下于本院順利行"椎間孔鏡下髓核摘除術(shù)"并術(shù)后出現(xiàn)殘余痛的患者,利用隨機(jī)數(shù)字分組法對(duì)各觀察對(duì)象隨機(jī)分組為試驗(yàn)組和對(duì)照組。在相同一般處理的基礎(chǔ)下,試驗(yàn)組術(shù)后第1天開始采用電針針刺夾脊穴、腎俞、環(huán)跳、委中、環(huán)跳陽(yáng)陵泉治療,治療頻率一天一次,連續(xù)六天為一個(gè)療程,兩療程間休息一天,共治療兩個(gè)療程;對(duì)照組術(shù)后第1天開始予口服艾瑞昔布治療至術(shù)后第14天。所有患者至少隨訪3個(gè)月,對(duì)比兩組患者術(shù)后第1天、7天、14天、3個(gè)月的視覺(jué)模擬疼痛評(píng)分(Visual Analogue Scale,VAS)、腰椎功能障礙評(píng)分(Oswestry Dability Index,ODI)、日本骨科協(xié)會(huì)(Japanese Orthopaedic Association Scores,JOA)下腰痛疾患療效評(píng)定表及臨床療效評(píng)估治療分?jǐn)?shù),進(jìn)行統(tǒng)計(jì)學(xué)分析,比較兩組治療方式的治療效果。結(jié)果:1.兩組在性別、年齡、病程、脫落病例、病變節(jié)段、病變部位分布等方面無(wú)顯著性差異(P0.05),具有可比性。2.VAS評(píng)分比較:兩組組內(nèi)對(duì)比:治療干預(yù)后,兩組VAS評(píng)分均呈下降趨勢(shì),分別將兩組術(shù)后第1天與術(shù)后第7天、術(shù)后第7天與術(shù)后第14天VAS、術(shù)后第14天與術(shù)后第3個(gè)月VAS評(píng)分比較,差異具有統(tǒng)計(jì)學(xué)意義(P=0.000,P0.05)。兩組組間對(duì)比:術(shù)后第1天兩組差異不具有統(tǒng)計(jì)學(xué)意義(P=0.772,P0.05);術(shù)后第7天兩組差異具有統(tǒng)計(jì)學(xué)意義(P=0.028、P0.05);術(shù)后第14天兩組差異具有統(tǒng)計(jì)學(xué)意義(P=0.022、P0.05);術(shù)后3個(gè)月兩組差異具有統(tǒng)計(jì)學(xué)意義(P=0.004、P0.05)。兩組間VAS評(píng)分下降幅度使用重復(fù)測(cè)量方差分析,試驗(yàn)組較對(duì)照組下降幅度較大,說(shuō)明其治療作用由于對(duì)照組。3.ODI評(píng)分比較:兩組組內(nèi)對(duì)比:治療干預(yù)后,兩組ODI評(píng)分均呈下降趨勢(shì),兩組術(shù)后第1天與術(shù)后第7天、術(shù)后第7天與術(shù)后第14天、術(shù)后第14天與術(shù)后第3個(gè)月差異具有統(tǒng)計(jì)學(xué)意義(P=0.000,P0.05)。兩組組間對(duì)比:術(shù)后第1天組間差異不具有統(tǒng)計(jì)學(xué)差異(P=0.797,P0.05);術(shù)后第7天兩組差異具有統(tǒng)計(jì)學(xué)意義(P=0.028、P0.05);術(shù)后第14天兩組差異具有統(tǒng)計(jì)學(xué)意義(P=0.001、P0.05);術(shù)后第3個(gè)月兩組差異具有統(tǒng)計(jì)學(xué)意義(P=0.000、P0.05)。兩組間ODI評(píng)分下降幅度使用重復(fù)測(cè)量方差分析,試驗(yàn)組較對(duì)照組下降幅度較大,說(shuō)明其治療作用由于對(duì)照組。4.JOA評(píng)分比較:兩組組內(nèi)對(duì)比:治療干預(yù)后,兩組JOA評(píng)分均呈上升趨勢(shì),兩組術(shù)后第1天與術(shù)后第7天、第7天與術(shù)后第14天、術(shù)后第7天與術(shù)后第14天差異具有統(tǒng)計(jì)學(xué)意義(P=0.000,P0.05)。兩組組間對(duì)比:術(shù)后第1天組間差異不具有統(tǒng)計(jì)學(xué)差異(P=0.632,P0.05);術(shù)后第7天兩組差異具有統(tǒng)計(jì)學(xué)意義(P=0.021、P0.05)術(shù)后第14天兩組差異具有統(tǒng)計(jì)學(xué)意義(P=0.000、P0.05);術(shù)后第3個(gè)月兩組差異具有統(tǒng)計(jì)學(xué)意義(P=0.000、P0.05)。兩組間JOA評(píng)分上升幅度使用重復(fù)測(cè)量方差分析,試驗(yàn)組較對(duì)照組上升幅度較大,說(shuō)明其治療作用由于對(duì)照組。5.治療后兩組總體臨床療效:試驗(yàn)組總優(yōu)良率為84.62%,對(duì)照組總優(yōu)良率為68.97%,試驗(yàn)組臨床療效明顯優(yōu)于對(duì)照組(P=0.029,P0.05),差異具有統(tǒng)計(jì)學(xué)意義。結(jié)論:電針及艾瑞昔布口服對(duì)腰椎間盤突出癥椎間孔鏡術(shù)后殘余痛均具有顯著療效,且電針療法優(yōu)于艾瑞昔布,值得臨床推廣。
[Abstract]:Objective: To observe the clinical efficacy of electroacupuncture in the treatment of residual pain after lumbar intervertebral disc herniation (Lumbar Disc Herniation, LDH), and to discuss the possible mechanism of electroacupuncture treatment, and provide a new possibility for the treatment of residual pain after intervertebral foraminoscopy in traditional Chinese medicine. Method: selected from June 2015 to December 2016, our hospital department of orthopedics diagnosis is clear, On the basis of the same general treatment, electroacupuncture was used first days after the operation on the basis of the same general treatment. Acupuncture at Jiaji acupoint, Shenshu, ring jump, in the committee, the ring jump Yang Mausoleum treatment, the treatment frequency one day, six days as a course of treatment, two courses rest one day, a total of two courses of treatment; the control group began first days after the operation to take oral erixib to fourteenth days after the operation. The patients were followed up for at least 3 months, compared to two groups of patients first days after the operation, 7 14 days, 14 days, 3 months of visual analogue pain score (Visual Analogue Scale, VAS), lumbar dysfunction score (Oswestry Dability Index, ODI), Japan Department of orthopedics Association (Japanese Orthopaedic Association Scores,) low back pain disease efficacy assessment table and clinical efficacy assessment of treatment scores, statistical analysis, compare the two groups of treatment methods Results: 1. in the two groups, there were no significant differences in sex, age, course of disease, diseased cases, segmental lesions, and the distribution of lesion sites (P0.05). Compared with the comparable.2.VAS score, the two groups were compared: after the treatment, the two groups of VAS scores showed a downward trend, and the two groups were first days after the operation and seventh days after the operation, and seventh days after the operation, respectively. Fourteenth days after the operation, VAS, fourteenth days after the operation and third months after the VAS score, the difference was statistically significant (P=0.000, P0.05). The two groups were compared: first days after the operation, the two groups were not statistically significant (P=0.772, P0.05); seventh days after the operation, two groups were statistically significant (P=0.028, P0.05); two groups of differences were statistically significant on the fourteenth day after the operation. Meaning (P=0.022, P0.05), 3 months after the operation, the two groups were statistically significant (P=0.004, P0.05). The decrease of VAS score between the two groups was analyzed by repeated measurement of variance, and the experimental group was significantly lower than the control group, indicating that the therapeutic effect of the control group was compared with that of the control group: the comparison of the two groups: the two groups of ODI scores were all below the treatment intervention. Descending trend, two groups first days after operation and seventh days after operation, seventh days after operation and fourteenth days after operation, fourteenth days after operation and third months after the operation have statistical significance (P=0.000, P0.05). Two groups on the first day after group difference was not statistically significant difference (P=0.797, P0.05), seventh days after operation, two group differences were statistically significant (P=0.028, P0.05); The difference between the two groups was statistically significant (P=0.001, P0.05) fourteenth days after the operation, and the difference between the two groups was statistically significant (P=0.000, P0.05) third months after the operation. The decrease of the ODI score between the two groups was analyzed by repeated measurement of variance, and the experimental group was significantly lower than the control group, indicating that the therapeutic effect of the control group was compared with the.4.JOA score in the control group: the two groups were in the same group. Ratio: after the treatment, the two groups of JOA scores increased, the two groups first days after the operation and seventh days after the operation, seventh days and fourteenth days after the operation, seventh days after the operation and fourteenth days difference was statistically significant (P=0.000, P0.05). The two groups were compared: first days after the operation, the difference was not statistically significant (P=0.632, P0.05); seventh day postoperative two group differences after the operation The difference between the two groups was statistically significant (P=0.000, P0.05) fourteenth days after the operation (P=0.000, P0.05). The difference between the two groups was statistically significant (P=0.000, P0.05) third months after the operation (P=0.000, P0.05). The increase amplitude of the JOA score between the two groups was analyzed by the repeated measurement of variance, and the experimental group was higher than the control group, indicating that the therapeutic effect of the test group was compared with the control group. Group.5. after treatment, the total clinical efficacy of the two groups: the total excellent rate in the experimental group was 84.62%, the total excellent rate in the control group was 68.97%. The clinical effect of the test group was obviously superior to the control group (P=0.029, P0.05), and the difference was statistically significant. Electroacupuncture is superior to erixib and is worthy of clinical promotion.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3

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