經(jīng)胸椎關(guān)節(jié)突銀質(zhì)針導(dǎo)熱療法治療慢性胸背痛的療效
發(fā)布時(shí)間：2018-08-01 14:55
【摘要】：研究背景:根據(jù)相關(guān)研究表明,CTDP的發(fā)生概率約為15%～22%[1],按照國(guó)際疼痛研究協(xié)會(huì)(IASP)改良的診斷標(biāo)準(zhǔn),TVF病變引起的慢性胸背部疼痛約占34%～48%。在脊椎退變性疾病中,椎間盤退變是大家最容易意識(shí)到的退行性改變。臨床工作中,對(duì)椎間盤退變和突出已經(jīng)給予高度的重視,然而對(duì)小關(guān)節(jié)退變帶來(lái)的問題認(rèn)識(shí)不足或重視不夠。長(zhǎng)久以來(lái),小關(guān)節(jié)由于其解剖特點(diǎn)及對(duì)影像檢查技術(shù)和閱片要求較高等特點(diǎn),其退變所引起的疾病常常被漏診或誤診。實(shí)際上,椎間盤退變基本都伴隨小關(guān)節(jié)退變,主要包括關(guān)節(jié)面的破壞,關(guān)節(jié)囊的鈣化,關(guān)節(jié)突的增生以及相鄰黃韌帶的肥厚等等。另一方面,小關(guān)節(jié)參與構(gòu)成雙側(cè)神經(jīng)根管的后壁,其退變過程中的增生、鈣化等繼發(fā)病理改變,可導(dǎo)致占位性壓迫神經(jīng)通道,產(chǎn)生神經(jīng)根性刺激癥狀、感覺障礙和根性癱瘓等,具有普遍性和危害性,所以我們應(yīng)提高對(duì)小關(guān)節(jié)退變疾病的認(rèn)識(shí)。目前大多數(shù)研究認(rèn)為小關(guān)節(jié)退變的病理過程包括以下三個(gè)時(shí)期:早期退變主要表現(xiàn)為小關(guān)節(jié)軟骨面代謝紊亂,炎癥介質(zhì)釋放,軟骨面變薄,缺損,關(guān)節(jié)松弛;中期退變則在早期基礎(chǔ)之上,小關(guān)節(jié)突增生肥大、關(guān)節(jié)囊及其周圍附著韌帶逐步纖維化;退變晚期,程度進(jìn)一步加重,主要表現(xiàn)為小關(guān)節(jié)增生、肥大,關(guān)節(jié)突關(guān)節(jié)由矢狀面向冠狀面移行而發(fā)生小關(guān)節(jié)內(nèi)聚,關(guān)節(jié)軟骨面完全被破壞,關(guān)節(jié)間隙變窄,功能受限,部分發(fā)生融合,關(guān)節(jié)囊纖維化、鈣化,嚴(yán)重者骨化。退變發(fā)生在脊柱胸段,可能會(huì)引起一系列癥狀和體征,如胸背部疼痛、胸悶、束帶感、呼吸困難、腹脹等。目前慢性胸背部疼痛的治療方法主要為非手術(shù)治療,采用藥物、銀質(zhì)針導(dǎo)熱治療、神經(jīng)阻滯、針灸理療以及康復(fù)治療等綜合療法。多數(shù)急性胸背痛患者經(jīng)藥物、康復(fù)理療等治療能緩解疼痛,少數(shù)急性胸背痛患者未能正規(guī)治療而轉(zhuǎn)為慢性胸背痛,藥物治療無(wú)效或病情嚴(yán)重者需要進(jìn)一步行銀質(zhì)針導(dǎo)熱治療或神經(jīng)阻滯等有創(chuàng)治療。目的:探討經(jīng)胸椎關(guān)節(jié)突銀質(zhì)針導(dǎo)熱療法治療胸椎小關(guān)節(jié)病變引起慢性胸背痛的療效。方法:胸椎小關(guān)節(jié)病變引起慢性胸背痛患者110例,隨機(jī)分為銀質(zhì)針組和藥物組。前者采用經(jīng)胸椎關(guān)節(jié)突銀質(zhì)針導(dǎo)熱療法,后者單純應(yīng)用藥物治療。治療前和治療后的2周、2個(gè)月和4個(gè)月隨訪,分別進(jìn)行視覺模擬評(píng)分,并記錄疼痛對(duì)患者工作和生活的影響程度。結(jié)果:銀質(zhì)針組的治療后不同時(shí)點(diǎn)視覺模擬評(píng)分及對(duì)患者工作和生活的影響程度均優(yōu)于對(duì)照組(P0.05)。結(jié)論:經(jīng)胸椎關(guān)節(jié)突銀質(zhì)針導(dǎo)熱療法治療胸椎小關(guān)節(jié)病變引起慢性胸背痛效果良好。
[Abstract]:Background: according to the relevant studies, the probability of occurrence of CTDPs is about 15% [1]. According to the modified diagnostic criteria of the International Association of pain Research (IASP), chronic chest and back pain caused by TTV lesions accounts for about 344,48%. Disc degeneration is one of the most recognizable degenerative changes in spinal degenerative diseases. In clinical work, high attention has been paid to disc degeneration and herniation, but insufficient understanding or attention has been paid to the problems caused by facet joint degeneration. For a long time, because of its anatomical characteristics and high requirements for image examination and film reading, the diseases caused by facet joint degeneration are often missed or misdiagnosed. In fact, intervertebral disc degeneration is associated with facet degeneration, including destruction of articular surface, calcification of articular capsule, hyperplasia of articular process and hypertrophy of adjacent ligamentum flavum, etc. On the other hand, facet joints are involved in the formation of the posterior wall of bilateral nerve root canals. The secondary pathological changes, such as hyperplasia and calcification during degeneration, may lead to the occupying compression of nerve channels, the production of symptoms of nerve root stimulation, sensory disorders and root paralysis, etc. It is universal and harmful, so we should improve the understanding of facet joint degeneration disease. At present, most studies believe that the pathological process of facet articular degeneration includes the following three stages: early degeneration is mainly characterized by metabolic disorder of facet articular cartilage surface, release of inflammatory mediators, thinning of cartilage surface, defect and relaxation of joint; On the other hand, the middle stage degeneration is based on the early stage, the facet process hyperplasia and hypertrophy, the articular capsule and its surrounding attachment ligament gradually fibrosis, the degenerative late stage, the degree further aggravation, the main manifestation is the facet joint hyperplasia, the hypertrophy, The facet articular cohesion occurs in the articular process from the sagittal to the coronal plane, the articular cartilage is completely destroyed, the articular space is narrowed, the function is limited, partial fusion occurs, the articular capsule is fibrosis, calcification, and serious ossification. Degeneration occurs in the thoracic segment of the spine and may cause a series of symptoms and signs, such as chest pain, chest tightness, band sense, dyspnea, abdominal distension, etc. At present, the main treatment methods of chronic chest and back pain are non-surgical treatment, drug, silver needle heat conduction treatment, nerve block, acupuncture and physical therapy and rehabilitation therapy. Most patients with acute chest and back pain can relieve the pain by medication, rehabilitation therapy, etc. A few patients with acute chest and back pain have become chronic chest and back pain without regular treatment. If the drug treatment is not effective or serious, it needs to be further treated with silver needle heat conduction or nerve block and other invasive treatment. Objective: to investigate the therapeutic effect of transthoracic vertebrae articular process silver needle heat conduction therapy for chronic thoracolumbar pain caused by thoracic facet joint disease. Methods: 110 patients with chronic chest and back pain caused by thoracic facet joint disease were randomly divided into silver needle group and drug group. The former was treated with silver needle through thoracic vertebrae and the latter was treated with drugs alone. The patients were followed up for 2 weeks, 2 months and 4 months before and after treatment. Visual analogue scores were performed, and the influence of pain on the work and life of the patients was recorded. Results: the visual analogue score at different time points and the influence on the work and life of patients in the silver needle group were better than those in the control group (P0.05). Conclusion: it is effective to treat chronic thoracolumbar pain caused by thoracic facet joint disease by transthoracic vertebrae silver needle heat conduction therapy.
【學(xué)位授予單位】：揚(yáng)州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R681.5
，
本文編號(hào)：2157941
[Abstract]:Background: according to the relevant studies, the probability of occurrence of CTDPs is about 15% [1]. According to the modified diagnostic criteria of the International Association of pain Research (IASP), chronic chest and back pain caused by TTV lesions accounts for about 344,48%. Disc degeneration is one of the most recognizable degenerative changes in spinal degenerative diseases. In clinical work, high attention has been paid to disc degeneration and herniation, but insufficient understanding or attention has been paid to the problems caused by facet joint degeneration. For a long time, because of its anatomical characteristics and high requirements for image examination and film reading, the diseases caused by facet joint degeneration are often missed or misdiagnosed. In fact, intervertebral disc degeneration is associated with facet degeneration, including destruction of articular surface, calcification of articular capsule, hyperplasia of articular process and hypertrophy of adjacent ligamentum flavum, etc. On the other hand, facet joints are involved in the formation of the posterior wall of bilateral nerve root canals. The secondary pathological changes, such as hyperplasia and calcification during degeneration, may lead to the occupying compression of nerve channels, the production of symptoms of nerve root stimulation, sensory disorders and root paralysis, etc. It is universal and harmful, so we should improve the understanding of facet joint degeneration disease. At present, most studies believe that the pathological process of facet articular degeneration includes the following three stages: early degeneration is mainly characterized by metabolic disorder of facet articular cartilage surface, release of inflammatory mediators, thinning of cartilage surface, defect and relaxation of joint; On the other hand, the middle stage degeneration is based on the early stage, the facet process hyperplasia and hypertrophy, the articular capsule and its surrounding attachment ligament gradually fibrosis, the degenerative late stage, the degree further aggravation, the main manifestation is the facet joint hyperplasia, the hypertrophy, The facet articular cohesion occurs in the articular process from the sagittal to the coronal plane, the articular cartilage is completely destroyed, the articular space is narrowed, the function is limited, partial fusion occurs, the articular capsule is fibrosis, calcification, and serious ossification. Degeneration occurs in the thoracic segment of the spine and may cause a series of symptoms and signs, such as chest pain, chest tightness, band sense, dyspnea, abdominal distension, etc. At present, the main treatment methods of chronic chest and back pain are non-surgical treatment, drug, silver needle heat conduction treatment, nerve block, acupuncture and physical therapy and rehabilitation therapy. Most patients with acute chest and back pain can relieve the pain by medication, rehabilitation therapy, etc. A few patients with acute chest and back pain have become chronic chest and back pain without regular treatment. If the drug treatment is not effective or serious, it needs to be further treated with silver needle heat conduction or nerve block and other invasive treatment. Objective: to investigate the therapeutic effect of transthoracic vertebrae articular process silver needle heat conduction therapy for chronic thoracolumbar pain caused by thoracic facet joint disease. Methods: 110 patients with chronic chest and back pain caused by thoracic facet joint disease were randomly divided into silver needle group and drug group. The former was treated with silver needle through thoracic vertebrae and the latter was treated with drugs alone. The patients were followed up for 2 weeks, 2 months and 4 months before and after treatment. Visual analogue scores were performed, and the influence of pain on the work and life of the patients was recorded. Results: the visual analogue score at different time points and the influence on the work and life of patients in the silver needle group were better than those in the control group (P0.05). Conclusion: it is effective to treat chronic thoracolumbar pain caused by thoracic facet joint disease by transthoracic vertebrae silver needle heat conduction therapy.
【學(xué)位授予單位】：揚(yáng)州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R681.5
，
本文編號(hào)：2157941
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