彩色多普勒超聲在宮廷理筋術(shù)治療肱骨外上髁炎中的應(yīng)用探討
發(fā)布時間：2019-01-11 11:11
【摘要】：第一部分：文獻(xiàn)研究本文通過近十年來對于肱骨外上髁炎診斷及治療的相關(guān)文獻(xiàn),分別從病因病機(jī)、發(fā)病機(jī)制、聲像圖特點(diǎn)及推拿治療等方面,進(jìn)行綜合評述。第二部分：臨床研究目的：探討彩色多普勒高頻超聲在宮廷理筋術(shù)治療肱骨外上髁炎中的應(yīng)用價值。宮廷理筋術(shù)是治療肱骨外上髁炎的一種非常有效方式,而其治療重點(diǎn)是對于病灶的診斷及定位分析。而超聲檢查因其成像特點(diǎn)成為診斷肌肉軟組織損傷性疾病的首選方法。本研究嘗試將彩色多普勒高頻超聲與傳統(tǒng)中醫(yī)手法按摩宮廷理筋術(shù)相結(jié)合,為傳統(tǒng)治療法的定位提供更為準(zhǔn)確的方式,從而提高診療效果,并探討其對治療效果的指導(dǎo)作用,為推拿可視化和臨床機(jī)制研究提供客觀依據(jù)。材料方法：對經(jīng)臨床診斷的70例肱骨外上髁炎患者進(jìn)行隨機(jī)分為兩組,分別進(jìn)行灰階圖像掃查和CDFI掃查。實(shí)驗(yàn)組利用超聲定位病灶后,指導(dǎo)臨床以宮廷理筋術(shù)手法治療；對照組利用傳統(tǒng)按壓定位法,以宮廷理筋術(shù)手法治療。治療前后觀察兩組資料的VAS評分變化及彩色多普勒超聲聲像圖的改變(包括：伸肌總腱厚度、血流信號情況,伸肌總腱撕裂狀況),并進(jìn)行統(tǒng)計(jì)學(xué)分析。治療后對兩組資料的臨床綜合療效、治療次數(shù)進(jìn)行對比,并進(jìn)行統(tǒng)計(jì)學(xué)分析。對伸肌總腱的厚度、撕裂范圍、血流評分與VAS評分做相關(guān)性分析。結(jié)果：1.疼痛度評分(VAS)：治療前兩組間對比無明顯差異(P0.05)；治療7天、14天后實(shí)驗(yàn)組與對照組比較具有顯著性差異(P0.01)；治療后21天兩組間無明顯差異(P0.05)；兩組內(nèi)治療前后對比,VAS評分具有顯著性差異(P0.01)。2.利用Ridit檢驗(yàn),實(shí)驗(yàn)組療效優(yōu)于對照組(R實(shí)驗(yàn)組=0.435,R對照組=0.568,P0.05)。3.兩組間在治療次數(shù)上存在明顯差異(P0.01),實(shí)驗(yàn)組(5.97±2.34次)明顯少于對照組(7.67±1.36次)。4.伸肌總腱厚度變化：兩組內(nèi)治療前后對比,存在顯著性差異(P0.01)；兩組間對比,治療前后伸肌總腱厚度無明顯差異(P0.05)。5.伸肌總腱撕裂范圍：兩組內(nèi)治療前后對比,具有顯著差異(P0.01)；兩組間對比,治療前無明顯差異(P0.05),治療后存在差異(P0.05)。6.CDFI血流情況：治療前后兩組間比較,無明顯差異(P0.05)。治療前后兩組內(nèi)比較,均有顯著性差異(P0.01)。7伸肌總腱厚度與VAS評分無明顯相關(guān)性(P0.05,)；CDFI血流評分與VAS評分呈正相關(guān)(P0.01,R=0.449)；伸肌總腱撕裂范圍與VAS評分呈正相關(guān)(P0.05,R=0.454,)。結(jié)論1.利用超聲定位痛點(diǎn)的宮廷理筋術(shù)與傳統(tǒng)定位法相比較,治療肱骨外上髁炎的療效更好,并且對于患者疼痛的改善更為快速有效。在治療次數(shù)上,也明顯減少。2.肱骨外上髁炎的患者中,其伸肌總腱的厚度與癥狀無相關(guān)性,而CDFI血流計(jì)數(shù)評分高低及伸肌總腱的撕裂與患者疼痛程度有一定相關(guān)性。3.宮廷理筋術(shù)手法治療肱骨外上髁炎中,能幫助增厚腫脹的肌腱恢復(fù),能改善損傷處急性炎癥的情況。4.超聲觀察指標(biāo)中,伸肌總腱的厚度不能做為療效評價的指標(biāo),CDFI血流計(jì)數(shù)評分及伸肌總腱撕裂范圍可做為評價療效的參考指標(biāo)。
[Abstract]:The first part: The literature studies the literature on the diagnosis and treatment of the external humeral epicondylitis in the last ten years, and makes a comprehensive review from the aspects of the etiology, the pathogenesis, the characteristics of the image and the treatment of the massage. Part 2: The purpose of clinical study: To study the application value of color Doppler high-frequency ultrasound in the treatment of external humeral epicondylitis. It is a very effective way to treat the epicondylitis of the external humeral epicondylitis, and its treatment is focused on the diagnosis and location analysis of the focus. and the ultrasound examination is the preferred method for diagnosing the soft tissue injury disease of the muscle due to its imaging characteristics. The study attempts to combine the color Doppler high-frequency ultrasound with the traditional Chinese medicine technique to massage the royal treatment of the court and provide a more accurate way for the positioning of the traditional treatment, so as to improve the diagnosis and treatment effect, and to explore the guiding role of the color Doppler high-frequency ultrasound in the treatment effect. and provides an objective basis for the research of the massage visualization and the clinical mechanism. Methods: 70 patients with external humeral epicondylitis diagnosed by clinical diagnosis were randomly divided into two groups, and the gray-scale image scanning and CDFI scanning were performed. The experimental group, after using the ultrasound to locate the focus, guided the clinical treatment with the technique of the court of the court; the control group used the traditional pressing and positioning method to treat with the manipulation of the court. The VAS scores of the two groups of data and the change of the color Doppler ultrasound were observed before and after the treatment (including the total tendon thickness of the extensor, the condition of the blood flow signal, the total tendon tear of the extensor), and the statistical analysis. After the treatment, the clinical comprehensive curative effect and the number of treatment times of the two groups of data were compared, and the statistical analysis was carried out. The thickness, tear range, blood flow score and VAS score of the extensor total tendon were analyzed. Results: 1. Pain degree score (VAS): There was no significant difference between the two groups before treatment (P0.05); after the treatment for 7 days and 14 days, the experimental group had a significant difference with the control group (P0.01); there was no significant difference between the two groups after the treatment (P0.05); and the two groups were compared before and after treatment. There was a significant difference in the VAS scores (P0.01). The efficacy of the experimental group was superior to that of the control group (R group = 0.435, R control group = 0.568, P0.05). There was a significant difference between the two groups in the number of treatment (P0.01), and the experimental group (5.97% 2.34 times) was significantly less than that in the control group (7.67% 1.36 times). The change of total tendon thickness of extensor muscle: There was a significant difference between the two groups before and after treatment (P0.01). There was no significant difference between the two groups (P0.05). There was no significant difference between the two groups (P0.05). There was no significant difference between the two groups (P0.05). There was a significant difference between the two groups before and after the treatment (P0.01). The total tendon thickness of the extensor was not significantly correlated with the VAS score (P0.05); the CDFI flow score was positively correlated with the VAS score (P0.01, R = 0.449); the tear range of the extensor total tendon was positively correlated with the VAS score (P0.05, R = 0.454,). Conclusion 1. Compared with the traditional positioning method, the effect of the treatment of the epicondylitis on the external humeral epicondylitis is better, and the improvement of the pain of the patient is more rapid and effective. the number of treatment was also significantly reduced. In the patients with external humeral epicondylitis, the thickness of the total tendon of the extensor was not related to the symptoms, and the score of the CDFI blood flow and the tear of the total tendon of the extensor muscle had a certain correlation with the degree of pain of the patient. In the treatment of the external epicondylitis of the humerus, the method of the court of the court can help to increase the tendon recovery of the swelling and improve the condition of the acute inflammation at the lesion. In the ultrasonic observation index, the thickness of the total tendon of the extensor can not be the index of the evaluation of the curative effect, and the CDFI blood flow counting score and the total tendon tear range of the extensor can be used as the reference index for evaluating the curative effect.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R681.7
本文編號：2407073
[Abstract]:The first part: The literature studies the literature on the diagnosis and treatment of the external humeral epicondylitis in the last ten years, and makes a comprehensive review from the aspects of the etiology, the pathogenesis, the characteristics of the image and the treatment of the massage. Part 2: The purpose of clinical study: To study the application value of color Doppler high-frequency ultrasound in the treatment of external humeral epicondylitis. It is a very effective way to treat the epicondylitis of the external humeral epicondylitis, and its treatment is focused on the diagnosis and location analysis of the focus. and the ultrasound examination is the preferred method for diagnosing the soft tissue injury disease of the muscle due to its imaging characteristics. The study attempts to combine the color Doppler high-frequency ultrasound with the traditional Chinese medicine technique to massage the royal treatment of the court and provide a more accurate way for the positioning of the traditional treatment, so as to improve the diagnosis and treatment effect, and to explore the guiding role of the color Doppler high-frequency ultrasound in the treatment effect. and provides an objective basis for the research of the massage visualization and the clinical mechanism. Methods: 70 patients with external humeral epicondylitis diagnosed by clinical diagnosis were randomly divided into two groups, and the gray-scale image scanning and CDFI scanning were performed. The experimental group, after using the ultrasound to locate the focus, guided the clinical treatment with the technique of the court of the court; the control group used the traditional pressing and positioning method to treat with the manipulation of the court. The VAS scores of the two groups of data and the change of the color Doppler ultrasound were observed before and after the treatment (including the total tendon thickness of the extensor, the condition of the blood flow signal, the total tendon tear of the extensor), and the statistical analysis. After the treatment, the clinical comprehensive curative effect and the number of treatment times of the two groups of data were compared, and the statistical analysis was carried out. The thickness, tear range, blood flow score and VAS score of the extensor total tendon were analyzed. Results: 1. Pain degree score (VAS): There was no significant difference between the two groups before treatment (P0.05); after the treatment for 7 days and 14 days, the experimental group had a significant difference with the control group (P0.01); there was no significant difference between the two groups after the treatment (P0.05); and the two groups were compared before and after treatment. There was a significant difference in the VAS scores (P0.01). The efficacy of the experimental group was superior to that of the control group (R group = 0.435, R control group = 0.568, P0.05). There was a significant difference between the two groups in the number of treatment (P0.01), and the experimental group (5.97% 2.34 times) was significantly less than that in the control group (7.67% 1.36 times). The change of total tendon thickness of extensor muscle: There was a significant difference between the two groups before and after treatment (P0.01). There was no significant difference between the two groups (P0.05). There was no significant difference between the two groups (P0.05). There was no significant difference between the two groups (P0.05). There was a significant difference between the two groups before and after the treatment (P0.01). The total tendon thickness of the extensor was not significantly correlated with the VAS score (P0.05); the CDFI flow score was positively correlated with the VAS score (P0.01, R = 0.449); the tear range of the extensor total tendon was positively correlated with the VAS score (P0.05, R = 0.454,). Conclusion 1. Compared with the traditional positioning method, the effect of the treatment of the epicondylitis on the external humeral epicondylitis is better, and the improvement of the pain of the patient is more rapid and effective. the number of treatment was also significantly reduced. In the patients with external humeral epicondylitis, the thickness of the total tendon of the extensor was not related to the symptoms, and the score of the CDFI blood flow and the tear of the total tendon of the extensor muscle had a certain correlation with the degree of pain of the patient. In the treatment of the external epicondylitis of the humerus, the method of the court of the court can help to increase the tendon recovery of the swelling and improve the condition of the acute inflammation at the lesion. In the ultrasonic observation index, the thickness of the total tendon of the extensor can not be the index of the evaluation of the curative effect, and the CDFI blood flow counting score and the total tendon tear range of the extensor can be used as the reference index for evaluating the curative effect.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R681.7
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