本文選題：椎間盤源性下腰痛 + 推拿手法��； 參考：《湖北中醫(yī)藥大學(xué)》2013年碩士論文

【摘要】：目的 椎間盤源性下腰痛在近些年來逐漸被臨床重視，其疼痛部位多位于下腰部中線附近，少有根性疼痛及干性疼痛，疼痛往往以患者主觀感受為多而客觀陽性體征較少。本病多慢性起病，且緩解與復(fù)發(fā)遷延不斷，被臨床醫(yī)生認(rèn)為是極為棘手的疾病之一。椎間盤源性下腰痛目前主要有手術(shù)治療和非手術(shù)治療兩種方法。由于手術(shù)治療的有創(chuàng)性與風(fēng)險(xiǎn)性、治療費(fèi)用的高昂性以及患者自身的恐懼心理，使得手術(shù)治療的局限性逐漸被放大，而非手術(shù)治療則成為了大多數(shù)患者的第一選擇。因目前保守治療中的傳統(tǒng)療法及物理療法種類較多、方式多樣，本文主要著重將傳統(tǒng)療法中的推拿治療跟物理療法中的熱療相結(jié)合，并與單純的推拿治療做對(duì)比，以此來探究推拿手法與熱療組合治療的作用原理、實(shí)際療效與臨床價(jià)值。 方法 收集了自2011年8月-2013年3月就診于湖北省中醫(yī)院推拿科的椎間盤源性下腰痛的患者共80例，年齡為22-46歲,平均年齡為38.25歲，男性患者48例、女性患者32例，病程6月-3年,平均20.25月，符合本研究診斷標(biāo)準(zhǔn)、納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)。采用隨機(jī)數(shù)表將80人平均分為2組：觀察組和對(duì)照組，每組40例。兩組患者的性別、年齡、療程經(jīng)統(tǒng)計(jì)學(xué)分析，無顯著性差異(p0.05)，具有可比性。 對(duì)照組采用單純推拿手法治療，連續(xù)治療5次為一療程，一共3個(gè)療程；觀察組則采用推拿手法與熱療兩種方法組合治療，熱療在先，手法操作在后，手法操作同對(duì)照組，熱療為每日一次，連續(xù)治療5次為一療程，一共3個(gè)療程。 在治療前和治療后，對(duì)所有病例均應(yīng)用VAS疼痛評(píng)分、Oswestry腰椎功能指數(shù)以及安靜狀態(tài)下持續(xù)坐立時(shí)間進(jìn)行觀察記錄，數(shù)據(jù)采用SPSS17.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)分析。 結(jié)果 觀察組總有效率為95%，對(duì)照組總有效率為90%，差異無統(tǒng)計(jì)學(xué)意義（P0.05），說明單純運(yùn)用推拿手法和聯(lián)合運(yùn)用推拿熱療這兩種方法均有效果；觀察組一個(gè)療程有效率為90%，對(duì)照組一個(gè)療程有效率為72.5%，兩者比較觀察組優(yōu)于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P0.05），說明觀察組起效時(shí)間比對(duì)照組更快；兩組病例治療前VAS評(píng)分、持續(xù)坐立時(shí)間、Oswestry腰椎功能指數(shù)比較無顯著性差異(P0.05)，具有可比性，兩組病例治療前后VAS評(píng)分、持續(xù)坐立時(shí)間、Oswestry腰椎功能指數(shù)的差值經(jīng)t檢驗(yàn)， P0.05，差異有統(tǒng)計(jì)學(xué)意義，說明觀察組在對(duì)患者癥狀和體征的改善方面優(yōu)于對(duì)照組。 結(jié)論 在治療椎間盤源性下腰痛時(shí)，推拿手法和熱療組合運(yùn)用比單純使用推拿手法起效更快、療效更好、改善預(yù)后方面更可靠，，值得臨床應(yīng)用與推廣。
[Abstract]:Objective in recent years, discogenic low back pain has been paid more and more attention in clinic. Its pain location is located near the middle line of lower waist, and there is little root pain and dry pain. Pain is often more subjective than objective positive signs. Chronic onset, remission and recurrence are regarded by clinicians as one of the most intractable diseases. Disc-derived low back pain has two main methods: surgical treatment and non-operative treatment. Because of the invasiveness and risk of surgical treatment, the high cost of treatment and the fear of patients themselves, the limitation of surgical treatment is enlarged gradually, and non-operative treatment becomes the first choice of most patients. Because there are many kinds of traditional therapy and physical therapy in conservative treatment at present, this article mainly focuses on the combination of massage therapy in traditional therapy and hyperthermia in physical therapy, and makes a comparison with simple massage therapy. In order to explore the combination of massage manipulation and hyperthermia treatment of the principle of the actual effect and clinical value. Methods from August 2011 to March 2013, 80 patients with low back pain of intervertebral disc origin, aged 22-46 years, with an average age of 38.25 years, including 48 male patients and 32 female patients, were collected. The course of disease ranged from 6 months to 3 years, with an average of 20.25 months. 80 patients were randomly divided into two groups: observation group and control group with 40 cases in each group. There was no significant difference in sex, age and course of treatment between the two groups (p0.05). The control group was treated with simple massage manipulation for 5 consecutive courses of treatment for a course of treatment, and the observation group was treated with massage manipulation and hyperthermia. Hyperthermia once a day, continuous treatment for 5 times a course of treatment, a total of 3 courses. Before and after treatment, VAS pain score and Oswestry Lumbar function Index (Oswestry) were used to observe and record all the patients. SPSS 17.0 statistical software was used to analyze the data. Results the total effective rate of the observation group was 95%, the total effective rate of the control group was 90, the difference was not statistically significant (P0.05). The effective rate of one course of treatment in the observation group was 90 and that in the control group was 72.5. The comparison between the two groups was better than that in the control group, and the difference was statistically significant (P0.05), which indicated that the effective time of the observation group was faster than that of the control group; the VAS score of the two groups before treatment was better than that of the control group. There was no significant difference in the Oswestry lumbar functional index between the two groups (P0.05). The VAS scores before and after treatment and the Oswestry lumbar functional index difference between the two groups were statistically significant. The observation group was superior to the control group in improving the symptoms and signs of the patients. Conclusion in the treatment of low back pain caused by intervertebral disc, the combination of massage and hyperthermia is more effective, effective and reliable in improving the prognosis than that of simple massage. It is worthy of clinical application and popularization.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R244.1;R274.9

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