本文關(guān)鍵詞：毫火針針刺結(jié)筋病灶點(diǎn)治療肩周炎療效觀察　出處：《廣州中醫(yī)藥大學(xué)》2016年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 肩周炎 毫火針 結(jié)筋病灶點(diǎn) 臨床研究

【摘要】：目的：通過與常規(guī)針刺治療為對照組的比較,觀察“毫火針針刺結(jié)筋病灶點(diǎn)為主”治療肩周炎的總臨床療效,以及毫火針針刺結(jié)筋病灶點(diǎn)與常規(guī)針刺兩種不同的療法在不同時段的療效指標(biāo)的變化,初步探討毫火針針刺結(jié)筋病灶點(diǎn)為主這種特色療法在治療肩周炎中的臨床有效性和時效性,以及火針針刺結(jié)筋病灶點(diǎn)療法治療肩周炎的可能作用機(jī)理,說明“毫火針針刺結(jié)筋病灶點(diǎn)”治療肩關(guān)節(jié)周圍炎的臨床價值及推廣意義,為今后臨床選擇更有效的肩周炎治療方法提供循證醫(yī)學(xué)依據(jù)。方法：本研究課題病例主要是來自廣東省中醫(yī)院、廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院在2014年12月至2015年12月期間到門診就診的病人,根據(jù)本研究的病例選擇標(biāo)準(zhǔn)納入60例研究病例,將合格病例按照隨機(jī)分配原則平均分配至治療組(毫火針針刺結(jié)筋病灶點(diǎn)組)與對照組(常規(guī)針刺組),毫火針針刺結(jié)筋病灶點(diǎn)治療組和常規(guī)針刺對照組的病例數(shù)分別都是三十例。治療組參照《中國經(jīng)筋學(xué)》的經(jīng)筋查體方法在肩關(guān)節(jié)周圍近端和遠(yuǎn)端查找結(jié)筋病灶點(diǎn)(規(guī)律性阿是穴)進(jìn)行毫火針留針針刺治療,對照組則參照王啟才主編《針灸治療學(xué)》中肩周炎的治療處方選取相關(guān)穴位進(jìn)行常規(guī)針刺。毫火針針刺結(jié)筋病灶點(diǎn)治療組和常規(guī)針刺對照組的患者均接受隔天1次的針刺治療,完成6次治療為1個療程,整個研究要求兩組的肩周炎患者需完成2個療程的治療。本研究的臨床總療效標(biāo)準(zhǔn)參照《中醫(yī)病證診斷療效標(biāo)準(zhǔn)》中有關(guān)肩周炎的療效標(biāo)準(zhǔn),療效指標(biāo)為Constant - Murley score肩關(guān)節(jié)評定法(簡稱CMS評定),其中總臨床療效在兩個療程結(jié)束后評估,第一次治療、兩個療程后、兩個療程結(jié)束后1個月的隨訪時三個時段對對毫火針針刺結(jié)筋病灶點(diǎn)組與常規(guī)針刺組的病例的療效指標(biāo)進(jìn)行評估,運(yùn)用SPSS20.0對研究的數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析。結(jié)果：1.治療前毫火針針刺結(jié)筋病灶點(diǎn)組與常規(guī)針刺組的病例兩組間的基線資料的比較：兩組患者無論在性別、年齡、病程、中醫(yī)證型亦或是SCM評分量表總分和SCM評分量各成分積分方面經(jīng)統(tǒng)計(jì)學(xué)統(tǒng)計(jì)分析比較可知差異無統(tǒng)計(jì)學(xué)意義(P0.05),提示兩組肩關(guān)節(jié)周圍炎患者治療前的基線條件一致。2.總臨床療效的比較：毫火針針刺結(jié)筋病灶點(diǎn)治療組與常規(guī)針刺對照組兩組治療后總臨床療效進(jìn)行比較,數(shù)據(jù)經(jīng)秩和檢驗(yàn)提示兩組治療后總臨床療效差異有統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性,治療組的30例肩周炎患者中,達(dá)到痊愈水平的有4例,達(dá)到顯效水平的肩周炎患者有多達(dá)16例,達(dá)到有效水平的肩周炎患者也有6例,只有4例無效,總有效率達(dá)86.67%,；對照組的30例肩周炎患者中,達(dá)到痊愈水平的有3例,達(dá)到顯效水平的肩周炎患者有7例,多數(shù)患者(12例)療效達(dá)到有效水平,8例患者為無效,所以該組的總有效率為73.33%。3.不同時段療效指標(biāo)的比較：分別將毫火針針刺結(jié)筋病灶點(diǎn)治療組和常規(guī)針刺對照組兩組的肩周炎患者在第一次治療后,兩個療程后,兩個療程后一個月隨訪時的3個不同時段的CMS評分量表總分、CMS評分量表各成分積分(主要包括疼痛積分、日常生活活動水平積分、肩關(guān)節(jié)活動度積分、肌力積分)與治療前的CMS評分量表總分、CMS評分量表各成分積分作組內(nèi)比較；將毫火針針刺結(jié)筋病灶點(diǎn)治療組和常規(guī)針刺對照組兩組的兩個療程后一個月隨訪時的CMS評分量表總分、CMS評分量表各成分積分與隨訪前即兩個療程后的CMS評分量表總分、CMS評分量表各成分積分做組內(nèi)比較；將毫火針針刺結(jié)筋病灶點(diǎn)治療組和常規(guī)針刺對照組兩組的患者在治療后3個不同時段的CMS評分量表總分、CMS評分量表各成分積分作組間比較。毫火針針刺結(jié)筋病灶點(diǎn)治療組的組內(nèi)比較：統(tǒng)計(jì)結(jié)果表明毫火針針刺結(jié)筋病灶點(diǎn)治療組在治療后不同時段的CMS評分量表總分、CMS評分量表各成分積分(第一次治療后的肌力積分除外)與治療前的CMS評分量表總分、CMS評分量表各成分積分相比均升高,組內(nèi)差異有統(tǒng)計(jì)學(xué)意義(P0.05),研究結(jié)果表明,經(jīng)過治療,毫火針針刺結(jié)筋病灶點(diǎn)療法對提高CMS評分量表總分、緩解患側(cè)的疼痛、改善日常生活活動水平、增加患側(cè)肩關(guān)節(jié)的活動度、改善肩關(guān)節(jié)周圍炎患者的患側(cè)肌力方面均有效,且對提高CMS評分量表總分、緩解患側(cè)的疼痛、改善日常生活活動水平、增加患側(cè)肩關(guān)節(jié)的活動度這四項(xiàng)的療效起效快速(第一次治療后的評分結(jié)果較治療前的評分結(jié)果升高,差異有統(tǒng)計(jì)學(xué)意義,P0.05),對改善肩關(guān)節(jié)周圍炎患者的患側(cè)肌力方面起效較慢(第一次治療后的肌力積分與治療前的肌力積分相比無統(tǒng)計(jì)學(xué)意義上的差別,P0.05)；毫火針針刺結(jié)筋病灶點(diǎn)治療組隨訪時的CMS評分量表總分、CMS評分量表各成分積分與隨訪前的CMS評分量表總分、CMS評分量表各成分積分對比,統(tǒng)計(jì)結(jié)果表明,只有在改善日常生活活動水平方面,組內(nèi)差異有統(tǒng)計(jì)學(xué)意義,P0.05,CMS評分量表總分和CMS評分量表其他的成分積分在隨訪時與隨訪前的結(jié)果無統(tǒng)計(jì)學(xué)意義上的差異,提示毫火針針刺結(jié)筋病灶點(diǎn)療法對改善日常生活活動水平方面的遠(yuǎn)期療效顯著,對于CMS評分量表總分、緩解患側(cè)的疼痛、增加患側(cè)肩關(guān)節(jié)的活動度、改善肩關(guān)節(jié)周圍炎患者的患側(cè)肌力方面的遠(yuǎn)期療效穩(wěn)定。常規(guī)針刺對照組的組內(nèi)比較：統(tǒng)計(jì)結(jié)果表明,常規(guī)針刺對照組在兩個療程后、兩個療程后一個月隨訪時的兩個時段的CMS評分量表總分、CMS評分量表各成分積分與治療前的CMS評分量表總分、CMS評分量表各成分積分相比均升高,組內(nèi)差異有統(tǒng)計(jì)學(xué)意義,P0.05,研究結(jié)果表明常規(guī)針刺療法對提高CMS評分量表總分、緩解患側(cè)的疼痛、改善日常生活活動水平、增加患側(cè)肩關(guān)節(jié)的活動度、改善肩關(guān)節(jié)周圍炎患者的患側(cè)肌力方面均有效,但起效較慢(第一次治療后的CMS評分量表總分、CMS評分量表各成分積分與治療前的CMS評分量表總分、CMS評分量表各成分積分相比無統(tǒng)計(jì)學(xué)意義上的差別,P0.05)；常規(guī)針刺對照組隨訪時的CMS評分量表總分、CMS評分量表各成分積分與隨訪前的CMS評分量表總分、CMS評分量表各成分積分對比,結(jié)果無統(tǒng)計(jì)學(xué)意義上的差異,提示常規(guī)針刺對照組的療法對提高CMS評分量表總分、緩解患側(cè)的疼痛、改善日常生活活動水平、增加患側(cè)肩關(guān)節(jié)的活動度、改善肩關(guān)節(jié)周圍炎患者的患側(cè)肌力方面的遠(yuǎn)期療效穩(wěn)定。毫火針針刺結(jié)筋病灶點(diǎn)治療組和常規(guī)針刺對照組兩組的組間比較：毫火針針刺結(jié)筋病灶點(diǎn)治療組和常規(guī)針刺對照組兩組的CMS評分量表中的肌力積分在第一次治療后,兩個療程后,兩個療程后一個月隨訪時的3個不同時段的組間差異經(jīng)統(tǒng)計(jì)分析可知無統(tǒng)計(jì)學(xué)意義,P0.05,提示在改善肩周炎患者患側(cè)肌力方面,毫火針針刺結(jié)筋病灶點(diǎn)治療組與常規(guī)針刺對照組在治療后三個不同時段的療效相當(dāng)。毫火針針刺結(jié)筋病灶點(diǎn)治療組和常規(guī)針刺對照組兩組的CMS評分量表總分、CMS評分量表中的疼痛積分、日常生活活動水平積分、肩關(guān)節(jié)活動度積分在治療后的3個不同時段的組間差異有統(tǒng)計(jì)學(xué)意義,P0.05,經(jīng)統(tǒng)計(jì)分析可知對提高CMS評分量表總分、緩解患側(cè)的疼痛、改善日常生活活動水平、增加患側(cè)肩關(guān)節(jié)的活動度這四方面,無論是第一次治療后還是兩個療結(jié)束后,抑或是兩個療程結(jié)束后1個月的隨訪時三個不同時段,毫火針針刺結(jié)筋病灶點(diǎn)治療組的療效均優(yōu)于常規(guī)針刺對照組。結(jié)論：毫火針針刺結(jié)筋病灶點(diǎn)治療組和常規(guī)針刺對照組治療肩周炎都有一定臨床療效,但和常規(guī)針刺對照組的療法相比,毫火針針刺結(jié)筋病灶點(diǎn)組的療法的總臨床療效更佳,在提高CMS評分量表總分、緩解患側(cè)的疼痛、改善日常生活活動水平、增加患側(cè)肩關(guān)節(jié)的活動度方面具有一定優(yōu)勢,毫火針針刺結(jié)筋病灶點(diǎn)療法不僅起效快,在即時、近期、遠(yuǎn)期療效均優(yōu)于常規(guī)針刺療法。毫火針針刺結(jié)筋病灶點(diǎn)治療肩周炎的臨床療效顯著,穩(wěn)定持久,臨床應(yīng)用安全有效,值得推廣應(yīng)用和進(jìn)行深入研究。
[Abstract]:Objective: To compare with the conventional acupuncture treatment as control group, to observe the clinical efficacy of acupuncture with filiform needle total tendon lesions mainly in the treatment of periarthritis of shoulder, and the change of rib lesions acupuncture filiform needle and conventional acupuncture therapy in two different therapeutic indexes in different periods, to explore milli fire needle rib lesions the main point of this special therapy in the treatment of scapulohumeral periarthritis in clinical effectiveness and timeliness, and fire needle rib lesions therapy for periarthritis of shoulder of the possible mechanism of action, that "the milli fire needle clinical value and application significance in treatment of shoulder joint inflammation around the rib lesion acupuncture point", provide evidence-based basis for future clinical selection a more effective method for treatment of scapulohumeral periarthritis. Methods: this research case is mainly from the Guangdong Province Traditional Chinese Medical Hospital, the First Affiliated Hospital of Guangzhou University of Chinese Medicine from December 2014 to 2015 In December 2005 to outpatient patients, according to the study of the selection criteria for the patients included 60 cases of cases, the qualified cases according to the average distribution of randomized to treatment group (milli fire needle rib lesion group) and control group (conventional acupuncture group), acupuncture filiform needle rib lesions and treatment group the number of cases of routine acupuncture group were thirty cases. The treatment group according to China by bar check < > in the method of reinforcement learning around the shoulder joint proximal and distal rib lesions (find the regularity of Ashi) for filiform needle acupuncture treatment, control group according to the prescriptions of acupuncture and moxibustion Wang Qicai. "Learn > in the treatment of periarthritis of shoulder acupoints selected routine acupuncture. Milli fire needle rib lesions treatment group and routine acupuncture group. The patients received 1 day acupuncture treatment, 6 treatment for 1 courses, the whole research Two groups of patients with scapulohumeral periarthritis is required to complete 2 courses of treatment. The total clinical efficacy criteria of this study refer to < efficacy standards related to periarthritis TCM syndrome diagnostic efficacy standards > in the index of Constant - Murley, the curative effect of shoulder joint score evaluation method (CMS test), of which the total clinical efficacy was assessed at the end of the two courses after the first treatment, after two courses of treatment, two months after follow-up of 1 months during the three periods of the therapeutic index milli fire needle rib lesions group and routine acupuncture group were evaluated using SPSS20.0 to study the data for statistical analysis. Results: compared with before treatment was 1. fire needle rib lesions group and conventional acupuncture group of patients between the two groups: baseline data of two groups of patients in terms of gender, age, course of disease, TCM syndrome type or SCM score and SCM score of the integral component The statistical analysis showed no significant difference (P0.05), suggesting that compared baseline condition two groups of patients before treatment of periarthritis of shoulder with.2. clinical curative effect: the milli fire needle rib lesion treatment group and routine acupuncture group and two in the control group after treatment the total clinical efficacy were compared by rank data test showed the differences between the two groups after treatment the total efficacy was statistically significant (P0.05), comparable, 30 patients in the treatment group, the level of cure in 4 cases, reaching significant levels of patients with periarthritis of shoulder in 16 cases, achieve the effective level of periarthritis patients also had 6 cases, only 4 invalid cases, the total effective rate was 86.67%; 30 patients in the control group, the level of cure in 3 cases, reaching significant levels of patients with periarthritis of shoulder in 7 cases, the majority of patients (12 cases) the curative effect reached to the effective level of 8 cases Invalid, so the group in the total efficiency of 73.33%.3. in different periods respectively: indicators of the effect of milli fire needle rib lesion treatment group and routine acupuncture control group, two groups of patients with scapulohumeral periarthritis in after the first treatment, after two courses, 3 different periods of one month follow-up of two courses after the CMS score, CMS score of each component score (including pain scores, activities of daily living level of integral, integral, integral of shoulder muscle) before treatment with the CMS score, CMS score of each component points within the group; the milli fire needle rib the focus of treatment group and routine acupuncture control group two courses of the two groups after one month follow-up, CMS score, CMS score and the integral before follow-up after two cycles of CMS score, CMS score of each component Integral comparison in the group; the milli fire needle rib lesion treatment group and routine acupuncture group of two groups of patients after treatment in 3 different periods of CMS score, CMS score of each component was compared between the groups. The integral milli fire needle rib lesion treatment group compared node group the statistical results show that: the milli fire needle treatment group node focus in the treatment of tendon in different periods after the CMS score, CMS score of each component (except the first integral integral strength after treatment) before treatment with the CMS score, CMS score of each component was increased compared with the integral. Significant differences in group (P0.05), the results showed that after treatment, milli fire needle rib lesions therapy to improve CMS score, alleviate ipsilateral pain, improve the activities of daily living level, increase the risk of shoulder joint activities and change The ipsilateral muscle in patients with periarthritis of shoulder were good and effective, and to improve the CMS score, alleviate ipsilateral pain, improve the activities of daily living level, increase the risk of shoulder joint activities of the four effect of rapid onset (for the first time after treatment score than before treatment score results increased, the difference was statistically significant, P0.05), to improve the ipsilateral muscle slow onset patients with periarthritis of shoulder (muscle strength score and treatment after the first treatment before the integral strength had no significant difference. The difference, P0.05); milli fire needle rib lesion treatment group follow-up CMS scores the total score, CMS score of each component integral with the follow-up before the CMS score, CMS score of each component integral comparison, the statistical results showed that only in the improvement of activities of daily living level, there were differences in each group Meaning, P0.05, CMS score and CMS score of other components integral in the follow-up and follow-up the results no statistically significant difference, suggesting that the long-term curative effect of node milli fire needle therapy on tendon lesions improve the activities of daily living level significantly, the CMS score, alleviate the suffering the side of pain, increase the risk of shoulder joint activities, improve the long-term efficacy of stable ipsilateral muscle of patients with periarthritis of shoulder. Compared with conventional acupuncture control group: the statistical results show that the conventional acupuncture in the control group after two month treatment, two hours a month follow-up of two courses after the CMS score, CMS score of each component score before treatment CMS score, CMS score of each component score was increased compared, statistically significant differences in group P0.05, the results showed that the conventional acupuncture Therapy to improve the CMS score, alleviate ipsilateral pain, improve the activities of daily living level, increase the risk of shoulder joint activities, improve the ipsilateral muscle strength in patients with periarthritis of shoulder were effective, but the effect is relatively slow (for the first time after treatment, CMS score, CMS score CMS, the integral scale CMS score of each component score before treatment compared with no significant difference, P0.05); routine acupuncture control group follow-up CMS score, CMS score of each component integral with the follow-up before the CMS score, CMS score the integral comparison results, no statistically significant difference in the control group, suggesting that the conventional acupuncture therapy to improve CMS score, alleviate ipsilateral pain, improve the activities of daily living level, increase the risk of shoulder joint activity, improve the shoulder off The long-term curative effect of stable ipsilateral muscle in patients with periarthritis of section. Milli fire needle rib lesion treatment group and routine acupuncture group and two in the control group between the two groups: milli fire needle rib lesion treatment group and routine acupuncture control group, two groups of CMS score in the first treatment in integral strength after two months after treatment, the differences of the 3 different periods of one month follow-up of treatment after the two groups by statistical analysis showed no statistical significance, P0.05, suggesting improvement in patients with scapulohumeral periarthritis ipsilateral muscle, milli fire needle treatment group node and conventional acupuncture point rib lesion control group after treatment efficacy three different periods of time. A milli fire needle rib lesion treatment group and routine acupuncture control group, two groups of CMS score, CMS pain score scale score, activities of daily living level points, activity of shoulder joint in integral There are statistically significant differences, 3 different periods of time after treatment of the group P0.05, with statistical analysis to improve the CMS score, alleviate ipsilateral pain, improve the activities of daily living level, increase the risk of shoulder joint activities of the four aspects, whether it is the first time after treatment or therapy over two later, or two months after 1 months of follow-up in three different time periods, filiform needle is superior to that of conventional acupuncture group acupuncture effect reinforcement treatment group lesions. Conclusion: the milli fire needle rib lesions treatment group and routine acupuncture group treatment of scapulohumeral periarthritis has certain clinical curative effect. But compared with the normal control group of acupuncture treatment, the total clinical efficacy of acupuncture filiform needle rib lesion group therapy, improve CMS score, alleviate ipsilateral pain, improve the activities of daily living level, increase the risk of shoulder joint Have the advantage of activity, milli fire needle rib lesions therapy is not only fast, in an instant, short-term, long-term efficacy was better than routine acupuncture therapy. The clinical efficacy of acupuncture with filiform needle for treatment of periarthritis of shoulder tendons lesions significantly, stable and durable, safe and effective in clinical use, is worthy of popularization and application and in-depth research.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R246.9

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