本文關(guān)鍵詞： 繆刺 臨床研究 急性踝關(guān)節(jié)扭傷　出處：《廣州中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：采用隨機(jī)對照的臨床試驗研究方法,探討繆刺法治療急性踝關(guān)節(jié)扭傷的臨床療效,評價其安全性及有效性,為今后的臨床推廣提供科學(xué)依據(jù)。方法：將門診收集的90例患者隨機(jī)分配至試驗組A、對照組B及對照組C,試驗組A采用繆刺的方法,通過選取患足對側(cè)的腕關(guān)節(jié),在腕關(guān)節(jié)上采取按壓的方法找出阿是穴,并在阿是穴上施針,囑患者活動踝關(guān)節(jié),留針20min。對照組B采用普通針刺的方法,依據(jù)石學(xué)敏主編的“十一五”規(guī)劃教材中治療踝關(guān)節(jié)扭傷的處方,選取申脈、昆侖、解溪、太沖、丘墟等穴。對照組C選用現(xiàn)代醫(yī)學(xué)中本病的治療規(guī)范,即RICE處理原則,包括制動、冰敷、加壓包扎、抬高患肢等四個方面。三組療程均為1周,試驗組A與試驗組B每日施針,針灸每天1次,研究以疼痛、腫脹、關(guān)節(jié)活動度及Kofoed評分為主要觀測指標(biāo),分別在治療前、第1次治療后、第7次治療后進(jìn)行觀測指標(biāo)評分,最后整理數(shù)據(jù),進(jìn)行統(tǒng)計學(xué)分析,做出科學(xué)的系統(tǒng)的評價。結(jié)果：VAS評分方面,三組的VAS評分在第1次治療后、第7次治療后與治療前比較,組內(nèi)差異均具有統(tǒng)計學(xué)意義(P＜0.05)； 三組組間在第1次治療后評分比較,繆刺組評分均值高于常規(guī)針刺組及RICE組,差異具有統(tǒng)計學(xué)意義(P＜0.05),第7次治療后組間評分比較,繆刺組評分均值高于常規(guī)針刺組及RICE 組。關(guān)節(jié)活動度ROM評分方面,三組組內(nèi)關(guān)節(jié)活動度第1次治療后評分、第7次治療后評分與治療前評分比較,三組均具有統(tǒng)計學(xué)意義(P＜0.05)； 三組組間在第1次治療評分后比較,繆刺組評分均值高于常規(guī)針刺組及RICE組,差異具有統(tǒng)計學(xué)意義(P＜0.05),但在第7次治療后組間評分比較,差異沒有統(tǒng)計學(xué)意義(P＞0.05)。腫脹度評分方面,三組組內(nèi)關(guān)節(jié)腫脹度第1次治療后評分、第7次治療后評分與治療前評分比較,三組組內(nèi)均具有統(tǒng)計學(xué)意義(P＜0.05)；三組組間關(guān)節(jié)腫脹度在第1次治療后評分,組間差異均沒有統(tǒng)計學(xué)意義(P＞0.05),第7次治療后評分,RICE組與繆刺組及普通針刺組比較差異具有統(tǒng)計學(xué)意義(P＜0.05)。臨床療效方面,三組組間治療后kofoed評分組間比較不具有統(tǒng)計學(xué)意(P＞0.05),這說明繆刺法與普通針刺、RICE原則比較在治療急性踝關(guān)節(jié)扭傷的總療效方面具有相同優(yōu)勢。結(jié)論：三種方法治療急性踝關(guān)節(jié)扭傷均有效,均能很好地緩解疼痛、減輕腫脹、改善踝關(guān)節(jié)的功能狀態(tài)。在緩解疼痛方面,繆刺、普通針刺及RICE原則均能改善急性踝關(guān)節(jié)扭傷的疼痛,但是繆刺法在即時止痛方面,效果明顯。在改善關(guān)節(jié)活動度方面,繆刺、普通針刺與RICE原則均能改善踝關(guān)節(jié)活動度,但繆刺對改善關(guān)節(jié)活動度的即時效果明顯。在改善關(guān)節(jié)的腫脹度方面,繆刺、普通針刺與RICE原則均能降低踝關(guān)節(jié)腫脹度,RICE原則治療療效要優(yōu)于針刺繆刺及普通針刺。從kofoed評分的總優(yōu)良率來看,試驗組優(yōu)良率與兩對照組無明顯差異,但繆刺法操作更為簡單,患者依從性較好,是臨床上治療急性踝關(guān)節(jié)扭傷的一種簡便有效的方法,值得在臨床上推廣。
[Abstract]:Objective: To study clinical trials using randomized controlled methods, to explore the clinical curative effect of needling method for treatment of acute ankle sprain, evaluate its safety and effectiveness, and provide scientific basis for clinical application in the future. Methods: collected 90 cases of clinic patients were randomly assigned to the test group A, control group B and control group C and the test group A by using the method of needling, by selecting the foot on the side of the wrist, the wrist to press the method to find the needle at Ashi Ashi, and, ask the patient motion of ankle joint for 20min. control group B using the ordinary acupuncture, according to Shi Xuemin editor of the "11th Five-Year" planning materials in the treatment of ankle sprain prescription, selection of Shen Mai, Kunlun, JieXi, Taichong, Qiuxu point. The control group used C therapy for the disease of modern medicine, RICE treatment, including brake, ice, compression bandaging, elevate the limb Four. Three groups were treated for 1 weeks, the test group A and test group B daily acupuncture, acupuncture 1 times a day, with pain, swelling, joint activity and Kofoed score as the main observation indexes, respectively before treatment, after first treatments, seventh observation index score after treatment finally, the data, statistical analysis, evaluation of scientific system. Results: the VAS score, VAS score of three groups in first after treatment, compared with seventh times before and after treatment, group differences were statistically significant (P < 0.05); the three groups in first after treatment scores of needling group mean score was higher than that of conventional acupuncture group and RICE group, the difference was statistically significant (P < 0.05), after the seventh treatment groups were compared, the mean score is higher than that of the conventional needling group, acupuncture group and RICE group. The joint activity score of ROM, the three groups in the joint activity first After treatment score, scoring seventh times after treatment compared with before treatment, three groups were statistically significant (P < 0.05); the difference between three groups in the first treatment score, needling group mean score was higher than that of conventional acupuncture group and RICE group, the difference was statistically significant (P < 0.05), but in the seventh treatment groups were compared, the difference was not statistically significant (P > 0.05). The swelling score, joint swelling degree in the three groups after the first treatment score, scoring seventh times after treatment compared with before treatment, the three groups had statistical significance (P < 0.05); between the three groups in the first joint swelling scores after the treatment, the differences between groups were not statistically significant (P > 0.05), after the seventh treatment score, RICE group and contralateral needling group and common acupuncture group with significant difference (P < 0.05). The clinical curative effect aspect, three groups after the kofoed score Comparison between groups was not statistically significance (P > 0.05), indicating that miuci and ordinary acupuncture, RICE principle has the same advantages in total curative effect in the treatment of acute ankle sprain. Conclusion: the three methods in the treatment of acute ankle sprain were effective, can well relieve the pain, reduce swelling. To improve the function of the ankle joint. Needling in pain relief, and the principle of RICE, the ordinary acupuncture can improve the acute sprain of ankle pain, but miuci in immediate pain relief, the effect is obvious. Needling in improving joint activity, and the RICE principle, the ordinary acupuncture can improve the activity of ankle joint however, the immediate effect of needling joint activity. Needling in swelling, improve joint, common acupuncture and RICE principle can reduce the ankle swelling, the efficacy of RICE treatment is superior to the principle of acupuncture needling and ordinary acupuncture from KOF. According to the total excellent and good rate of OED score, the excellent and good rate of the experimental group is not significantly different from that of the two control group, but the operation of the needling method is simpler and the patient's compliance is better. It is a simple and effective method for the treatment of acute ankle sprain in clinical practice, and is worthy of clinical promotion.

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

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