本文選題：員利針療法　切入點：腰椎間盤突出癥　出處：《中國中醫(yī)科學(xué)院》2016年碩士論文

【摘要】：研究背景：腰椎間盤突出癥是由椎間盤變性,纖維環(huán)破裂、髓核突出,刺激或壓迫神經(jīng)根、馬尾神經(jīng)所表現(xiàn)的一種綜合征,是臨床常見病和多發(fā)��；發(fā)病節(jié)段以腰4/5、腰5/骶1椎間隙發(fā)病率最高,臨床以腰背痛、下肢放射痛為典型癥狀；多見于25-55歲的患者,且男性多于女性。腰椎間盤突出癥的治療分為保守治療和手術(shù)治療,以保守治療為主,80-90%的患者可經(jīng)過針灸、推拿、中藥、物理療法、神經(jīng)阻滯等中醫(yī)或西醫(yī)保守方法得到緩解,有的甚至痊愈。在保守療法中,針灸以其簡、便、廉、效的特點,在臨床上運用廣泛。員利針為針灸中古九針演變而來,目前文獻對于它治療腰椎間盤突出癥的報道較少,但因在臨床中它以快速、有效、操作簡單等優(yōu)點脫穎而出,基于此,本研究以觀察員利針療法治療不同突出類型腰椎間盤突出癥的療效,并比較外側(cè)型和中央型的療效,優(yōu)化腰椎間盤突出癥的治療方案,以指導(dǎo)臨床。研究目的：觀察員利針療法治療腰椎間盤突出癥的臨床療效及不同突出類型療效相互比較(包括癥狀、疼痛程度、生活質(zhì)量的改善),進一步明確臨床適應(yīng)癥,以便臨床推廣應(yīng)用。研究方法：1.將符合納入排除標(biāo)準(zhǔn)的70例腰椎間盤突出癥患者根據(jù)CT分型分為兩組,外側(cè)型組和中央型組分別35例。2.患者俯臥位,選取病變部位及上下節(jié)段腰夾脊穴、阿是穴,用75%酒精對皮膚常規(guī)消毒后用0.8x50mm的員利針,運用提插直刺傍刺法,針刺得氣后不留針的方法,每日1次,5次為一個療程。3.兩組患者均選用JOA、VAS、SF-36量表,并對治療前、后進行評分。4.療效評價根據(jù)《中藥新藥臨床研究指導(dǎo)原則》及國家中醫(yī)藥管理局制定的《中醫(yī)病證診斷療效標(biāo)準(zhǔn)》中治療腰椎間盤突出癥的療效評定標(biāo)準(zhǔn)擬定。5.運用SPSS 16.0軟件進行統(tǒng)計分析,計數(shù)資料用%表示,兩組間差異比較用卡方檢驗；計量資料用x±s表示,兩組間差異比較采用獨立樣本t檢驗,治療前與治療后比較采用配對t檢驗；兩組間有效率差異比較采用卡方檢驗。P0.05為差異有統(tǒng)計學(xué)意義。研究結(jié)果：1.員利針對治療外側(cè)型和中央型腰椎間盤突出癥均有療效,但更適用于外側(cè)型腰椎間盤突出癥患者。2.VAS和臨床療效外側(cè)型均優(yōu)于中央型(P0.05)。3.JOA和SF-36比較結(jié)果顯示,外側(cè)型和中央型治療均有效(P0.05),但差異不明顯,無統(tǒng)計學(xué)意義(P0.05)。結(jié)論：員利針療法對外側(cè)型和中央型腰椎間盤突出癥患者在改善癥狀、減輕疼痛、提高生活質(zhì)量、臨床療效方面均有效；在減輕疼痛和臨床療效方面外側(cè)型優(yōu)于中央型。
[Abstract]:Background: lumbar disc herniation is a syndrome characterized by degeneration of intervertebral disc, rupture of fibrous ring, protrusion of nucleus pulposus, stimulation or compression of nerve root and cauda equina nerve.The incidence rate of lumbar 5 / sac1 intervertebral space was the highest. The typical symptoms were low back pain and lower extremity radialgia, which were more common in patients aged 25 to 55 years, and more in men than in women.The treatment of lumbar disc herniation can be divided into conservative treatment and surgical treatment. 80-90% of patients with lumbar disc herniation can be relieved by acupuncture, massage, Chinese medicine, physical therapy, nerve block and so on.In conservative therapy, acupuncture is widely used in clinic because of its simple, convenient, cheap and effective characteristics.Shenli Needle is the evolution of acupuncture and moxibustion. At present, there are few reports on the treatment of lumbar disc herniation in the literature, but it stands out because of its advantages in clinical practice, such as speed, effectiveness, simple operation, and so on.In this study, the therapeutic effects of different types of lumbar disc herniation were compared with those of lateral type and central type, and the treatment scheme of lumbar disc herniation was optimized to guide clinical practice.Objective: to evaluate the clinical efficacy of acupuncture therapy in the treatment of lumbar disc herniation and to compare the effects of different herniation types (including symptoms, pain degree, quality of life), and to determine the clinical indications.In order to promote clinical application.Research method: 1.According to CT classification, 70 patients with lumbar disc herniation were divided into two groups: the lateral type group and the central type group.In the prone position, the patients were selected the diseased position and upper and lower lumbar Jiaji points and Ashi points. After routine disinfection of the skin with 75% alcohol, the patients were treated with 0.8x50mm 's needling, and the method of lifting and inserting straight needling was used, and the method of not keeping the needle after acupuncture was used.Once a day, 5 times as a course of treatment. 3.JOAA VASS SF-36 scale was used in both groups, and the scores before and after treatment were. 4. 4.The evaluation of curative effect was made according to the guiding principles of Clinical Research on New drugs of traditional Chinese Medicine and the criteria for the diagnosis and treatment of Lumbar Intervertebral Disc Herniation made by the State Administration of traditional Chinese Medicine. 5.The statistical analysis was carried out by using SPSS 16.0 software. The counting data were expressed in%, the differences between the two groups were compared by chi-square test, the measurement data were expressed by x 鹵s, and the differences between the two groups were compared by independent sample t test.Before and after treatment, paired t test was used; the difference of effective rate between the two groups was statistically significant by chi-square test.The result of the study was: 1.Both lateral and central types of lumbar disc herniation were treated by Shen Li, but it was more suitable for patients with lateral lumbar disc herniation. 2.VAS and clinical efficacy of lateral type were better than that of central type (P 0.05). 3. The results of JOA and SF-36 showed that the patients with lateral lumbar disc herniation were more effective than those with central type of lumbar disc herniation.There was no significant difference in the treatment of lateral type and central type (P 0.05), but there was no significant difference (P 0.05).Conclusion: Shenli acupuncture therapy is effective in improving symptoms, alleviating pain, improving quality of life and clinical curative effect in patients with lateral and central lumbar disc herniation, and lateral type is superior to central type in relieving pain and clinical effect.
【學(xué)位授予單位】：中國中醫(yī)科學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R246.9

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