本文選題：跟痛癥 + 筋傷1號(hào)方��； 參考：《中國(guó)中醫(yī)科學(xué)院》2017年碩士論文

【摘要】：研究背景跟痛癥是骨科臨床醫(yī)學(xué)中一種常見(jiàn)的足部疾患。多為慢性發(fā)病,早期一般不易引起患者的重視。當(dāng)疼痛已對(duì)患者正常生活造成一定影響時(shí),方才會(huì)對(duì)該病引起重視。該病慢性起病,病程較長(zhǎng),且經(jīng)治療后時(shí)有反復(fù)。對(duì)患者的生活造成很大的不便。由于跟痛癥常見(jiàn)于臨床,故對(duì)該病的治療已有了較為久遠(yuǎn)的歷史。祖國(guó)醫(yī)學(xué)經(jīng)過(guò)成百上千年來(lái)對(duì)該病的治療,各大醫(yī)家也都采用不同的理念及方法力求改善患者足跟痛的癥狀,所得效果良莠不齊。現(xiàn)代醫(yī)學(xué)依托于科技水平的不斷發(fā)展,對(duì)跟痛癥的發(fā)病機(jī)理和治療方法也在逐步的深入。就目前來(lái)看,現(xiàn)代醫(yī)學(xué)把跟痛癥的發(fā)生歸因于跖腱膜損傷、足跟墊病變、跟骨骨刺、神經(jīng)性足跟痛及跟骨內(nèi)高壓等因素,在治療上目前較為常見(jiàn)的方法是局部的物理治療、足部的主動(dòng)功能鍛煉治療以及被動(dòng)的足部夜間夾板固定,以求減輕甚至消除足跟部局部炎癥,以此來(lái)改善足跟部疼痛。近年來(lái)隨著生物力學(xué)的發(fā)展,通過(guò)測(cè)量足部不同負(fù)重及非負(fù)重區(qū)的受力情況,并根據(jù)其所得結(jié)果所制作足部鞋墊以治療跟痛癥,取得了不錯(cuò)的效果,但因其價(jià)格較為昂貴,對(duì)科學(xué)技術(shù)的依賴較高,目前該治療方案還沒(méi)有廣泛開(kāi)展。局部封閉治療作為一種骨科臨床較為常用的治療手段,止疼效果較為確切,可快速短期內(nèi)解除患者疼痛。但因?yàn)樘瞧べ|(zhì)激素的應(yīng)用,所帶來(lái)的副作用也為廣大臨床醫(yī)生所忌憚。目前最新的富含血小板血漿局部注射治療還在探索過(guò)程中,已有了相關(guān)的臨床治療報(bào)道,不過(guò)目前缺乏更多樣本病例的驗(yàn)證,目前還沒(méi)有被進(jìn)一步推廣。針對(duì)一些保守治療不能取得滿意效果的跟痛癥患者,手術(shù)治療也不失為一種選擇。通過(guò)分析患者病痛產(chǎn)生的原因,而采用不同的術(shù)式,通過(guò)去除病因而解除患者的疼痛。手術(shù)治療的效果較為確切,不過(guò)因其治療帶有創(chuàng)傷性,且存在著一定感染的風(fēng)險(xiǎn),并不能被所有患者所接受。研究目的我們通過(guò)對(duì)千百年來(lái)傳統(tǒng)醫(yī)學(xué)對(duì)跟痛癥治療過(guò)程中總結(jié)出的理論和實(shí)踐經(jīng)驗(yàn)的學(xué)習(xí)和提煉,按照傳統(tǒng)經(jīng)典理念自擬方劑,且經(jīng)打粉后與凡士林混合制成筋傷1號(hào)方,外敷于患處,使治療操作過(guò)程十分簡(jiǎn)便快捷,且成本低廉。本試驗(yàn)希望能通過(guò)筋傷1號(hào)方對(duì)跟痛癥患者的臨床療效觀察,以期能獲得較為確切的療效,為跟痛癥的治療提供一個(gè)較為便捷低廉且毒副作用較低的治療方法。方法根據(jù)隨機(jī)分組的臨床試驗(yàn)原則,我們把符合納入標(biāo)準(zhǔn)的60例跟痛癥患者隨機(jī)分成兩組,治療組采用筋傷1號(hào)方疼痛部位外敷,對(duì)照組采用扶他林膏劑疼痛部位外敷,每日2次。以視覺(jué)模擬評(píng)分法(visual analogue scale,VAS)及臨床癥狀評(píng)分法為評(píng)價(jià)方法,觀察其臨床效果。以1周作為觀察周期,持續(xù)觀察3周。如提前達(dá)到痊愈標(biāo)準(zhǔn),即停止治療。結(jié)果1.臨床總體療效結(jié)果:治療組30例患者中臨床痊愈10例,顯效11例,好轉(zhuǎn)7例,無(wú)效2例,總有效率93.3%;對(duì)照組29例患者中(對(duì)照組脫落1例患者)臨床痊愈4例,顯效8例,好轉(zhuǎn)13例,無(wú)效4例,總有效率86.2%。治療組的總體有效率高于對(duì)照組。2.VAS評(píng)分變化結(jié)果:兩組治療前后VAS疼痛分值均有一定程度的下降(P0.05),說(shuō)明兩組對(duì)跟痛癥的療效具有統(tǒng)計(jì)學(xué)意義,且同時(shí)治療組在VAS疼痛評(píng)分改善方面優(yōu)于對(duì)照組。3.跟痛癥癥狀分級(jí)量化評(píng)分積分:兩組治療前后臨床癥狀積分均數(shù)明顯下降,(P0.05),說(shuō)明兩組治療方法對(duì)跟痛癥的癥狀分級(jí)量化評(píng)分均有改善,且在壓痛癥狀積分指標(biāo)中,治療組療效要優(yōu)于對(duì)照組(P0.05)。結(jié)論兩組療法對(duì)改善跟痛癥的臨床癥狀都是有效的,但應(yīng)用筋傷1號(hào)方對(duì)跟痛癥的治療取得了更好的療效。
[Abstract]:Background and pain syndrome is a common foot disease in Department of orthopedics clinical medicine. Most of them are chronic disease, which is usually not easy to cause attention in the early stage. When pain has had a certain influence on the normal life of the patient, it will pay attention to the disease. The disease is chronic and has a long course, and it has repeated treatment after treatment. The treatment of the disease has a long history because the pain is common in the clinic. After hundreds of thousands of years of medical treatment of the disease, the great doctors have adopted different ideas and methods to improve the symptoms of the heel pain of the patients. At present, the occurrence of heel pain is due to the injury of the plantar aponeurosis, the lesion of the heel pad, the calcaneus bone spur, the neurotic heel pain and the internal high pressure of the calcaneus, and the common methods are local physical therapy at present. In order to reduce or even eliminate local inflammation in the heel, the active functional exercise therapy and the passive foot nocturnal splint are used to improve the heel pain. In recent years, with the development of biomechanics, the stress of different weight and non weight bearing areas in the foot is measured, and the foot insole is made according to the results. Heel pain has achieved good results, but because of its high price and high dependence on science and technology, the treatment scheme has not been widely carried out at present. As a commonly used clinical treatment in Department of orthopedics, local closed therapy is more effective in pain relief, but it can quickly relieve the pain in the short term. However, it is due to glucocorticoid. The side effects of the most recent platelet rich plasma injection therapy are still being explored, and related clinical reports have been reported. However, there is no further validation of the sample cases and is not yet further promoted. Some conservative treatments can not achieve satisfactory results. It is an option to treat the patients with heel pain. By analyzing the causes of the patient's pain and using different surgical procedures to remove the pain of the patient by removing the cause of the disease. The effect of the operation is more accurate, but the treatment is traumatic and there is a risk of infection and can not be accepted by all patients. The purpose of this study is to study and refine the theoretical and practical experience summed up in the treatment of heel pain by traditional medicine for thousands of years. In accordance with the traditional classical concept, we make up a prescription for self preparation, and make a combination of 1 square tendons with Vaseline after powdered powder, and apply it to the affected area to make the treatment process very simple, quick and cheap. We hope to observe the clinical efficacy of the 1 Prescription of tendon injury to the patients with heel pain, in order to get a more accurate therapeutic effect, and to provide a more convenient and inexpensive treatment for the treatment of heel pain. Methods according to the principle of randomized clinical trials, we have followed the inclusion criteria of 60 patients with heel pain. The machine was divided into two groups. The treatment group was used for external application of the pain part of tendon injury No. 1 in the treatment group. The control group was applied with the external application of the pain area of the cream in the control group, 2 times a day. The visual analogue score (visual analogue scale, VAS) and the clinical symptom score were used as evaluation methods to observe the clinical effect. The observation period was taken as the observation period and continued to be observed for 3 weeks. For example, the effect was achieved early in advance. The more standard, that is, stop treatment. Results 1. clinical overall results: 30 patients in the treatment group were cured in 10 cases, 11 cases were markedly effective, 7 cases were improved, 2 cases were invalid, the total effective rate was 93.3%, 4 cases, 8 cases, good turn 13, invalid 4, total effective efficiency of 86.2%. treatment group were effective in 29 patients in the control group (the control group dropped 1 patients). Higher than the control group.2.VAS score change results: two groups of VAS pain scores before and after treatment have a certain degree of decrease (P0.05), indicating that the two groups have statistical significance for the effect of heel pain, and at the same time the treatment group in the improvement of VAS pain score is better than the control group of.3. and pain symptom grading score score score: two groups of clinical symptoms before and after treatment. The average number of integral declines, (P0.05), indicating that the two groups of treatment methods have improved the grading and quantifying score of the symptoms of heel pain, and the curative effect of the treatment group is better than the control group (P0.05). Conclusion the treatment group is effective in improving the clinical symptoms of heel pain, but the application of tendon injury 1 to the treatment of heel pain is taken. Got a better effect.

【學(xué)位授予單位】：中國(guó)中醫(yī)科學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R274.9

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