本文選題：封閉治療 + 清宮正骨手法��； 參考：《北京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：研究背景枕大神經(jīng)痛系枕大神經(jīng)分布區(qū)域的神經(jīng)、肌肉、血管等軟組織非特異性炎癥、卡壓或損傷引起的陣發(fā)性或持續(xù)性呈刀割樣、抽搐樣、電擊樣、鈍痛樣疼痛,可放射至頭頂、乳突、外耳部及以枕大神經(jīng)出口處有壓痛或者與其相對應(yīng)的皮膚節(jié)段有感覺過敏或者感覺減退為主要臨床表現(xiàn)的一種非遺傳神經(jīng)疾病。該病具有發(fā)病率高、發(fā)病人群廣的特點(diǎn),多見于中老年人,是一種臨床常見病、多發(fā)病。尤其是隨著現(xiàn)在生活方式的改變,人們的工作過多的趨向于坐位及低頭姿勢,直接導(dǎo)致屈頸活動的增多,頸椎局部活動的減少,導(dǎo)致了枕大神經(jīng)痛的發(fā)病率的日趨增高。各地區(qū)枕大神經(jīng)痛的流行病學(xué)調(diào)查結(jié)果不一,不同性別、不同年齡段、不同職業(yè)和地區(qū)的發(fā)病存在差異,患病率呈逐年升高和年輕化趨勢,嚴(yán)重影響患者的生活質(zhì)量及工作學(xué)習(xí)效率。目前該病的治療主要以中西醫(yī)結(jié)合保守治療為主,手術(shù)治療相對較少。中醫(yī)治療目前主要包括中藥治療、針灸治療、穴位注射、推拿手法及小針刀松解治療等。針灸治療相對運(yùn)用較多,其中又細(xì)分為針刺、艾灸、溫針灸、火針、刺血、電針治療等多種治療方法。西醫(yī)治療目前主要包括非甾體類止痛抗炎藥、物理方法、神經(jīng)阻滯術(shù)、手術(shù)治療為主,還有心理療法較為新穎,物理治療又可細(xì)分為激光治療和射頻治療。上述治療方法在臨床研究報(bào)道中均取得了一定的治療效果,至于哪種治療方法更佳,以及每種治療方法的適應(yīng)癥的選擇,目前尚無定論。有時甚至導(dǎo)致患者病情的延誤,導(dǎo)致病情的纏綿難愈和反復(fù)。清宮正骨手法治療該病,在治療的過程中通過重點(diǎn)施術(shù)于"筋結(jié)"部位。以放松理筋手法調(diào)和氣血、活血化瘀、舒緩痙攣,緊張的肌肉,消除頸部局部異常應(yīng)力的作用。同時又依據(jù)中醫(yī)骨傷"筋骨"理論,運(yùn)用頸部不定點(diǎn)旋轉(zhuǎn)手法,糾正"筋出槽"與"骨錯縫",解除頸枕部枕大神經(jīng)周圍小關(guān)節(jié)及軟組織的嵌壓,恢復(fù)頸椎關(guān)節(jié)的正常序列,達(dá)到恢復(fù)頸椎功能,起到治療的目的。最后又以善后手法緩解緊張情緒,釋放心理壓力,達(dá)到舒筋活絡(luò),貫通筋脈氣血,增加局部軟組織的血液供應(yīng),從而達(dá)到治療的目的。目的:探討清宮正骨手法治療枕大神經(jīng)痛的作用機(jī)理,觀察清宮正骨手法對于該病治療的臨床療效。方法:按照納入排除標(biāo)準(zhǔn)收集本次研究所需的60例病例。均為2014年10月至2017年1月在北京中醫(yī)藥大學(xué)第三附屬醫(yī)院骨科門診及病房就診的患者。隨機(jī)分為清宮正骨手法試驗(yàn)組和封閉治療對照組各30例。按照已制定的治療及隨訪方案分析兩組治療前、治療后2周及治療后3個月VAS減分率、VAS及NDI評分,進(jìn)行療效分析。結(jié)果:①治療后2周VAS評分減分率:試驗(yàn)組痊愈率13.33%、顯效率50.00%、有效率30.00%、無效率6.67%、總有效率93.33%;對照組痊愈率3.33%、顯效率53.33%、有效率36.67%、無效率6.67%、總有效率93.33%。②治療后3個月VAS評分減分率:試驗(yàn)組痊愈率6.67%、顯效率53.33%、有效率33.33%、無效率6.67%、總有效率93.33%;對照組痊愈率0、顯效率10.00%、有效率73.33%、無效率16.67%、總有效率83.33%。③非參數(shù)檢驗(yàn)分析治療前后VAS評分,試驗(yàn)組治療前均值為:6.10±0.92,治療后均值為:2.10± 1.15。Z=-4.802,P=0.0000.05;對照組治療前均值為:5.96±0.76,治療后均值為:2.33±1.03。Z=-4.809,P=0.0000.05。④非參數(shù)檢驗(yàn)分析治療前后NDI評分,試驗(yàn)組治療前均值為:33.20±2.77,治療后均值為:10.23±2.28。Z=-4.794,P=0.0000.05;對照組治療前均值為:34.83±1.89,治療后均值為:11.37±3.26。Z=-4.789,P=0.0000.05。⑤非參數(shù)檢驗(yàn),分析兩組治療后VAS、NDI評分,VAS評分Z=-0.672,P=0.5020.05;NDI 評分 Z=-1.118,P=0.2630.05。⑥非參數(shù)檢驗(yàn),兩組治療3個月隨訪VAS、NDI評分,VAS評分Z=-4.411,P=0.0000.05;NDI 評分 Z=-3.334,P=0.0010.05。結(jié)論:清宮正骨手法和封閉治療對于枕大神經(jīng)痛患者疼痛及頸椎功能改善上都有顯著的療效。近期療效兩種治療方法沒有明顯的差異。中長期療效,清宮正骨手法治療該病的效果優(yōu)于封閉治療。
[Abstract]:Background of the occipital great neuralgia of the occipital neuralgia of the occipital nerve. The soft tissues such as the nerve, muscle, blood vessel, and other soft tissues are nonspecific. The paroxysmal or continuous knife cuts, convulsions, electric shocks, and dull pain like pain caused by pressure or injury can radiate to the head, the mastoid, the external ear, and the pain of the exportation of the large occipital nerve or corresponding to it. A non genetic neuropathy with hypersensitivity or hypersensitivity as the main clinical manifestation of the skin segment. The disease is characterized by high incidence and a wide range of patients. It is often seen in the middle and old age. It is a common clinical disease and frequently occurring disease. In particular, with the change of lifestyle now, people tend to work too much to sit and bow. The incidence of occipital neuralgia is increasing. The incidence of occipital neuralgia is increasing. There are different epidemiological investigation results in various areas, different sex, different age groups, different occupational and regional differences, the prevalence rate is increasing year by year and young trend, serious. At present, the treatment of the disease is mainly based on the conservative treatment of traditional Chinese and Western medicine, and the surgical treatment is relatively less. The treatment of traditional Chinese medicine mainly includes the treatment of Chinese medicine, acupuncture and moxibustion, acupoint injection, manipulation of massage and the treatment of small needle knife and so on. A variety of treatment methods such as acupuncture, moxibustion, warm acupuncture, fire needle, blood pricking, electroacupuncture treatment. Western medicine mainly includes non steroidal analgesics, physical methods, nerve block, surgical treatment, psychological therapy more novel, physical therapy can be subdivided into laser therapy and radiofrequency therapy. The above treatment methods are reported in clinical research report. There is a certain therapeutic effect in the course. As for the better treatment and the selection of the indications for each treatment, there is no final conclusion. Sometimes it even leads to the delay of the patient's condition, which leads to the difficulty and repetition of the disease. At the same time, according to the theory of "muscle and bone" of the bone injury of the traditional Chinese medicine, using the unfixed rotation of the neck to correct the inlay of the small joint and soft tissue around the great nerve of the occipital nerve of the neck and pillow, and restore the compression of the small joints and soft tissues around the occipital nerve of the neck and pillow, and restore the compression of the small joints and soft tissues around the occipital nerve of the neck and pillow, and restore the compression of the small joints and soft tissues around the occipital nerve of the neck and pillow, and restore the pressure of the small joints and soft tissues around the occipital nerve of the neck and pillow, and restore the pressure of the small joints and soft tissues around the neck and pillow part of the nerve. The normal sequence of the cervical vertebra joint to restore the function of the cervical vertebra and play the purpose of treatment. At last, the aim of treatment is to relieve the tension, release the psychological pressure, reach the relaxing and activating circulation, through the veins and blood, and increase the blood supply of the local soft tissue. The mechanism was used to observe the clinical effect of the bone manipulation of the Qing Palace on the treatment of the disease. Methods: according to the inclusion of the exclusion criteria, 60 cases were collected from the Department of orthopedics, the Department of orthopedics, the Department of orthopedics, the Affiliated Hospital of Beijing University of Chinese Medicine, from October 2014 to January 2017. In the treatment control group, 30 cases were treated, and the results were analyzed in two groups before treatment, 2 weeks after treatment and 3 months' VAS score, VAS and NDI score. Results: (1) the reduction rate of VAS score in 2 weeks after treatment was 13.33%, the effective rate was 50%, the effective rate was 30%, the invalid rate was 6.67%, and the total effective rate was 93.33%; The recovery rate of the control group was 3.33%, the effective rate was 53.33%, the effective rate was 36.67%, the inefficiency was 6.67%. The total effective rate of 93.33%. was 3 months after the treatment. The rate of VAS score reduction was 6.67%, the effective rate was 53.33%, the effective rate was 33.33%, the invalid rate was 6.67%, the total effective rate was 93.33%, the control group recovered rate 0, significant efficiency 10%, efficiency 73.33%, inefficient 16.67%, total effective rate 3.33%. (6.10 + 0.92) before and after treatment, the mean value of the test group was 2.10 + 1.15.Z=-4.802, P=0.0000.05, the mean value before treatment was 5.96 + 0.76, the average after treatment was 2.33 + 1.03.Z=-4.809, and the NDI score before and after treatment was analyzed by the non parametric test of P=0.0000.05.; the test group was treated before treatment. The mean value was 33.20 + 2.77, the mean value after treatment was 10.23 + 2.28.Z=-4.794, P=0.0000.05, the mean value before treatment in the control group was 34.83 + 1.89, the average after treatment was 11.37 + 3.26.Z=-4.789, P=0.0000.05. 5 non parameter test, VAS, NDI score after the two groups of treatment, Z= -0.672, P=0.5020.05; NDI score Z=-1.118, non parametric test. The two groups were followed up for 3 months of follow-up VAS, NDI score, VAS score Z=-4.411, P=0.0000.05; NDI score Z=-3.334, P=0.0010.05. conclusion: there is a significant effect on the pain and the function improvement of the cervical vertebra in the patients with big neuralgia and the improvement of the function of the cervical vertebra. There is no obvious difference between the two treatment methods in the short term effect. The effect of bone setting manipulation on the disease is better than that of closed therapy.

【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R244.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 閆惠鵬;胡士其;;推拿配合五子散熱敷治療枕大神經(jīng)痛33例[J];浙江中醫(yī)雜志;2016年03期

2 田永紅;;桂枝加葛根湯合止痙散加減治療枕大神經(jīng)痛13例[J];內(nèi)蒙古中醫(yī)藥;2015年07期

3 陳艷;;心理療法對枕大神經(jīng)痛在門診治療中的觀察[J];中國醫(yī)藥指南;2015年08期

4 李冰;羅建昌;郎伯旭;;針刺配合頭皮阿是穴留針治療枕大神經(jīng)痛療效觀察[J];上海針灸雜志;2014年11期

5 鄭皓云;王慶甫;吳忌;石鑫超;楊黎黎;趙軍;張棟;;清宮正骨治療青少年頸痛寰樞關(guān)節(jié)紊亂的療效觀察[J];中國中醫(yī)骨傷科雜志;2014年10期

6 胡勇文;劉鋼;;清宮廷正骨手法治療胸椎小關(guān)節(jié)紊亂癥60例[J];中國中醫(yī)骨傷科雜志;2014年10期

7 呂游;張明波;;針刺提插瀉法治療枕大神經(jīng)痛40例臨床觀察[J];實(shí)用中醫(yī)內(nèi)科雜志;2014年08期

8 李平;;小針刀治療枕大神經(jīng)痛46例療效觀察[J];青海醫(yī)藥雜志;2014年09期

9 陳金萍;陳日新;焦琳;;熱敏灸配合針刺治療頑固性枕大神經(jīng)痛1例[J];江西中醫(yī)藥;2014年03期

10 韋存生;;針刀治療20例枕大神經(jīng)卡壓綜合征的療效觀察[J];中國實(shí)用神經(jīng)疾病雜志;2014年04期

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