發(fā)布時(shí)間：2018-06-18 19:48

  本文選題：針刀 + 頸椎病��； 參考：《湖北中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：研究目的:通過運(yùn)用針刀醫(yī)學(xué)基礎(chǔ)理論來研究頸椎病發(fā)病機(jī)制及其病理構(gòu)架,以此為依據(jù)研究設(shè)定了“T”形針刀整體松解術(shù)。觀察該方法治療頸椎病的療效,以評(píng)價(jià)“T”形針刀整體松解術(shù)的臨床應(yīng)用價(jià)值。研究方法:1.基于針刀醫(yī)學(xué)基礎(chǔ)理論人體弓弦力學(xué)解剖系統(tǒng)及力學(xué)病理構(gòu)架“網(wǎng)眼理論”,模仿弓箭組成結(jié)構(gòu)和受力模式,將生物力學(xué)和人體解剖學(xué)相結(jié)合,重新構(gòu)建頸段弓弦力學(xué)解剖系統(tǒng)的運(yùn)動(dòng)模型,從而分析頸椎病的發(fā)病機(jī)制及病理構(gòu)架,并以此為依據(jù)研究“T”形針刀整體松解術(shù)。2.對(duì)湖北中醫(yī)大黃家湖醫(yī)院針刀科2014年9月—2016年12月收治的的60名頸椎病患者,采用隨機(jī)數(shù)字表,按照1:1的比例隨機(jī)分為壓痛點(diǎn)組(30例)和術(shù)式組(30例)。壓痛點(diǎn)組以壓痛點(diǎn)為針刀治療部位,術(shù)式組采用“T”形針刀整體松解術(shù)治療。分別于術(shù)前、術(shù)后2周、術(shù)后3個(gè)月觀察兩組的臨床療效,并采用頸椎病臨床評(píng)價(jià)量表(CASCS)和簡(jiǎn)化Mc Gi LL疼痛量表(SF-MPQ)作為評(píng)價(jià)指標(biāo),基于SPSS20.0軟件進(jìn)行數(shù)據(jù)統(tǒng)計(jì),評(píng)估兩組的近期和遠(yuǎn)期療效。研究結(jié)果:1.頸段弓弦力學(xué)解剖系統(tǒng)模型。弓:枕骨、頸椎骨、肩胛骨。弦:附著于弓上的軟組織。(1)肌肉:斜方肌;肩胛提肌;菱形肌;豎脊肌;椎枕肌;夾肌;半棘肌;頸部多裂肌;頸部回旋肌;棘間肌;橫突間肌;胸鎖乳突肌;斜角肌。(2)韌帶:項(xiàng)韌帶;棘上韌帶;棘間韌帶;黃韌帶;橫突間韌帶;關(guān)節(jié)囊韌帶;前縱韌帶和后縱韌帶。(3)筋膜:頸固有筋膜;臟器筋膜和頸血管鞘。(4)輔助裝置:頸部神經(jīng)、血管。2.頸椎病的立體網(wǎng)絡(luò)狀病理構(gòu)架,首先是頸段弓弦力學(xué)解剖系統(tǒng)中淺層的項(xiàng)韌帶、棘間韌帶、斜方肌等軟組織,由于長(zhǎng)期不良姿態(tài)等原因造成的慢性損傷,導(dǎo)致軟組織受力異常。若人體得不到及時(shí)修復(fù),損傷日久,次序由淺入深,引起周圍與之有連接的深層軟組織,如斜方肌;夾肌;椎枕肌群;肩胛提肌等軟組織的聯(lián)合損傷。最終形成以各軟組織起始部位(弓弦結(jié)合部)為點(diǎn);各軟組織走形路徑的交叉部位(弦應(yīng)力集中部位)為線;各軟組織覆蓋層次為面的立體網(wǎng)絡(luò)狀病理構(gòu)架。3.“T”形針刀整體松解術(shù)的研究,是以頸段弓弦力學(xué)解剖系統(tǒng)模型為物質(zhì)基礎(chǔ),依據(jù)上述內(nèi)容分析的本病立體網(wǎng)絡(luò)狀病理構(gòu)架來確定針刀治療具體部位�！癟”的橫線為5個(gè)點(diǎn),在枕骨下緣上項(xiàng)線處,中點(diǎn)為枕外隆突,在依此線略成的弧形平面上,距離枕外隆突向左、右旁開2.5cm和5cm定4個(gè)點(diǎn);豎線為6個(gè)點(diǎn),分別為C2~C7棘突頂點(diǎn)。將橫線5個(gè)點(diǎn)和豎線6個(gè)點(diǎn)連起來,形似字母“T”。所以稱之為“T”形針刀整體松解術(shù)。4.通過對(duì)兩組患者術(shù)后3個(gè)月的隨訪,術(shù)式組愈顯率80.00%,總有效率96.67%,明顯高于壓痛點(diǎn)組,且差異具有統(tǒng)計(jì)學(xué)意義(Ρ0.05)。兩組患者術(shù)前、術(shù)后2周和術(shù)后3個(gè)月SF-MPQ積分比較,壓痛點(diǎn)組術(shù)后2周與術(shù)前SF-MPQ積分比較明顯下降(Ρ0.05),差異有統(tǒng)計(jì)學(xué)意義;術(shù)后3個(gè)月與術(shù)后2周比較,Ρ0.05,差異有統(tǒng)計(jì)學(xué)意義。術(shù)式組術(shù)后2周與術(shù)前比較,差異有統(tǒng)計(jì)學(xué)意義(Ρ0.05);術(shù)后3個(gè)月與術(shù)后2周比較,差異有統(tǒng)計(jì)學(xué)意義(Ρ0.05)。同時(shí),經(jīng)過術(shù)后2周、術(shù)后3個(gè)月的隨訪,術(shù)式組與壓痛點(diǎn)組的組間SF-MPQ積分比較,Ρ0.05,差異有統(tǒng)計(jì)學(xué)意義。通過術(shù)前、術(shù)后2周及術(shù)后3個(gè)月的隨訪和對(duì)比,壓痛點(diǎn)組與術(shù)式組,術(shù)后2周、術(shù)后3個(gè)月與術(shù)前比較,CASCS總積分均有明顯的改善(Ρ0.05),且術(shù)式組的術(shù)后2周、術(shù)后3個(gè)月積分改善程度明顯好于壓痛點(diǎn)組(Ρ0.05)。但是,CASCS的主觀癥狀積分中,壓痛點(diǎn)組術(shù)后3個(gè)月與術(shù)后2周比較,Ρ0.05,差異無統(tǒng)計(jì)學(xué)意義;而術(shù)式組的術(shù)后3個(gè)月與術(shù)后2周比較,Ρ0.05,差異有統(tǒng)計(jì)學(xué)意義。研究結(jié)論:1.頸椎病形成的主要因素是頸段弓弦力學(xué)解剖系統(tǒng)力平衡失調(diào)。其病理過程首先是頸部周圍軟組織(肌肉、韌帶、筋膜、關(guān)節(jié)囊)由于姿勢(shì)不正、慢性勞損等各種因素,導(dǎo)致軟組織受力異常,且損傷次序由淺入深,并引起周圍與之有連接的深層軟組織的聯(lián)合損傷。損傷的軟組織通過粘連、瘢痕、攣縮和堵塞進(jìn)行自我代償和自我調(diào)節(jié)。如果代償失敗,人體會(huì)啟動(dòng)第二套代償系統(tǒng)即硬化、鈣化和骨化,這也就是X片上的骨質(zhì)增生或骨刺。如果仍然不能代償弦的異常應(yīng)力,就會(huì)形成以各軟組織起始部位(弓弦結(jié)合部)為點(diǎn);各軟組織的走形路徑為線;各軟組織覆蓋層次為面的三維立體狀網(wǎng)絡(luò)病理構(gòu)架。最終導(dǎo)致頸段弓弦力學(xué)解剖系統(tǒng)的力平衡失調(diào),引起軟組織疼痛、僵硬及血管、神經(jīng)束卡壓等系列臨床表現(xiàn)和體征。并且,據(jù)此病理構(gòu)架我們可以得出頸椎病壓痛點(diǎn)的分布規(guī)律,從而制定規(guī)范化的臨床基礎(chǔ)術(shù)式,以促進(jìn)針刀醫(yī)學(xué)的現(xiàn)代化、科學(xué)化和規(guī)范化的發(fā)展。2.根據(jù)頸段弓弦力學(xué)解剖系統(tǒng)及頸椎病的立體網(wǎng)絡(luò)狀病理構(gòu)架分析,頸椎病的早期可以歸屬為慢性軟組織損傷類疾病的范疇。因此,在頸椎病的早期治療上,必須要遵循慢性軟組織損傷類疾病的發(fā)生、發(fā)展規(guī)律,采用慢性軟組織損傷類疾病的治療方法。在頸椎病的進(jìn)展期,人體啟動(dòng)第二套代償系統(tǒng)即硬化、鈣化和骨化來進(jìn)一步對(duì)異常應(yīng)力進(jìn)行代償時(shí),即影像學(xué)上出現(xiàn)骨質(zhì)增生階段,也必須先從恢復(fù)頸段弓弦力學(xué)解剖系統(tǒng)的軟組織力平衡入手。由此可以初步窺探針刀醫(yī)學(xué)關(guān)于頸椎病的分型診療研究,其科學(xué)術(shù)式的研究和臨床操作的規(guī)范,將有待進(jìn)一步的研究。3.通過壓痛點(diǎn)組和術(shù)式組的臨床資料分析,兩種治療方法對(duì)改善頸椎病的臨床癥狀均有明顯的療效。從臨床療效、CASCS總積分和MPQ積分的評(píng)價(jià)分析,“T”形針刀整體松解術(shù)無論是在近期還是遠(yuǎn)期療效上,都明顯優(yōu)于壓痛點(diǎn)組,且術(shù)式組的遠(yuǎn)期效果好于近期療效;壓痛點(diǎn)組雖然遠(yuǎn)期療效也優(yōu)于近期療效,但是從CASCS主觀癥狀積分來看,患者對(duì)遠(yuǎn)期和近期療效的主觀判斷并無改變,提示我們針對(duì)頸椎病的治療,不能過于依賴客觀檢查和臨床體征,而要更加的重視患者本人的主觀癥狀改善程度。
[Abstract]:Objective: To study the pathogenesis and pathological framework of cervical spondylosis by using the basic theory of acupotomy, based on which "T" shaped Acupotomy was set up to observe the therapeutic effect of this method in the treatment of cervical spondylosis, and to evaluate the clinical application value of "T" shaped Acupotomy as a whole. 1. The basic theory of the anatomy system of human body and the mechanics pathological frame "mesh theory", imitate the structure and the force mode of the bow and arrow, combine the biomechanics and the human anatomy, reconstruct the motion model of the mechanical anatomy system of the neck segment, and analyze the pathogenesis and pathological frame of the cervical spondylosis, and Study on this basis. 60 patients with cervical spondylosis treated by "T" shaped Acupotomy (.2.) were randomly divided into 60 cases of cervical spondylosis treated in the Department of needle knife department from September 2014 to December 2016. According to the proportion of 1:1, they were randomly divided into the pain point group (30 cases) and the operation group (30 cases). The pain point group was treated with the Acupotomy point in the pain point group, and the operation group adopted the "T" shaped needle. The clinical efficacy of the two groups was observed before the operation, 2 weeks after the operation and 3 months after the operation. The clinical evaluation scale of the cervical spondylosis (CASCS) and the simplified Mc Gi LL pain scale (SF-MPQ) were used as evaluation indexes. The results of the short-term and long-term effects of the two groups were evaluated based on the data of the software, and the results of the study: 1. neck segment force. Anatomical system model. Arch: occipital bone, cervical spine, scapula. Chord: strings attached to the arch of soft tissue. (1) muscle: trapezius muscle; scapula muscle; rhombus muscle; erector muscle; vertebral occipital muscle; cervical spinous muscle; cervical spinous muscle; interspinous muscle; intertransverse muscle; sternocleidomastoid; 2) ligament; ligament; interspinous ligament; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; interspinous ligaments; interspinous ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; interspinous ligaments; interspinous ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; ligaments; interspinous ligaments; interspinous ligaments; ligaments; yellowish toughened ligaments Band; intertransverse ligaments; articular capsule ligaments; anterior longitudinal ligaments and posterior longitudinal ligaments. (3) fascia: cervical inherent fascia; visceral fascia and cervical vascular sheath. (4) auxiliary device: cervical nerve,.2. cervical spondylosis of the neck; first of all, the superficial ligament, interspinous ligament, trapezius muscle, and other soft tissues of the cervical spine mechanical anatomy system, because of the soft tissue such as the interspinous ligament, the trapezius muscle, and so on. Chronic injury caused by long-term bad posture and other causes leads to abnormal stress of soft tissue. If the human body can not be repaired in time, the damage is long and the order of deep soft tissue, such as the trapezius muscle, the splinters, the occipital muscle group, the muscle of the scapula, and other soft tissues, is finally formed in the beginning of the soft tissues. The cross section of the bow string is a point; the cross section of the walking path of the soft tissues (the central part of the chord stress) is a line; the study of the holistic loosening of the.3. "T" shaped Acupotomy of the three-dimensional network like pathological framework of the soft tissues is the material basis of the mechanical anatomy system model of the cervical segment of the bow string and the three-dimensional network of the disease based on the above content. To determine the specific site of acupotomy, the transverse line of "T" is 5 points, on the lower edge of the occipital border, the middle point of the occipital protuberance, the outer occipital protuberance to the left, the right side of the occipital protuberance to the left, the right side open 2.5cm and 5cm on the right side, the vertical line of 6 points, and the apex of the C2~C7 spinous process. The 5 points and the vertical lines of the transverse line are connected by 6 points. It is similar to the letter "T". Therefore, it is called "T" shaped Acupotomy for the overall release of.4. through the follow-up of two groups of patients 3 months after operation, the healing rate is 80%, the total effective rate is 96.67%, obviously higher than the pressure pain point group, and the difference has statistical significance (0.05). Two groups of patients, 2 weeks after the operation, and 3 months after the Surgery score comparison, pressure pain. The difference was statistically significant between the 2 weeks after the operation and the preoperative SF-MPQ score (0.05). The difference was statistically significant between 3 months after the operation and 2 weeks after the operation. The difference was statistically significant (0.05) at 2 weeks after the operation (0.05) and 3 months after the operation and 2 weeks after the operation (0.05). At the same time, the difference was statistically significant. 2 weeks after the operation and 3 months after the operation, the SF-MPQ score of the group was compared with the group of pressure pain, and the difference was 0.05. The difference was statistically significant. The total score of CASCS was obviously improved (0.05), and the total score of the group was significantly improved (0.05) after the operation, after the operation and 3 months after the operation, and in the 3 months after the operation (0.05). 2 weeks after operation, the improvement degree of the 3 months after operation was better than that of the pressure pain point group (0.05). But, in the subjective symptom score of CASCS, the score of the pain point group was 3 months after the operation and 2 weeks after the operation. The difference was not statistically significant, but the difference was statistically significant 3 months after the operation of the operation group and 2 weeks after the operation, and the difference was statistically significant. The conclusion of the study: 1. cervical spondylosis. The main factor is the imbalance of force balance in the mechanical anatomy system of the cervical segment. The pathological process is first of all the soft tissues around the neck (muscles, ligaments, fascia, joint capsule) due to various factors such as incorrect posture, chronic strain, and so on. Joint injury. The damaged soft tissue is self compensatory and self regulating through adhesion, scar, contracture, and clogging. If compensation fails, the body starts second sets of compensatory systems, that is, hardening, calcification, and ossification. This is the osteogeny or bone spur on the X slices. If the abnormal stress of the chord is still not compensable, it will form a soft tissue. The starting position (the joint of the bow string) is a point; the walking path of each soft tissue is a line; the soft tissue is covered with a three-dimensional three-dimensional network pathological framework. Finally, it leads to the imbalance of the force balance of the mechanical anatomy system of the cervical segment, causing the pain, stiffness and blood vessels of the soft tissue, the compression of the nerves, and other clinical manifestations and signs. We can obtain the distribution of the pressure and pain points of the cervical spondylosis, so as to formulate a standardized clinical basic operation to promote the modernization of needle knife medicine, scientific and standardized development of.2. based on the anatomy system of the cervical segment and the three-dimensional network of cervical spondylosis. The early stage of cervical spondylosis can be classified as chronic soft. Therefore, in the early treatment of cervical spondylosis, it is necessary to follow the occurrence of chronic soft tissue injury, the law of development, and the treatment of chronic soft tissue injury. In the development period of cervical spondylosis, the human body starts second sets of compensatory systems, that is, hardening, calcification and ossification to further the abnormal stress. When it is compensatory, that is, the appearance of hyperosteogeny in imaging, it is also necessary to start with the restoration of the soft tissue force balance of the mechanical anatomy system of the cervical segment. Thus, the study of the classification of the cervical spondylosis by Acupotomy can be preliminarily explored. The academic research and the standard of clinical operation in the Department of acupuncture will be further studied by.3. through the pressure pain. The clinical data of the point group and the operation group were analyzed. The two treatments had obvious effect on improving the clinical symptoms of cervical spondylosis. From the clinical effect, the total score of CASCS and the evaluation of the MPQ integral, the "T" shape Acupotomy was obviously superior to the pressure pain point group in both the short term and the long term effect, and the long-term effect of the operation group was better. It is better than the short-term effect. Although the pain point group is better than the short-term effect, the subjective judgment of the long-term and recent curative effect is not changed from the CASCS subjective symptom score. It suggests that we should not rely too much on the objective examination and clinical signs for the treatment of cervical spondylosis, but we should pay more attention to the subjective symptoms of the patient. The degree of improvement.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R246.9

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 肖紅;;針刀松解法對(duì)膝骨性關(guān)節(jié)炎兔軟骨基質(zhì)金屬蛋白酶-3和Ⅱ型膠原蛋白表達(dá)的影響[J];上海針灸雜志;2016年11期

2 饒子龍;劉芳;宋南昌;;基于激痛點(diǎn)理論應(yīng)用針刀治療頸型頸椎病40例[J];中國針灸;2016年11期

3 李煜漢;;混合型頸椎病患者中醫(yī)針?biāo)幒嫌玫呐R床療效[J];深圳中西醫(yī)結(jié)合雜志;2016年20期

4 張?zhí)烀?張強(qiáng);;針刀醫(yī)學(xué)對(duì)阿是穴的認(rèn)識(shí)[J];中國針灸;2016年07期

5 李敏;李開平;田彎彎;;“川”字針刀松解術(shù)治療椎動(dòng)脈型頸椎病的臨床觀察[J];中國中醫(yī)基礎(chǔ)醫(yī)學(xué)雜志;2016年06期

6 張強(qiáng);張?zhí)烀?;針刀醫(yī)學(xué)對(duì)肩周炎立體網(wǎng)絡(luò)狀病理構(gòu)架的分析[J];針灸臨床雜志;2016年04期

7 郭永林;;針刀頸部閉合松解治療神經(jīng)根型頸椎病32例臨床觀察[J];湖南中醫(yī)雜志;2016年03期

8 姜紅月;王小瓊;;某三甲醫(yī)院2012年-2014年頸椎病住院患者臨床流行病學(xué)特征分析[J];中國病案;2016年03期

9 韋英成;吳肖梅;梁曉行;姜炳毅;覃喜揚(yáng);;針刀滅活肌筋膜觸發(fā)點(diǎn)術(shù)結(jié)合復(fù)合扳法治療椎動(dòng)脈型頸椎病療效觀察[J];中國中醫(yī)急癥;2016年03期

10 周華茂;唐小容;;五針法針刀閉合松解術(shù)治療頸椎病的療效觀察[J];湖北中醫(yī)雜志;2016年02期

相關(guān)博士學(xué)位論文 前4條

1 金英利;針刀對(duì)KOA兔韌帶力學(xué)改變及韌帶膠原相關(guān)因子基因蛋白表達(dá)的影響研究[D];北京中醫(yī)藥大學(xué);2014年

2 肖紅;針刀松解法對(duì)膝骨關(guān)節(jié)炎兔軟骨基質(zhì)Col-Ⅱ、Aggrecan基因及蛋白表達(dá)的影響[D];北京中醫(yī)藥大學(xué);2013年

3 劉福水;針刀干預(yù)對(duì)頸椎病兔頸后伸肌細(xì)胞凋亡的影響[D];北京中醫(yī)藥大學(xué);2012年

4 鐘鼎文;針刀松解法對(duì)頸椎病兔頸后肌纖維化影響的研究[D];北京中醫(yī)藥大學(xué);2012年

相關(guān)碩士學(xué)位論文 前7條

1 吳華國;多節(jié)段頸椎病—手術(shù)入路的選擇[D];山東大學(xué);2014年

2 黃永杰;頸椎病發(fā)病相關(guān)因素臨床分析[D];廣州中醫(yī)藥大學(xué);2014年

3 馬林;激痛點(diǎn)針刀治療神經(jīng)根型頸椎病的臨床觀察[D];廣州中醫(yī)藥大學(xué);2014年

4 王琳;針刀松解頸周腧穴治療椎動(dòng)脈型頸椎病臨床研究[D];山東中醫(yī)藥大學(xué);2013年

5 趙琬清;神經(jīng)根型頸椎病針刀微創(chuàng)治療探討[D];南京中醫(yī)藥大學(xué);2013年

6 齊丹丹;針刀治療肌筋膜疼痛綜合征的實(shí)驗(yàn)與臨床研究及機(jī)理探討[D];南京中醫(yī)藥大學(xué);2012年

7 李住閔;針刀松解法對(duì)第三腰椎橫突綜合征模型家兔SOD及TAC影響的實(shí)驗(yàn)研究[D];北京中醫(yī)藥大學(xué);2011年

，

本文編號(hào)：2036659