按揉膝關(guān)節(jié)配合常規(guī)針刺治療腰椎椎管狹窄癥的臨床觀察
發(fā)布時間：2018-09-18 13:06
【摘要】：目的根據(jù)導師在臨床上多年的經(jīng)驗,在治療腰椎管狹窄癥患者的過程中,發(fā)現(xiàn)按揉膝關(guān)節(jié)配合針刺治療腰椎管狹窄癥患者有較好的療效。因此,本實驗通過觀察按揉膝關(guān)節(jié)配合常規(guī)針刺治療腰椎管狹窄癥患者的臨床療效、體征的改善情況,初步的探討這種方法治療腰椎管狹窄癥的作用機理,為治療腰椎管狹窄癥提供一種新的安全有效的非手術(shù)途徑。方法根據(jù)中華中醫(yī)藥學會的腰椎椎管狹窄癥診斷標準,將湖北中醫(yī)藥大學附屬國醫(yī)堂門診收治病人中,以腰腿痛、間歇性跛行為主要表現(xiàn)的腰椎椎管狹窄癥患者納入研究。將2014年5月至2016年1月就診的腰椎管狹窄患者60例,隨機分為針刺組(A組)、推拿組(B組)和按揉配合針刺組(C組),每組各20例。針刺組(A組)采用常規(guī)針刺法,選取雙側(cè)腰3~腰5的華佗夾脊穴、委中、合陽、承山、阿是穴。推拿組(B組)采用點、按、揉、撥等推拿手法,重點在腰部及雙下肢有條索、結(jié)節(jié)的部位及疼痛反應點行揉撥法。按揉結(jié)合針刺組(C組)綜合按揉膝關(guān)節(jié)治療與常規(guī)針刺治療的方法。針刺組和推拿組每次操作時間為30min,隔1天治療1次,6次為1個療程。按揉結(jié)合針刺組每次針刺20min,推拿10min,隔1天治療1次,6次為1個療程。觀察治療前后腰部疼痛VAS評分及J OA評分,數(shù)據(jù)進行統(tǒng)計學分析,并做三組間比較。比較三種方案在腰椎管狹窄癥患者的VAS評分,JOA評分變化。比較上述治療方法的效果差異。結(jié)果(1)A組治療前后VAS評分,JOA評分比較,經(jīng)配對t檢驗,P0.05,具有統(tǒng)計學差異。說明治療后,患者的癥狀、體征方面有改善。(2)B組治療前后VAS評分,JOA評分比較,經(jīng)配對t檢驗,P0.05,具有統(tǒng)計學差異。說明治療后,患者的癥狀、體征方面有改善。(3)C組治療前后VAS評分,JOA評分比較,經(jīng)配對t檢驗,P0.05,具有統(tǒng)計學差異。說明治療后,患者的癥狀、體征方面有明顯改善。(4)在治療后,A組、B組、C組之間進行組間比較VAS評分,經(jīng)方差分析,PAC0.05,PBC0.05,有統(tǒng)計學差異,說明C組治療方法對于疼痛方面的改善明顯要優(yōu)于A組和B組。(5)在治療后,A組、B組、C組之間進行組間比較JOA評分,經(jīng)方差分析,PAC0.05,PBC0.05,有統(tǒng)計學差異,說明C組治療方法對于癥狀體征方面的改善明顯要優(yōu)于A組和B組。結(jié)論研究結(jié)果顯示,常規(guī)針刺治療、推拿治療和按揉膝關(guān)節(jié)配合針刺治療腰椎管狹窄癥的患者都有較好的療效。在VAS評分和J OA評分上按揉膝關(guān)節(jié)配合常規(guī)針刺治療腰椎管狹窄癥患者的變化要比針刺組和推拿組明顯。本次課題為治療腰椎管狹窄癥提供了一個新的思路,值得臨床進一步研究。
[Abstract]:Objective to find that the treatment of lumbar spinal stenosis by kneading knee joint combined with acupuncture has a good effect on the treatment of lumbar spinal stenosis according to the clinical experience of many years. Therefore, by observing the clinical curative effect and improvement of physical signs of patients with lumbar spinal canal stenosis treated by kneading knee joint and conventional acupuncture, we preliminarily discussed the mechanism of this method in treating lumbar spinal canal stenosis. To provide a new safe and effective non-operative approach for the treatment of lumbar spinal stenosis. Methods according to the diagnostic criteria of lumbar spinal canal stenosis of Chinese Academy of traditional Chinese Medicine, the patients with lumbar spinal stenosis, whose main manifestations were lumbago and leg pain and intermittent claudication, were included in the study. From May 2014 to January 2016, 60 patients with lumbar spinal stenosis were randomly divided into acupuncture group (group A), massage group (group B) and massage plus acupuncture group (group C) with 20 cases in each group. The acupuncture group (group A) was treated with conventional acupuncture. Huatuo Jiaji (3 ~ 5 waist) was selected as points of Huatuo Jiaji, Beizhong, Heyang, Chengshan and Ashi. Massage group (group B) used massage manipulation, such as point, press, knead, and so on. The emphasis was on the waist and lower extremities with stripes, nodule and pain response point. Massage combined with acupuncture group (group C) combined with kneading knee joint therapy and routine acupuncture treatment. The operation time of acupuncture group and massage group was 30 min. The group treated with massage and acupuncture for 20 minutes, massage for 10 minutes, treated once a day for 6 times as a course of treatment. The VAS score and J OA score of lumbar pain were observed before and after treatment, and the data were statistically analyzed and compared among the three groups. The changes of VAS score and VAS score in patients with lumbar spinal stenosis were compared. To compare the effect of the above methods. Results (1) before and after treatment, the VAS score and JOA score of group A were significantly different by paired t test (P0.05). After treatment, the symptoms and signs of the patients were improved. (2) the comparison of VAS scores before and after treatment in group B showed statistical difference by paired t test (P0.05). After treatment, the symptoms and signs of the patients were improved. (3) the comparison of VAS scores before and after treatment in group C showed statistical difference by paired t test (P0.05). After treatment, the symptoms and signs of the patients were significantly improved. (4) the scores of VAS were compared between groups A and B after treatment, and there was statistical difference between the two groups by ANOVA analysis of variance. The results showed that the improvement of pain in group C was better than that in group A and group B. (5) the scores of JOA were compared between group A and group B after treatment, and there was statistical difference between group A and group B by ANOVA analysis of variance. The results showed that the improvement of symptoms and signs in group C was better than that in group A and group B. Conclusion the results showed that the patients with lumbar spinal canal stenosis treated by routine acupuncture, massage and massage combined with acupuncture had better curative effect. The changes of VAS score and J OA score in patients with lumbar spinal canal stenosis treated by kneading knee joint combined with routine acupuncture were more obvious than those in acupuncture group and massage group. This project provides a new idea for the treatment of lumbar spinal stenosis and deserves further clinical study.
【學位授予單位】：湖北中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R246.9
本文編號：2248014
[Abstract]:Objective to find that the treatment of lumbar spinal stenosis by kneading knee joint combined with acupuncture has a good effect on the treatment of lumbar spinal stenosis according to the clinical experience of many years. Therefore, by observing the clinical curative effect and improvement of physical signs of patients with lumbar spinal canal stenosis treated by kneading knee joint and conventional acupuncture, we preliminarily discussed the mechanism of this method in treating lumbar spinal canal stenosis. To provide a new safe and effective non-operative approach for the treatment of lumbar spinal stenosis. Methods according to the diagnostic criteria of lumbar spinal canal stenosis of Chinese Academy of traditional Chinese Medicine, the patients with lumbar spinal stenosis, whose main manifestations were lumbago and leg pain and intermittent claudication, were included in the study. From May 2014 to January 2016, 60 patients with lumbar spinal stenosis were randomly divided into acupuncture group (group A), massage group (group B) and massage plus acupuncture group (group C) with 20 cases in each group. The acupuncture group (group A) was treated with conventional acupuncture. Huatuo Jiaji (3 ~ 5 waist) was selected as points of Huatuo Jiaji, Beizhong, Heyang, Chengshan and Ashi. Massage group (group B) used massage manipulation, such as point, press, knead, and so on. The emphasis was on the waist and lower extremities with stripes, nodule and pain response point. Massage combined with acupuncture group (group C) combined with kneading knee joint therapy and routine acupuncture treatment. The operation time of acupuncture group and massage group was 30 min. The group treated with massage and acupuncture for 20 minutes, massage for 10 minutes, treated once a day for 6 times as a course of treatment. The VAS score and J OA score of lumbar pain were observed before and after treatment, and the data were statistically analyzed and compared among the three groups. The changes of VAS score and VAS score in patients with lumbar spinal stenosis were compared. To compare the effect of the above methods. Results (1) before and after treatment, the VAS score and JOA score of group A were significantly different by paired t test (P0.05). After treatment, the symptoms and signs of the patients were improved. (2) the comparison of VAS scores before and after treatment in group B showed statistical difference by paired t test (P0.05). After treatment, the symptoms and signs of the patients were improved. (3) the comparison of VAS scores before and after treatment in group C showed statistical difference by paired t test (P0.05). After treatment, the symptoms and signs of the patients were significantly improved. (4) the scores of VAS were compared between groups A and B after treatment, and there was statistical difference between the two groups by ANOVA analysis of variance. The results showed that the improvement of pain in group C was better than that in group A and group B. (5) the scores of JOA were compared between group A and group B after treatment, and there was statistical difference between group A and group B by ANOVA analysis of variance. The results showed that the improvement of symptoms and signs in group C was better than that in group A and group B. Conclusion the results showed that the patients with lumbar spinal canal stenosis treated by routine acupuncture, massage and massage combined with acupuncture had better curative effect. The changes of VAS score and J OA score in patients with lumbar spinal canal stenosis treated by kneading knee joint combined with routine acupuncture were more obvious than those in acupuncture group and massage group. This project provides a new idea for the treatment of lumbar spinal stenosis and deserves further clinical study.
【學位授予單位】：湖北中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R246.9
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