針刺商丘穴治療橈骨莖突狹窄性腱鞘炎的臨床研究
發(fā)布時間：2019-06-28 15:59
【摘要】：目的：橈骨莖突狹窄性腱鞘炎是臨床常見的慢性勞損性骨傷科病變,手工勞動者,尤以婦女好發(fā)本病,比如抱嬰者,清潔工等群體,腱鞘炎患病率高且易復(fù)發(fā),雖然不會有直接致命的風險,但是卻會帶給患者生活工作帶來諸多不便和極度痛苦,仍是不可忽視的嚴重病癥。開展本臨床試驗研究,探索橈骨莖突狹窄性腱鞘炎的治療方法,拓寬臨床治療思路,為治療該病提供更多的臨床和試驗依據(jù)。方法：以本人在所執(zhí)業(yè)新北市新店區(qū)易豐中醫(yī)診所、與固定支持門診的基隆市忠生中醫(yī)診所,新北市中和區(qū)的三大中醫(yī)診所、新北市中和區(qū)的世安中醫(yī)診所,以及桃園市大溪區(qū)的安泰中醫(yī)診所的門診病患為本課題病例來源。必須以連續(xù)以本病癥門診連續(xù)治療2個療程,而且每個療程連續(xù)治療6次為限的患者,方為有效病例樣本。把60例符合納入和排除標準的病例按照統(tǒng)計學(xué)要求分成2個組,每組有30例患者,局部取穴位和遠部取穴加以結(jié)合,分為2個療程,選用中國大陸國家中醫(yī)藥管理局《中醫(yī)病證診斷療效標準》(2002年)制定療效判定標準以及王文華、王恒斌等的《運用的臨床癥狀及體征分級記分標準》等成績判定標準評價療效。評價內(nèi)容包括休息痛、患側(cè)腫脹、壓痛、握拳尺偏試驗疼痛等4個項目做判定,并設(shè)定、制作橈骨莖突狹窄性腱鞘炎的療效評價表,并且統(tǒng)計治療效果。結(jié)果：實驗組和對照組兩組患者在性別、年齡、年齡構(gòu)成比、以及二者患病因素、病情嚴重分級上根據(jù)統(tǒng)計學(xué)檢測,結(jié)果表明無統(tǒng)計學(xué)差異(P0.05),具有可比性。治療療程結(jié)束后,兩種治療方法在對患者癥狀改善上二者無統(tǒng)計學(xué)差異,但是在實驗組30個病例中：治愈1例,顯效10例,有效19例,無效0例；而對照組30個病例中：治愈0例,顯效2例,有效24例,無效4例。治療前休息痛評分組間差異比較經(jīng)獨立樣本t檢驗,P=0.451,P0.05,兩組患者治療前休息痛比較差異無統(tǒng)計意義,具有可比性；治療后評分組間比較不符合方差齊性檢驗(F檢驗),采用非參數(shù)Kolmogorov-Smirnov檢驗,P=0.236,P0.05,表明兩組患者治療后休息痛評分差異無統(tǒng)計學(xué)意義。組內(nèi)差異比較,治療前后差異經(jīng)配對樣本t檢驗,P=0.00,P0.05,表明治療前后休息痛評分具有統(tǒng)計學(xué)意義。治療前患側(cè)腫脹評分組間差異比較經(jīng)獨立樣本t檢驗,P=0.608,P0.05,兩組患者治療前患側(cè)腫脹比較差異無統(tǒng)計意義,具有可比性；治療后評分組間比較不符合方差齊性檢驗(F檢驗),采用非參數(shù)Kolmogorov-Smirnov檢驗,P=0.998,P0.05,表明兩組患者治療后患側(cè)腫脹評分差異無統(tǒng)計學(xué)意義。組內(nèi)差異比較,治療前后差異經(jīng)配對樣本t檢驗,P=0.00,P0.05,表明治療前后患側(cè)腫脹評分具有統(tǒng)計學(xué)意義。治療前壓痛評分組間差異比較經(jīng)獨立樣本t檢驗,P=0.321,P0.05,兩組患者治療前壓痛比較差異無統(tǒng)計意義,具有可比性；治療后評分組間比較不符合方差齊性檢驗(F檢驗),采用非參數(shù)Kolmogorov-Smirnov檢驗,P=0.388,P0.05,表明兩組患者治療后壓痛評分差異無統(tǒng)計學(xué)意義。組內(nèi)差異比較,治療前后差異經(jīng)配對樣本t檢驗,P=0.00,P0.05,表明治療前后壓痛評分具有統(tǒng)計學(xué)意義。治療前握拳尺偏試驗評分組間差異比較經(jīng)獨立樣本t檢驗,P=0.608,P0.05,兩組患者治療前握拳尺偏試驗比較差異無統(tǒng)計意義,具有可比性；治療后評分組間比較不符合方差齊性檢驗(F檢驗),采用非參數(shù)Kolmogorov-Smirnov檢驗,P=0.586,P0.05,表明兩組患者治療后握拳尺側(cè)偏壓試驗評分差異無統(tǒng)計學(xué)意義。組內(nèi)差異比較,治療前后差異經(jīng)配對樣本t檢驗,P=0.00,P0.05,表明治療前后握拳尺偏試驗驗評分具有統(tǒng)計學(xué)意義。治療前總積分評分組間差異比較經(jīng)獨立樣本t檢驗,P=0.477,P0.05,兩組患者治療前總積分比較差異無統(tǒng)計意義,具有可比性；治療后評分組間比較符合方差齊性檢驗(F檢驗),經(jīng)獨立樣本t檢驗,P=0.063,P0.05,兩組患者治療后總積分比較差異無統(tǒng)計意義。組內(nèi)差異比較,治療前后差異經(jīng)配對樣本t檢驗,P=0.00,P0.05,表明治療前后總積分評分具有統(tǒng)計學(xué)意義。通過對兩組功能的整體評估,實驗組治療前總積分為279分,治療后總積分為116分,下降的總積分為163分,總平均由治療前的9.300,在兩個療程后則降至3.800分,平均總差距是5.500分；對照組治療前總積分為268分,治療后總積分為154分,下降的總積分為114分,總平均由治療前的8.933分,在兩個療程后則降至5.267分,平均總差距是3.666分。在視覺模擬評分法(VAS)治療前后的評分差距：在休息痛方面,實驗組是1.600±0.498)分,對照組是(1.100±0.305)分；在患側(cè)腫脹方面,實驗組是1.067±0.254)分,對照組是(0.800±0.484)分；在壓痛方面,實驗組是(1.500±0.507分,對照組是(1.067±0.254)分；在握拳尺偏試驗方面,實驗組是1.267±0.450分,對照組是(0.833±0.379)分；而以上四項的總和差距,實驗組是5.433±1.194分,對照組是(3.800±0.925)分。在療效方面：實驗組樣本30例,其中痊愈1例,占3.33%,顯效10例,占33.33%,有效19例,占63.33%,無效0例,占0%,總有效率100%；而組樣本30例,其中痊愈0例,0%,顯效2例,占6.67%,有效24例,占80%,無效4例,占13.33%,總有效率86.67%發(fā)現(xiàn)治療后兩組的各項積分和治療前相比,皆有明顯的下降但是實驗組下降的積分以及平均分數(shù)皆明顯多于對照組,差異有統(tǒng)計學(xué)意義(P0.05)。提示針刺商丘穴遠道取穴針刺法與局部取穴針刺法更能緩解患處腕關(guān)節(jié)休息痛、患側(cè)腫脹、壓痛、握拳尺偏試驗疼痛。結(jié)論：兩種治療都是治療橈骨莖突狹窄性腱鞘炎的有效方式,無論在改善患處腕關(guān)節(jié)休息痛、患側(cè)腫脹、壓痛、握拳尺偏試驗方面,皆可見到效果,但是實驗組的總體療效更佳,一定程度而言,商丘穴針刺這種遠處用穴位比單純的手腕局部針刺的方法療效更好。
[Abstract]:Objective: The osteopathyous tendinous tendonitis is a common chronic strain of the bone injury of the chronic strain. The manual worker, especially the women's disease, such as the infant, the cleaner and other groups, the prevalence of the tendinous aponeurosis is high and the recurrence is easy, although there is no direct and fatal risk, But it will bring the patient's life to work with many inconveniences and extreme pain, and it is still a serious condition that can't be ignored. The clinical trial was carried out to explore the treatment of the stenoses of the stenoses of the stem of the bone and to broaden the thinking of clinical treatment and to provide more clinical and experimental basis for the treatment of the disease. Method: I am in the Yi Feng Chinese Medicine Clinic in Xindian District, Xinbei City, and the three traditional Chinese medicine clinics in the middle and middle areas of Xinbei City and the Shian Traditional Chinese Medicine Clinic in the middle and middle areas of Xinbei City. And the outpatient department of the Antai Traditional Chinese Medicine Clinic in the Daxi District of Taoyuan City is the source of the subject. It is necessary to continuously treat 2 courses of treatment in the outpatient clinic in a continuous condition, and each treatment course will be treated continuously for 6 times with a limited number of patients, which is an effective case sample. The cases with the inclusion and exclusion criteria were divided into two groups according to the statistical requirements. The evaluation criteria for clinical symptoms and signs, such as Wang Wenhua, Wang Hengbin, etc., and the criteria for grading and scoring of clinical symptoms and signs, such as Wang Wenhua and Wang Hengbin and the like, were selected and evaluated according to the criteria for clinical symptoms and physical signs and scores of clinical symptoms and signs in the Chinese mainland China National Center for Traditional Chinese Medicine (TCM). The evaluation contents included four items, such as rest pain, swelling of the affected side, tenderness, and test pain of the hand, and set up the evaluation table of the curative effect of the osteopathytis of the stem of the bone, and the effect of the treatment was statistically analyzed. Results: There was no statistical difference between the two groups in the experimental group and the control group (P <0.05). After the treatment course was over, there was no statistical difference between the two treatment methods in the improvement of the symptoms of the patient, but in the 30 cases of the experimental group,1 case was cured,10 cases were effective,19 cases were effective,0 cases were not valid, and 30 cases of the control group:0 cases were cured,2 cases were effective, and 24 cases were effective. Invalid 4 cases. The difference between the pre-treatment and the rest pain scores was compared with the independent sample t test, P = 0.451, P0.05, the difference of the rest pain in the two groups was not statistically significant, and it was comparable; the comparison between the post-treatment score groups did not accord with the non-parametric test (F test), and the non-parametric Kolmogorov-Smirnov test was used, P = 0.236, P0.05, There was no significant difference in the scores of the rest pain scores after the treatment of the two groups. The difference of the intra-group and the before-and-after-treatment difference was tested by the paired sample t, P = 0.00, P <0.05, indicating that the score of the rest pain before and after treatment was of statistical significance. The difference between the two groups was compared with that of the independent sample t, P = 0.608, P <0.05, the difference between the two groups was not statistically significant, and the difference between the two groups was not statistically significant. The non-parametric Kolmogorov-Smirnov test, P = 0.998, was used to test the difference between the two groups. The results showed that there was no statistical significance between the two groups of patients with the side swelling scores after treatment. The difference in the group was compared with that of the paired samples t before and after treatment, P = 0.00, P <0.05, indicating the statistical significance of the side swelling scores after treatment. The difference between the pre-treatment scoring groups was compared with the independent sample t test, P = 0.321, P0.05, the difference of the pre-treatment pressure pain of the two groups was not statistically significant, and it was comparable; the comparison between the post-treatment score groups did not accord with the non-parametric test (F test), and the non-parametric Kolmogorov-Smirnov test was used, P = 0.388, P0.05, It was shown that there was no statistical significance between the two groups of patients after treatment. The difference of the intra-group and the before-and-after-treatment difference was tested by the paired samples t, P = 0.00, P <0.05, indicating the statistical significance of the pre-and post-treatment pressure pain scores. The difference between the pre-treatment score and the pre-treatment score group was compared with the independent sample t test, P = 0.608, P0.05, and the difference between the two groups in the pre-treatment group was not statistically significant, and it was comparable; the comparison between the post-treatment score groups did not accord with the self-alignment test (F test). The non-parametric Kolmogorov-Smirnov test, P = 0.586, P 0.05, showed no statistical significance in the difference of the test scores between the two groups. In group, the difference of pre-treatment and post-treatment was tested by paired sample t, P = 0.00, P <0.05, indicating that the pre-and post-treatment pre-and post-treatment scores were of statistical significance. The difference between the pre-treatment total score scores was compared with the independent sample t test, P = 0.477, P0.05, the difference of the total score of the two groups was not statistically significant, and the difference between the two groups was comparable; the comparison of the post-treatment score groups was in accordance with the homogeneity test (F test), and tested by the independent sample t, P = 0.063, P0.05, The difference of total score of the two groups was not statistically significant. The difference of the intra-group and the post-treatment difference was tested by the paired samples t, P = 0.00, P <0.05, indicating the statistical significance of the total score before and after treatment. The total score of the two groups was 279, the total score of the total score was 116, the total score of the decrease was 163, the total score was 9.300 before the treatment, and the total score of the decrease was 3.800, the average total difference was 5.500, and the total score before treatment in the control group was 268. After the treatment, the total score was 154 points, the total score of the reduction was 114 points, the total average was 8.933 points before treatment, and the total score decreased to 5.267 points after the two treatment courses, and the average total difference was 3.666 points. The scoring gap before and after the treatment of visual analogue scale (VAS): in the aspect of rest pain, the experimental group was 1.600 (0.498), and the control group was (1.100, 0.305); in the aspect of swelling of the affected side, the experimental group was 1.067 (0.254), and the control group was (0.800-0.484); in the aspect of tenderness, The experimental group was (1.500-0.507), the control group was (1.067-0.254), and the experimental group was 1.267-0.450, the control group was (0.833-0.379), and the total difference of the above four groups was 5.433-1.194 and the control group was (3.800-0.925). In the treatment group,30 cases were cured,1 case recovered, 3.33%,10 cases markedly effective, 33.33%, effective 19 cases, 63.33%, invalid 0 cases,0%, total effective rate 100%, and 30 cases of group samples, including 0,0%,2 cases, 6.67%, effective 24 cases. The total effective rate was 86.67%, the total effective rate was 86.67%, and the scores of the two groups were significantly lower than that of the control group (P <0.05). It is suggested that the acupuncture method and the local point-taking acupuncture method can relieve the rest pain of the wrist joint of the affected part, the swelling of the affected side, the pain of the affected part and the pain of the hand-holding device. Conclusion: The two kinds of treatment are effective in the treatment of the narrow tendinous tendinous tendinous inflammation, and the effect can be seen in the aspects of improving the rest pain of the wrist joint of the affected part, the swelling of the affected side, the tenderness of the affected part and the test of the exercise of the fist, but the overall curative effect of the experimental group is better, and in a certain degree, The point of acupuncture at the Shangqiu point is better than that of the simple wrist local acupuncture.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R246.9
本文編號：2507430
[Abstract]:Objective: The osteopathyous tendinous tendonitis is a common chronic strain of the bone injury of the chronic strain. The manual worker, especially the women's disease, such as the infant, the cleaner and other groups, the prevalence of the tendinous aponeurosis is high and the recurrence is easy, although there is no direct and fatal risk, But it will bring the patient's life to work with many inconveniences and extreme pain, and it is still a serious condition that can't be ignored. The clinical trial was carried out to explore the treatment of the stenoses of the stenoses of the stem of the bone and to broaden the thinking of clinical treatment and to provide more clinical and experimental basis for the treatment of the disease. Method: I am in the Yi Feng Chinese Medicine Clinic in Xindian District, Xinbei City, and the three traditional Chinese medicine clinics in the middle and middle areas of Xinbei City and the Shian Traditional Chinese Medicine Clinic in the middle and middle areas of Xinbei City. And the outpatient department of the Antai Traditional Chinese Medicine Clinic in the Daxi District of Taoyuan City is the source of the subject. It is necessary to continuously treat 2 courses of treatment in the outpatient clinic in a continuous condition, and each treatment course will be treated continuously for 6 times with a limited number of patients, which is an effective case sample. The cases with the inclusion and exclusion criteria were divided into two groups according to the statistical requirements. The evaluation criteria for clinical symptoms and signs, such as Wang Wenhua, Wang Hengbin, etc., and the criteria for grading and scoring of clinical symptoms and signs, such as Wang Wenhua and Wang Hengbin and the like, were selected and evaluated according to the criteria for clinical symptoms and physical signs and scores of clinical symptoms and signs in the Chinese mainland China National Center for Traditional Chinese Medicine (TCM). The evaluation contents included four items, such as rest pain, swelling of the affected side, tenderness, and test pain of the hand, and set up the evaluation table of the curative effect of the osteopathytis of the stem of the bone, and the effect of the treatment was statistically analyzed. Results: There was no statistical difference between the two groups in the experimental group and the control group (P <0.05). After the treatment course was over, there was no statistical difference between the two treatment methods in the improvement of the symptoms of the patient, but in the 30 cases of the experimental group,1 case was cured,10 cases were effective,19 cases were effective,0 cases were not valid, and 30 cases of the control group:0 cases were cured,2 cases were effective, and 24 cases were effective. Invalid 4 cases. The difference between the pre-treatment and the rest pain scores was compared with the independent sample t test, P = 0.451, P0.05, the difference of the rest pain in the two groups was not statistically significant, and it was comparable; the comparison between the post-treatment score groups did not accord with the non-parametric test (F test), and the non-parametric Kolmogorov-Smirnov test was used, P = 0.236, P0.05, There was no significant difference in the scores of the rest pain scores after the treatment of the two groups. The difference of the intra-group and the before-and-after-treatment difference was tested by the paired sample t, P = 0.00, P <0.05, indicating that the score of the rest pain before and after treatment was of statistical significance. The difference between the two groups was compared with that of the independent sample t, P = 0.608, P <0.05, the difference between the two groups was not statistically significant, and the difference between the two groups was not statistically significant. The non-parametric Kolmogorov-Smirnov test, P = 0.998, was used to test the difference between the two groups. The results showed that there was no statistical significance between the two groups of patients with the side swelling scores after treatment. The difference in the group was compared with that of the paired samples t before and after treatment, P = 0.00, P <0.05, indicating the statistical significance of the side swelling scores after treatment. The difference between the pre-treatment scoring groups was compared with the independent sample t test, P = 0.321, P0.05, the difference of the pre-treatment pressure pain of the two groups was not statistically significant, and it was comparable; the comparison between the post-treatment score groups did not accord with the non-parametric test (F test), and the non-parametric Kolmogorov-Smirnov test was used, P = 0.388, P0.05, It was shown that there was no statistical significance between the two groups of patients after treatment. The difference of the intra-group and the before-and-after-treatment difference was tested by the paired samples t, P = 0.00, P <0.05, indicating the statistical significance of the pre-and post-treatment pressure pain scores. The difference between the pre-treatment score and the pre-treatment score group was compared with the independent sample t test, P = 0.608, P0.05, and the difference between the two groups in the pre-treatment group was not statistically significant, and it was comparable; the comparison between the post-treatment score groups did not accord with the self-alignment test (F test). The non-parametric Kolmogorov-Smirnov test, P = 0.586, P 0.05, showed no statistical significance in the difference of the test scores between the two groups. In group, the difference of pre-treatment and post-treatment was tested by paired sample t, P = 0.00, P <0.05, indicating that the pre-and post-treatment pre-and post-treatment scores were of statistical significance. The difference between the pre-treatment total score scores was compared with the independent sample t test, P = 0.477, P0.05, the difference of the total score of the two groups was not statistically significant, and the difference between the two groups was comparable; the comparison of the post-treatment score groups was in accordance with the homogeneity test (F test), and tested by the independent sample t, P = 0.063, P0.05, The difference of total score of the two groups was not statistically significant. The difference of the intra-group and the post-treatment difference was tested by the paired samples t, P = 0.00, P <0.05, indicating the statistical significance of the total score before and after treatment. The total score of the two groups was 279, the total score of the total score was 116, the total score of the decrease was 163, the total score was 9.300 before the treatment, and the total score of the decrease was 3.800, the average total difference was 5.500, and the total score before treatment in the control group was 268. After the treatment, the total score was 154 points, the total score of the reduction was 114 points, the total average was 8.933 points before treatment, and the total score decreased to 5.267 points after the two treatment courses, and the average total difference was 3.666 points. The scoring gap before and after the treatment of visual analogue scale (VAS): in the aspect of rest pain, the experimental group was 1.600 (0.498), and the control group was (1.100, 0.305); in the aspect of swelling of the affected side, the experimental group was 1.067 (0.254), and the control group was (0.800-0.484); in the aspect of tenderness, The experimental group was (1.500-0.507), the control group was (1.067-0.254), and the experimental group was 1.267-0.450, the control group was (0.833-0.379), and the total difference of the above four groups was 5.433-1.194 and the control group was (3.800-0.925). In the treatment group,30 cases were cured,1 case recovered, 3.33%,10 cases markedly effective, 33.33%, effective 19 cases, 63.33%, invalid 0 cases,0%, total effective rate 100%, and 30 cases of group samples, including 0,0%,2 cases, 6.67%, effective 24 cases. The total effective rate was 86.67%, the total effective rate was 86.67%, and the scores of the two groups were significantly lower than that of the control group (P <0.05). It is suggested that the acupuncture method and the local point-taking acupuncture method can relieve the rest pain of the wrist joint of the affected part, the swelling of the affected side, the pain of the affected part and the pain of the hand-holding device. Conclusion: The two kinds of treatment are effective in the treatment of the narrow tendinous tendinous tendinous inflammation, and the effect can be seen in the aspects of improving the rest pain of the wrist joint of the affected part, the swelling of the affected side, the tenderness of the affected part and the test of the exercise of the fist, but the overall curative effect of the experimental group is better, and in a certain degree, The point of acupuncture at the Shangqiu point is better than that of the simple wrist local acupuncture.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R246.9
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