按揉膝关节配合常规针刺治疗腰椎椎管狭窄症的临床观察

发布时间：2018-09-18 13:06

【摘要】：目的根据导师在临床上多年的经验,在治疗腰椎管狭窄症患者的过程中,发现按揉膝关节配合针刺治疗腰椎管狭窄症患者有较好的疗效。因此,本实验通过观察按揉膝关节配合常规针刺治疗腰椎管狭窄症患者的临床疗效、体征的改善情况,初步的探讨这种方法治疗腰椎管狭窄症的作用机理,为治疗腰椎管狭窄症提供一种新的安全有效的非手术途径。方法根据中华中医药学会的腰椎椎管狭窄症诊断标准,将湖北中医药大学附属国医堂门诊收治病人中,以腰腿痛、间歇性跛行为主要表现的腰椎椎管狭窄症患者纳入研究。将2014年5月至2016年1月就诊的腰椎管狭窄患者60例,随机分为针刺组(A组)、推拿组(B组)和按揉配合针刺组(C组),每组各20例。针刺组(A组)采用常规针刺法,选取双侧腰3~腰5的华佗夹脊穴、委中、合阳、承山、阿是穴。推拿组(B组)采用点、按、揉、拨等推拿手法,重点在腰部及双下肢有条索、结节的部位及疼痛反应点行揉拨法。按揉结合针刺组(C组)综合按揉膝关节治疗与常规针刺治疗的方法。针刺组和推拿组每次操作时间为30min,隔1天治疗1次,6次为1个疗程。按揉结合针刺组每次针刺20min,推拿10min,隔1天治疗1次,6次为1个疗程。观察治疗前后腰部疼痛VAS评分及J OA评分,数据进行统计学分析,并做三组间比较。比较三种方案在腰椎管狭窄症患者的VAS评分,JOA评分变化。比较上述治疗方法的效果差异。结果(1)A组治疗前后VAS评分,JOA评分比较,经配对t检验,P0.05,具有统计学差异。说明治疗后,患者的症状、体征方面有改善。(2)B组治疗前后VAS评分,JOA评分比较,经配对t检验,P0.05,具有统计学差异。说明治疗后,患者的症状、体征方面有改善。(3)C组治疗前后VAS评分,JOA评分比较,经配对t检验,P0.05,具有统计学差异。说明治疗后,患者的症状、体征方面有明显改善。(4)在治疗后,A组、B组、C组之间进行组间比较VAS评分,经方差分析,PAC0.05,PBC0.05,有统计学差异,说明C组治疗方法对于疼痛方面的改善明显要优于A组和B组。(5)在治疗后,A组、B组、C组之间进行组间比较JOA评分,经方差分析,PAC0.05,PBC0.05,有统计学差异,说明C组治疗方法对于症状体征方面的改善明显要优于A组和B组。结论研究结果显示,常规针刺治疗、推拿治疗和按揉膝关节配合针刺治疗腰椎管狭窄症的患者都有较好的疗效。在VAS评分和J OA评分上按揉膝关节配合常规针刺治疗腰椎管狭窄症患者的变化要比针刺组和推拿组明显。本次课题为治疗腰椎管狭窄症提供了一个新的思路,值得临床进一步研究。
[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.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.9

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