【作者】 李晓峰；

【导师】 贾春生；

【作者基本信息】 河北医科大学 ， 针灸推拿学， 2008， 硕士

【摘要】 目的:颈椎病是颈椎间盘组织退行性变及其继发病理改变累及周围组织结构(神经根、脊髓、椎动脉、交感神经等)而出现相应临床症状的疾病。颈、肩、背部酸痛不适甚至剧痛为其主要的临床表现。随着社会老龄化,人们的工作和生活方式的改变,现代社会生活节奏加快,电视、电脑、空调等电器的广泛应用,颈椎病的发病率较前有明显的提高,已成为影响青、中、老年人的常见病、多发病。该病已成为与现代社会发展相伴随的一种现代病,严重威胁着人类的生存质量和健康水平。专家们预测,该病将成为与现代社会发展相伴随的一种现代病,在整个脊柱病的临床与实验研究方面,颈椎病将取代以体力劳动为主要诱因的腰腿痛而上升为骨伤科临床的主要疾病,因而对其进行防治已成为热点的攻关课题之一。而对本病目前尚无特效疗法。长期的临床实践证明,针刺疗法对本病疗效显著,针灸具有镇痛的特性,尤其对患者疼痛等诸多症状的改善,有其独特的优势。耳针镇痛是耳针作用的一大特点,耳穴针刺也已经广泛应用于颈椎病临床治疗。吾师贾春生教授在多年的临床实践中发现了耳针沿皮透刺刺法——这一比传统耳穴针刺的点状刺法操作更方便,疗效更佳的刺法。为了为临床提供一中更有效、快速、简便的镇痛方法,导师承担了河北省中医药管理局科研项目《耳针沿皮透穴刺法对多种外周性神经痛快速镇痛效应的应用研究》的研究工作,本课题为其中的一部分,旨在通过对比观察耳针沿皮透穴刺法与耳针直刺法对颈椎病所引起的诸多疼痛症状的快速镇痛效应,验证耳针沿皮透穴刺法对颈椎病有更好的快速镇痛效应,为耳针治疗颈椎病提供更好的刺法技术。方法:根据1994年全国颈椎病专题会桂林会议通过的颈椎病诊断标准、诊断分型(因本课题主要研究针刺在镇痛方面的效果,故只取颈型和神经根型颈椎病作为研究对象)、纳入标准、排除标准选择了98例颈椎病患者。被选的患者按照性别相同、年龄相近(规定45岁以下包括45岁为青年组、46岁以上为中老年组)、病型相同(颈型、神经根型)、病情(轻、中、重)同级4个重要的预后因素一一配对,采用随机分组的方法分到透穴组和直刺组。试验组采用耳针沿皮透穴刺法,即利用毫针从某一穴点刺入,沿着皮下与皮下软骨之间通达另一穴点,或从某一穴区的一端刺入,沿着皮下与皮下软骨之间通贯该穴区的全程的毫针刺法;对照组采用耳穴直刺法。进针后,用小幅度的捻转手法5～7下,留针期间可行此法2～3次,以加强针感。针毕后,即刻令患者活动患部,两组均留针30分钟。以简化McGill疼痛评分表(简化MPQ)对入选的全部病例进行治疗前和治疗后5分钟、30分钟疼痛程度的积分记录,将获得的透穴刺法和直刺法治疗前与治疗后的疼痛积分,以α=0.05作为假设检验的水准,分别采用质反应序贯试验、配对t检验和χ2检验的统计方法,用SPSS11.5统计软件进行统计学处理与分析,综上验证耳针沿皮透穴刺法比耳针直刺法有更好的快速镇痛效应。结果:两组患者在治疗前各项疼痛评分及不同性别、病型、年龄、和病情组的疼痛积分均衡性检验差别均无显著性(P>0.05),两组间具有可比性。序贯试验结果显示:透刺组与直刺组在针刺后5分钟镇痛效应差别无显著性,而在针刺后30分钟镇痛效应比较,疗效差别有显著性(P<0.05),透刺组的镇痛效应优于直刺组。配对t检验结果显示:(1)针刺后5分钟两组颈椎病患者各项疼痛评分比较,透刺组和直刺组患者的PRI情绪分、PRI感觉分、PRI总分、VAS评分、PPI评分及总积分比较均有统计学意义(P<0.01),疗效差别有显著性,透刺组的效果优于直刺组。(2)针刺后5分钟两种针刺方法对不同性别、不同病型、不同年龄、不同病情颈椎病患者的镇痛效果比较,结果均有统计学意义(P<0.01),疗效差别均有显著性,透刺组的效果优于直刺组。(3)针刺后30分钟两组颈椎病患者各项疼痛评分比较,透刺组和直刺组患者的PRI情绪分、PRI感觉分、PRI总分、VAS评分、PPI评分及总积分比较均有统计学意义(P<0.01),疗效差别有显著性,透刺组的效果优于直刺组。(4)针刺后30分钟两种针刺方法对不同性别、不同病型、不同年龄、不同病情颈椎病患者的镇痛效果比较,结果均有统计学意义(P<0.01),疗效差别均有显著性,透刺组的效果优于直刺组。χ2检验结果显示:两种不同针刺方法对颈椎病的疗效差别有显著性(P<0.01),透刺法的镇痛效果优于直刺法。结论:通过对98例颈椎病患者的临床配对试验,采用序贯试验、配对t检验及χ2检验的统计方法,得出结论为:耳针沿皮透穴刺法对颈椎病中的颈型和神经根型的快速镇痛效应均优于耳针直刺法。更多还原

【Abstract】 Objective: Cervical spondylopathy is a kind of disease that due to the dedifferentiation of intervertebral disc and its secondary changes of pathogenesis and involved its surrounded weave construction (nerve root, spinal cord, vertebral artery, and sympathetic nerve etc.). Aches of the neck, shoulder, and back and even throe are its main clinical features. Incidence of this kind of disease is increased because of aging, changes of the life styles, high pace of the modern life and wide usage of TVs, computers, air conditioners and other electrical equipments, and commonly happens on young, middle and old age people. And it had become a popular disease and affects the quality of life and health level. And the cervical spondylopathy has become the major disease of the Department of Orthopedics and Traumatology instead of lumbocrural pain that caused by physical work. However, until now, there is no effective method to cure this disease, and during long time clinical practice, needling is effective in treatment. Needling is very helpful in pain receiving. During long time clinical practice, my advisor Mr. Jia Chunsheng found the otopoint-penetrative needling which is more concinient and effective in analgesics. This topic is one of the research works of rapid analgesic effect of acupuncture otopoint-penetrative needling for many kinds of peripheral neuralgia, aiming at through the comparison of the analgesic effect of acupuncture between otopoint-penetrative needling and otopoint-straight needling for cerbical type and nerve-root type cervical spondylopathy, to prove that the otopoint-penetrative needling is more rapid and effective in analgesis and supplied a better puncturing method for treating cervical spondylosis through needling.Method: According to the criteria and principles of management, type of diagnosis(this topic mainly research in the Analgesic Effect of needling, so only chose neck type and cyber-root type as object of study ) ,inclusion criteria , and exclusion criteria of Cervical spondylopathy that passed in Guilin,1994, 98 patients are chosen to take this test. These 98 patients are divided into two groups according to four crucial factors: the same gender, similar age (below and including 45 years old is youth group, above 46 years old is adults and elder group), the same type sickness (neck and cyber-root), and degree of illness (mild, middle and serious) and then match them one by one, then random divided these patients into two groups: Otopoint-penetrative group and Otopoint-straight group. For patients in Otopoint-penetrative group, use a needle to penetrate from one acupuncture point, and to anther acupuncture point, or penetrate from another point through subcutaneous part and subcutaneous cartilage to prong the whole point, after penetration, twist it 5 to 7 times lightly, and when the needle are retained, it can be twist like that mentioned above 2 to 3 times to reinforce the acanthesthesia, and needles are retained for 30 minutes for both groups. And when needles are put out, ask patient to move their afflicted part immediately. Using the simplified McGill score chart of painting to record the different painting degrees 5 minutes and 30minutes before and after treated, and makeα=0.05 as a criteria for hypothesis testing , use the sequential trial,matched-pair t test and Chi-square test, and use SPSS statistical software to analyze it, and all above made it clear that Otopoint-penetrative has a more rapid Analgesic Effect than Otopoint-straight needling.Results: Before acupuncture, the balance test of various pain scores, and the pain cumulative scores in different sex, disease types, ages and disease conditions showed that, There were no significant difference between the Otopoint-penetrative group and Otopoint-straight group (P>0.05), the two groups had comparability.The sequential trial showed that, 5 minutes after acupuncture, There was no significant difference between the Otopoint-penetrative group and Otopoint-straight group in analgesia effect (P>0.05), while 30 minutes after acupuncture, it had differences(P<0.05), the penetration group had a better effect than straight needling group.Findings of matched-pair t test showd that: (1) 5 minutes after the treatment, the comparison of the cervical spondylopathy patients various pain scores indicated that, there were statistical significance between the Otopoint-penetrative group and Otopoint-straight group in PRI-sence scores, PRI-emotional scores, total PRI scores, VAS scores and PPI scores(P<0.01), the healing effect had significant difference, and the penetration group is better than the straight group. (2) 5 minutes after acupuncture, the analgesia effect comparison of two needling methods for patients of different sex, disease types, ages and disease conditions showed that, there were statistical significance(P<0.01), the healing effect had significant difference, and the penetration group is better than the straight group.(3) 30 minutes after the treatment, the comparison of the cervical spondylopathy patients various pain scores indicated that, there were statistical significance between the Otopoint-penetrative group and Otopoint-straight group in PRI-sence scores, PRI-emotional scores, total PRI scores, VAS scores and PPI scores(P<0.01), the healing effect had significant difference, and the penetration group is better than the straight group. (4) 30 minutes after acupuncture, the analgesia effect comparison of two needling methods for patients of different sex, disease types, ages and disease conditions showed that, there were statistical significance(P<0.01), the healing effect had significant difference.Chi-square test indicated that: The healing effect had significant difference(P<0.01), and the otopoint-penetrative needling is better than otopoint-straight needling. Conclusions: According to the clinical test to 98 patients and the tests of sequential trials,matched-pair t test and Chi-square test, a conclusion is got as below: Otopoint-penetrative needling has a more rapid and better analgesic effect than otopoint-straight needling for both cerbical type and nerve-root type of Cervical spondylopathy.更多还原