【作者】 张琳；

【导师】 李滋平；

【作者基本信息】 广州中医药大学 ， 针灸推拿学（专业学位）， 2019， 硕士

【摘要】 目的:本研究旨在通过观察运动针法与常规针刺治疗慢性腰肌劳损患者的临床疗效,多维度对治疗疗效作对比及分析,探索运动针法治疗慢性腰肌劳损的短期和中期疗效以及应用价值,为慢性腰肌劳损的针灸治疗提供更多的客观依据。方法:本研究采用临床随机对照研究方法,共收集了 60例来自广东省中医院针灸门诊的慢性腰肌劳损患者及志愿者;招募时间从2018年1月至2018年12月。临床试验分组方法:将符合本病诊断、纳入及排除标准的60例慢性腰肌劳损患者采用完全随机法分成两组:治疗组(运动针法组)30例、对照组(常规针刺组)30例。治疗方法:两组患者均选取了相同的穴位:肾俞(双)、大肠俞(双)、委中(双),以及根据证候分型配穴:寒湿型配腰阳关、阴陵泉(双),瘀血型配膈俞(双)、血海(双),肾虚型配志室(双)、太溪(双),湿热型腰痛配合谷(双)、阴陵泉(双);治疗组采用运动针法治疗,对照组采用常规针刺治疗。治疗总时长均为1个月,每周治疗3次,同时完成病例报告表的填写,分3个时间点进行疗效评估:开始治疗前、疗程结束时、治疗结束后1个月(随访),主要临床疗效观察指标采用ODI指数和VAS疼痛量表,次要指标采用SF-36健康问卷及腰痛发作次数。治疗结束后采用SPSS 23.0统计软件进行分析,综合分析治疗慢性腰肌劳损疗效更优的方案。结果:本研究共收集了60例患者并完成试验,其中治疗组30例,对照组30例,治疗过程中未出现脱落病例。经统计学分析,治疗前两组患者在性别、年龄、病程、ODI、VAS、SF-36评分等基线特征方面差异均无统计学意义(P>0.05),两组基线特征均无明显差异,因此具有可比性。治疗结束时,两组治疗慢性腰肌劳损的疗效满意,治疗组总有效率为100%,总愈显率为63.33%,对照组总有效率为90%,总愈显率为33.33%,治疗组短期疗效与对照组相仿(P>0.05)。1个月后随访时,治疗组总有效率为100%,总愈显率为66.67%,对照组总有效率为93.33%,总愈显率为33.33%,两组患者病情均有改善,治疗组中期疗效优于对照组(P<0.05)。因此,治疗组的中期疗效优于对照组。在运动针法治疗该病不同证型的疗效比较方面,治疗结束时疗效等级比较Z=7.549,P=0.549>0.05,差异不具有统计学意义。随访1月疗效等级比较Z=6.745,P=0.675>0.05,疗效比较差异不具统计学意义,因此运动针法治疗不同证型患者在治疗结束后、随访时的疗效等级比较差异无统计学意义(P>0.05),没有明显的证型特异性。组内比较两组治疗结束、随访时ODI、VAS、腰痛发作次数差异均有统计学意义(P<0.001),说明两组在缓解腰痛、改善腰部功能、减少复发方面均有疗效;组间比较两组的ODI、VAS及发作次数,两组治疗前后差值的差异均有统计学意义(P<0.05),并且治疗组疗效优于对照组。SF-36评分方面,治疗前后及随访时各项评分组内比较差异有统计学意义(P<0.05),说明两组治疗均能改善患者的生存质量,而组间比较提示治疗组在改善患者生理机能、精力方面与对照组的差异有统计学意义(P<0.05),说明对于改善患者生理机能、精力方面的情况,治疗组疗效优于对照组。结论:研究结果提示运动针法及常规针刺均能不同程度明显缓解患者的腰部疼痛,但综合分析,在改善患者的腰部功能、生存质量、减少腰痛发作次数方面,运动针法疗效要优于常规针刺,并且对改善患者中期疗效更有优势。更多还原

【Abstract】 ObjectiveThrough comparing and analyzing the effect in multiple dimensions,the purpose of this study was to observe acupuncture kinesitherapy and routine acupuncture in the treatment of patients with chronic lumbar muscle strain in short-term and medium-term clini efficacy,application value of acupuncture kinesitherapy,and to provide more objective basis.Methods60 patients with chronic lumbar muscle strains and volunteers from the acupuncture clinic of the Guangdong Provincial Hospital of TCM were collected in this study,a randomized controlled trial.The recruitment period was from January 2018 to December 2018.Method:60 patients with chronic lumbar muscle strain who met the criteria for diagnosis,inclusion and exclusion of this disease were randomly divided into two groups:treatment group(acupuncture kinesitherapy group)30 cases,control group(routine acupuncture group))30 cases.Treatment:Both groups of patients selected the same acupuncture points Shenshu(double),large intestine shu(double),Weizhong(double),and assigned points according to symptom classification:cold and wet type with Yaoyangkuan,Yinlingquan(double),blood stasis type with Geshu(double),Xuehai(double),kidney deficiency type matching Zhishi(double),Taixi(double),damp heat type with Hegu(double),Yinl ingquan(double).The treatment group was treated with acupuncture kinesitherapy,while the control group was treated with routine acupuncture.The total duration of treatment is 1 month,three times a week,and the case report form is completed.The efficacy evaluation is performed at 3 time points:before treatment,at the end of treatment,and 1 month after treatment(follow-up).The main clinical efficacy index was measured by ODI index and VAS pain scale,and the secondary index was the SF-36 scale and the number of low back pain episodes.After the treatment,the SPSS 23.0 statistical software is used for analyzing and comparing which treatment of chronic lumbar strain was better.ResultsA total of 60 cases were finally collected and completed in this study,including 30 cases in the treatment group and 30 cases in the control group,and no cases of shedding occurred during the treatment.After statistical analysis,baseline characteristics of two groups of patients,including gender,age,course of disease,ODI,VAS,SF-36 score,all P>0.05,showed no difference,The baseline level of two groups are homogeneous,comparable.At the end of treatment,the efficacy of the two groups in treating chronic lumbar muscle strain was obvious,the results and short-term efficiency of treatment group(63.33%cured and markedly effective rate,100%effective rate)are similar to the control group(33.33%cured and markedly effective rate,90%effective rate)(P>0.05).On one month follow-up visit,the results and middle-term efficiency of treatment group(66.67%cured and markedly effective rate,100%effective rate)are better than the control group(33.33%cured and markedly effective rate,93.33%effective rate)(P<0.05).Therefore,the medium term efficacy of the treatment group was better than that of the control group.In the comparison of the therapeutic effects of acupuncture kinesitherapy on different syndromes of the disease,the efficacy level at the end of treatment was compared with Z=7.549,P=0.549>0.05,and there was no statistical difference.The efficacy level of follow-up in January was Z=6.745,P=0.675>0.05,no statistical difference.Therefore,there is no difference in the efficacy level of patients with different syndromes after treatment and at the follow-up,and there is no obvious syndrome specificity.Compared within the groups,there were statistically significant differences in ODI,VAS and the number of episodes after treatment and one month follow-up(P<0.001),which showed that Explain that both groups are effective in relieving low back pain,improving waist function and reducing recurrence.Compared between the groups in ODI,VAS and attack times,there were statistical differences(P<0.05)between two groups before and after treatment,and the effect of the treatment group was better than that of the control group.In terms of SF-36 score,there were statistically different within the groups before and after treatment(P<0.05),which showed that both groups of treatment could improve the quality of life of patients.While the comparison between the groups suggested that the treatment group had statistically significant differences with the control group in improving Physical Functioning(PF),Vitality(VT)(P<0.05),which shows that the treatment group was better than the control group in these aspects.ConclusionsThe results suggest that both acupuncture kinesitherapy and routine acupuncture can significantly alleviate the waist pain of patients in different degrees.But through Comprehensive analysis,in improving the patient’ s waist function,quality of life,reducing the number of episodes,the effect of acupuncture kinesitherapy is better than the routine needle.And acupuncture kinesitherapy is more advantageous for improving middle-term efficacy.更多还原