【作者】 吴晓萍；

【导师】 柴铁劬；

【作者基本信息】 广州中医药大学 ， 中医学（专业学位）， 2015， 硕士

【摘要】 腰椎间盘突出症(Lumbar disc herniation,LDH)是腰椎间盘退变后,在暴力作用下,纤维环破裂致髓核突出于纤维环之外,髓核脱出或突入椎管,刺激或压迫脊髓(圆锥)、马尾、血管或神经根而产生的腰腿痛,是临床常见的一种多发病。现代医学对LDH的流行病学、病因、发病机制、临床分型及治疗等有大量的研究报道。针灸在该病的非手术治疗中占据重要地位,近年来取得了明显进展。本研究在总结现有临床研究报道的基础上,以中医理论为指导,采用温针联合电针治疗腰椎间盘突出症急性期,试图探寻适用于该病急性期安全有效的针灸治疗方法。目的：观察比较温针加电针治疗与电针治疗腰椎间盘突出症急性期的疗效,为腰椎间盘突出症急性期的治疗提供一种思路和借鉴。方法：本研究参照2002年中华人民共和国卫生部颁布的《中药新药临床研究指导原则》中腰椎间盘突出症诊断标准,在自愿原则下,纳入2013年12月至2015年1月广州中医药大学第一附属医院针灸科、脊柱科诊断为腰椎间盘症急性期的60例患者,按数字随机化分组方法随机分为治疗组和对照组各30例。治疗组采用温针加电针治疗,对照组采用电针治疗。(1)治疗组以突出节段及上下的双侧夹脊穴位为主,配合患肢环跳、委中、阳陵泉、束骨、足临泣穴等针刺治疗,腰部同名穴位在针刺后连接电针,采用疏密波,2-24hz,再将点燃的艾段置于针柄上(燃端朝向皮肤),共燃烧2段,TDP神灯照射腰部,留针30分钟。每日1次,6次为1个疗程,治疗2个疗程。(2)对照组单纯电针治疗,治疗操作及疗程皆与治疗组相同。(3)日常护理要求两组均建议日常腰部防寒,忌食生冷,避免弯腰或直坐,避免弯腰抬提重物,卧硬板床休息,活动时佩戴腰带。(4)病例采集内容治疗前采集性别、年龄、起病时间、病变椎体等一般资料,治疗过程中采集临床疗效观察内容,包括：治疗前、首次治疗后、治疗3次后、治疗1个疗程后、治疗结束后的VAS评分,治疗前后的JOA下腰痛评分和Oswestry功能障碍指数评分,以及治疗结束后两组疗效(治愈、显效、有效、无效)统计。(5)结果统计采用SPSS19.0统计软件进行数据统计分析。结果：(1)60例患者中,26例既往有腰痛病史,突出节段28例为多节段,15例L4/5节段,17例L5/S1,其中多节段突出较多。(2)两组首次治疗后的VAS评分差异具有统计学意义(P<0.05)。表明温针加电针对腰椎间盘症急性期的即时止痛效果优于电针组。(3)两组治疗均可降低VAS评分、Oswestry功能障碍指数评分,提高JOA下腰痛评分,两组治疗前后各评分差异均具有统计学意义(P<0.01)。说明温针加电针治疗和电针治疗对腰椎间盘突出症急性期均具有镇痛及改善功能的作用。(4)两组间治疗后VAS评分、JOA评分、Oswestry功能障碍指数评分差异具有统计学意义(均为P<0.05),表明温针加电针治疗腰椎间盘突出症急性期疗效优于单纯电针。(5)疗效统计,治疗组痊愈2例,显效22例,有效4例,无效2例,总有效率93.3%；对照组治愈0例,显效11例,有效15例,无效4例,总有效率86.7%。治疗组总有效率优于对照组。两组间疗效比较具有统计学意义(P<0.01)。结论：温针灸加电针治疗和单纯电针治疗对腰椎盘突出症急性期均具有确切疗效。温针灸结合电针治疗腰椎间盘突出症急性期的即时镇痛效果优于单纯电针；且在改善腰椎间盘突出症急性期患者的主观症状、临床体征、日常生活能力具有优势,安全可行,对临床应用有较高指导意义。更多还原

【Abstract】 ObjectiveThe purpose of the observation and comparison of the clinical effects of lumbar disc herniation(LDH) of acute stage between Warm Needling working with Electroacupuncture and pure Electroacupuncture is to provide an idea and reference for the treatment of acute lumbar disc herniation.MethodsThis study was based on the diagnostic criteria and standards of TCM the lumbar disc herniation issued by The Ministry of Health of the People’s Republic of China in 2002. Under the voluntary principle, we have selected 60 patients, who are being diagnosed as the acute stage of LDH from December 2013 to January 2015. These cases come from The Acupuncture Department and Spine Surgery Department of the NO.1 Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine. The patients were randomly divided into 2 groups:treatment group and control group, respectively each 30 people. The treatment group-was treated with Warm Needling and Electroacupuncture, while the control group treated with only Electroacupuncture.(1)The Treatment GroupAcupuncture on paravertebral point on Lesions Lumbar disc segment and the upper and the lower, GB30, BL40, GB34, BL65, GB41 of the affected side. Giving paravertebral point on electric stimulation,using disperse-dense wave, frequencies of 2～24hz, then put the ignited moxa-stick on the neddles (the burning side face to the skin), burning two sticks, TDP irradiation on the waist, lasting 30mins. Once per day, six times per week as one treatment period. Take 2 treatment period.(2)The control GroupOnly Electroacupuncture treatment, the treatment operations and courses are the same as the treatment group.(3)Daily CareBoth groups are suggested to take cold protection, prevent raw and cold food, rest on hard board, and activities under protection of lumbar corset.(4)Cases Collected ContentPatients’age, sex, course of disease, lesion segment, the score charges of visual analogue scale (VAS) on 5 times, that is before treatment, after the first treatment, after the third treatment, after one treatment period and after all treatment; Oswestry functional disability index score on before and after treatment, lower back pain JOA score on before and after treatment, evaluation of the efficacy.(5)Statistical analysisUse SPSS19.0 statistical analysis Package to analyze the data.Results(1) Among 60 patients,26 cases have been backache,28 cases has Multi-segment disc herniation,15 cases L4/5,17 cases L5/S1. Multi-segment disc herniation is the most.(2) After the first time treatment, the VAS scores is significantly difference between two groups (P<0.05). According to this, in treating Lumbar disc herniation of acute stage, the Warm Needling and Electroacupuncture group’s immediately analgia effect is better than the Electroacupuncture group.(3) Both the two groups could reduce the Oswestry scores and the VAS scores, and raise the lower back pain JOA scores. The significant difference of the points was found between pretreatment and posttreatment(P<0.01). According to this, both treatment can relieve pain and improve the activity function of LDH of acute stage.(4) After all the treatment, the lower back pain JOA, the VAS scores, Oswestry scores between the two groups have significant differences (P<0.05), which showed that the effect of Warm Needling add Electroacupuncture on the acute stage of LDH is better than pure Electroacupuncture.(5)statistics of curative effect, the treatment group are clinic cured in 2 cases, marked effect in 22 cases, effective in 4 cases and no effect in 2 cases. The toal effective rate is 93.3%. The control group are clinic cured in no cases, marked effect in 11 cases, effective in 15 cases and no effect in 4 cases. The toal effective rate is 86.7%. The total efficacy of the treatment group is better than the control group (P<0.01)ConclusionIn treating Lumbar disc herniation of acute stage, both the Warm Needling combined with Electroacupuncture and pure the Electroacupuncture are effective. However, Warm Needling combined with Electroacupuncture has obvious analgesic effect immediately, which is better than pure Electroacupuncture; For the acute lumbar disc prolapse patients, it has advantages in subjective symptom, clinical signs and living ability. It is safe and feasible, with higher clinical guiding significance.更多还原