推拿配合针刺治疗血瘀证腰椎间盘突出症的临床研究(硕士)(论文19000字)
Clinical study of acupuncture treatment of lumbar disc herniation stasis syndrome with massage
中文摘要
腰椎间盘突出症表现为腰痛及下肢坐骨神经放射痛，是在腰椎间盘退变的基础上，加外力的作用，导致髓核突出，压迫神经根、脊髓等引起的。在保守疗法中，推拿配合针刺治疗腰椎间盘突出症不失为一种良好的选择。因为推拿可以缓解痉挛，纠正紊乱，解除压迫，而针刺可以改善循环，缓解疼痛。另外，推拿和针灸属于中医传统治疗部分，在经络学说指导下发挥作用，费用低、操作简单及无副作用也是他们的相似点。
目的：通过观察三种方案（推拿、针刺、推拿配合针刺）治疗血瘀证腰椎间盘突出症的临床疗效差异，探索治疗血瘀证腰椎间盘突出症的最佳方案，从而为今后进一步临床研究提供参考，最大程度地发挥非手术疗法治疗本病的优势和潜力。
方法：选择2014年2月至2015年2月在附属医院骨科住院的血瘀证腰椎间盘突出症患者90例，将其随机分为治疗组和对照组A、对照组B，疗程均为14天。治疗组采用推拿配合针刺治疗；对照组A采用推拿治疗；对照组B采用针刺治疗。将三组患者治疗前后进行量化评分，通过研究比较90例患者治疗前后的评价指标，最终得出科学的临床疗效。
结果：实际统计病例90例。三组方案均能有效治疗腰腿疼痛，但在治疗 14天后，治疗组总有效率为 93.3%；对照组A总有效率为86.6%；对照组B总有效率为83.3%，治疗组与对照组存在显著差异。在给患者治疗过程中未发现不良反应及不良事件。
结论：经过观察，三组方法治疗腰椎间盘突出症都能取得很好的疗效，对于血瘀证腰椎间盘突出症患者，推拿配合针刺的治疗组疗效优于单一推拿的对照组A，单一推拿的治疗组A疗效优于单一针刺的对照组Ｂ。提示中医综合治疗为治疗本病的发展趋势，各种方法协同作用,优势互补,疗效显著,而且简单、价廉、安全性高,是一种合理冇效的治疗方案,值得临床推广。
关键词 腰椎间盘突出症；血瘀证；推拿；针刺；临床研究
ABSTRACT
Lumbar disc herniation showed sciatic back pain and lower extremity radiating pain, is based on lumbar disc degeneration, plus the role of external forces, leading to prominent nucleus, nerve root and spinal cord caused. In conservative therapy, massage with acupuncture treatment of lumbar disc herniation after all, a good choice. Because massage can relieve cramps, correcting disorders, relieve the oppressed, and acupuncture can improve circulation, relieve pain. In addition, massage therapy and acupuncture is a traditional part of Chinese medicine, the role of guidance in Meridian, low cost, simple operation, and no side effects but also their similarities.
Purpose: To observe the three options (massage, acupuncture, and massage with acupuncture) differences in the clinical efficacy of the treatment of lumbar disc herniation stasis syndrome, the best option to explore the treatment of lumbar disc herniation stasis syndrome, which for the further clinical study provides reference, to maximize the advantages of non-surgical therapy and potential of this disease.
Method: February 2014 to February 2015 in the Affiliated Hospital of Changchun University of Traditional Chinese orthopedic hospital blood stasis in patients with lumbar disc herniation 90 cases were randomly divided into treatment group and control group A, group B, courses are 14 days. The treatment group was treated with acupuncture and massage; A control group using massage therapy; group B were treated with acupuncture treatment. The three groups of patients before and after treatment of quantitative score, comparing before and after evaluation of 90 patients treated by the study, the final results of clinical efficacy of science.
Result: 90 cases of actual statistics of cases. Three programs can effectively treat leg pain, but in the 14 days of treatment, the treatment group, the total effective rate was 93.3%; control group A total effective rate was 86.6%; group B, the total effective rate was 83.3% in the treatment group and the control group were significantly different. No adverse reactions and adverse events in the course of treatment to patients.
Conclusion: Through observation, three methods of treatment of lumbar disc herniation can achieve good results, for patients with lumbar disc herniation stasis syndrome, the treatment group with acupuncture massage massage is better than a single control group A, single massage The treatment group A single acupuncture more effective than a control group B. Tip integrated TCM therapy for the treatment of the development trend of the disease, various methods synergies, complementary advantages, a significant effect, and simple, inexpensive, safe, efficient Nuisance is a reasonable treatment plan, worthy of promotion.
Keyword: Lumbar disc herniation ; Stasis syndrome ; Massage ;
Acupuncture Clinical Research
英文缩略词
英文缩写 英文全称 中文名词
LDH Lumbar disc herniation 腰椎间盘突出症
VAS Visual Analogue Scale 视觉模拟评分法
COX Cyclooxygenase 环氧化酶
PALZ Phospholipase 磷脂酶
JOA JapaneseOrthopaedicAssociationScores 日本骨科协会评估治疗
目 录
中文摘要 1
ABSTRACT 3
英文缩略语 5
前 言 6
文献综述 7
1祖国医学对腰椎间盘突出症的认识 7
1.1 病名及症状表现 7
1.2 关于本病的病因 7
1.3 关于本病的发生 8
1.4 中医辨证分型 9
1.5 古代辨证论治记载 9
2西医学对腰椎间盘突出症的认识 10
2.1 解剖结构 10
2.2 腰椎间盘突出症的病因病机 11
2.3 腰椎间盘突出症发病机制 12
2.4 腰椎间盘突出症的分型 13
3腰椎间盘突出症非手术治疗的临床研究 13
3.1 中药治疗 13
3.2 西药治疗 14
3.3 针灸疗法 14
3.4 牵引疗法 15
3.5 手法治疗 15
3.6 物理疗法 15
3.7 封闭疗法 15
3.8 功能锻炼 16
3.9 卧床休息及佩戴腰围活动 16
3.10 综合疗法 16
4讨论与展望 16
临床研究 18
1 一般资料与方法 18
1.1 病例来源 18
1.2 诊断标准 18
1.3 纳入标准 18
1.4 排除标准 18
1.5 中止试验标准 19
1.6 脱落病例标准 19
2 研究方法与内容 19
2.1分组方法 19
2.2治疗方法 19
2.3观察指标 20
2.4统计方法 20
2.5安全性检查 21
3 治疗结果 21
3.1一般资料研究结果 21
3.2三组治疗前后疼痛改善程度比较 21
3.3三组腰椎功能改善疗效比较 21
3.4三组临床综合疗效比较 21
3.5安全性分析 22
讨 论 23
1选择 JOA 评分、VAS 评分，综合评价的理由 23
2对照组选择的意义 23
3探索临床路径的意义 23
4推拿针刺的互补性 23
5存在的问题和解决方法 23
结 语 25
参考文献 26
附 录 28
附 录A 28
附 录B 29
致 谢 31 |
