经络感传距离与腰椎间盘突出症临床疗效关系的随机对照试验  

A randomized controlled trial on the clinical efficacy relationship between meridian sensory distance and lumbar disc herniation

作　　者：张海霞 李曌嫱 赵建新 田元祥[2] 

机构地区：[1]北京中医药大学第三附属医院针灸科,北京100029 [2]中国中医科学院中医临床基础医学研究所,北京100700

出　　处：《河北中医》2017年第11期1710-1714,共5页Hebei Journal of Traditional Chinese Medicine

基　　金：北京中医药大学研究生自主课题(编号:2017-JYB-XS-126)

摘　　要：目的观察比较不同针刺治疗深度对腰椎间盘突出症临床疗效的影响,探讨经络感传距离与临床疗效间是否存在相关性。方法将60例腰椎间盘突出症患者随机分为2组,每组各30例。2组均采用电针治疗腰椎间盘突出症,并联合红外线治疗仪辅助治疗。深刺组采用0.40 mm×100 mm规格针灸针,直刺2.5~3寸,进针深度约60~70 mm,诸穴均用平补平泻手法;浅刺组采用0.35 mm×75 mm规格针灸针,直刺0.8~1.2寸,进针深度约20~30 mm,诸穴均用平补平泻手法。根据《针灸学》与《灵枢·骨度》中骨度分寸法,选定局部椎体、臀横纹、腘横纹、外踝尖及足部5个效应点,分别记录患者各主穴的经络感传距离情况。分别采用视觉模拟评分法(VAS)评价腰部疼痛情况及日本骨科协会评估治疗分数(JOA)评价腰椎功能情况,并评价疗效。结果深刺组各主穴经络感传距离频次最高的是外踝尖处及足部,浅刺组各主穴经络感传距离频次最高的是局部椎体;深刺组治疗后总有效率92.86%,浅刺组总有效率64.29%,深刺组疗效优于对照组(P<0.05);2组治疗后VAS评分及JOA评分与本组治疗前比较VAS评分降低(P<0.05),JOA评分升高(P<0.05),且深刺组VAS评分及JOA评分治疗前后差值与浅刺组比较差异均有统计学意义(P<0.05),深刺组对腰部疼痛及腰椎功能改善优于浅刺组。结论经络感传距离与临床疗效间存在相关性,深刺治疗较浅刺可以更好地缓解腰椎间盘突出症患者的疼痛症状,改善腰椎功能,提高临床疗效,针刺深度是影响经络感传距离的前提条件,临床疗效是体现经络感传距离的必然结果。Objective To compare the effects of different acupuncture treatment depth on the clinical efficacy of lumbar disc herniation,and explore whether there is a relationship between meridian sensory distance and clinical efficacy. Methods 60 patients with lumbar disc herniation were randomly divided into two groups,30 cases in each group. The two groups were treated by electro-acupuncture combined with infrared therapeutic apparatus adjuvant therapy. The acupuncture needles of 0. 40 mm × 100 mm were used in the deep acupuncture group,straight stinger 2. 5 ~ 3 inches and the depth of needles was 60 ~ 70 mm,reinforcing-reducing manipulation was used at all points. The acupuncture needles of 0. 35 mm × 75 mm were used in the shallow acupuncture group,straight stinger 0. 8 ~ 1. 2 inches and the depth of needles was 20 ~ 30 mm,reinforcing-reducing manipulation was used at all points. The five points including local vertebral body,hip crease,popliteal crease,lateral malleolus pointed and foot were selected by bone-length measurement according to Acupuncture and Moxibustion Science and Lingshu-Bone article,and the meridian sensory distances of the main points were recorded in patients. The waist pain was evaluated by Visual Analog Scale( VAS) and the lumbar vertebral function was evaluated by Japanese Orthopaedic Association( JOA) scores,and the effects were evaluated. Results The highest frequency of meridian sensory distance of each main point was lateral malleolus pointed and foot in the deep acupuncture group. The highest frequency of meridian sensory distance of each main point was local vertebral body in the shallow acupuncture group. The total effective rate in the deep acupuncture group was 92. 86%,which in the shallow acupuncture group was 64. 29%. The clinical efficacy in the deep acupuncture group was superior to that in the shallow acupuncture group( P < 0. 05). The scores of VAS after treatment were reduced in two groups( P < 0. 05),and JOA increased( P < 0. 05),and there were statistical differences on the di

关 键 词：腰椎 椎间盘移位 针刺疗法 经络循行 

分 类 号：R246.223[医药卫生—针灸推拿学] R681.533[医药卫生—中医临床基础]