针刺配合郑氏舒活酊涂擦治疗经皮内镜下腰椎间盘切除术后感觉异常的临床研究  

A clinical study of acupuncture therapy combined with inunction of Zheng’s Shuhuo Ding(舒活酊) for treatment of paresthesia after percutaneous endoscopic lumbar discectomy

作　　者：吴忌[1] 李越[1] 楚福明[1] 王雯[1] 苏洪[1] 王艳杰[1] 唐小松[1] 黄子洋 肖清清[1] 邓尚[1] WU Ji;LI Yue;CHU Fuming;WANG Wen;SU Hong;WANG Yanjie;TANG Xiaosong;HUANG Ziyang;XIAO Qingqing;DENG Shang(Sichuan Orthopaedic Hospital,Chengdu 610041,Sichuan,China)

机构地区：[1]四川省骨科医院

出　　处：《中医正骨》2019年第7期27-33,共7页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：四川省医学会科研课题(S16064);四川省卫生和健康委员会科研课题(17PJ211);四川省干部保健优秀人才培养项目(川干健办发[2017]20号)

摘　　要：目的:观察针刺配合郑氏舒活酊涂擦治疗经皮内镜下腰椎间盘切除术(percutaneous endoscopic lumbar discectomy,PELD)后感觉异常的临床疗效和安全性。方法:选择因腰椎间盘突出症接受PELD治疗后出现感觉异常的42例患者为研究对象。采用随机数字表随机分为基础治疗组和联合治疗组,每组21例。基础治疗组静脉滴注20%甘露醇注射液(每次250 mL,每天1次,连用3 d)、地塞米松注射液(每次10 mg,每天1次,连用3 d),口服甲钴胺片(每次0.5 mg,每天3次,连用30 d),同时进行仰卧位抬腿及踝泵等功能锻炼。联合治疗组在基础治疗组治疗方案的基础上增加针刺治疗和郑氏舒活酊涂擦治疗,针刺治疗每次20 min、郑氏舒活酊涂擦治疗每次15 min,2种治疗方法均每天1次,连续5次为1个疗程,每个疗程结束后休息2 d,共治疗2个疗程。根据患者治疗期间的疼痛程度,必要时给予镇痛药物。分别于治疗前、治疗开始后2周及治疗开始后3个月采用视觉模拟量表(visual analogue scale,VAS)评定患者下肢疼痛和麻木程度,采用 Oswestry功能障碍指数(Oswestry disability index,ODI)问卷表评定感觉异常对患者日常生活的影响,治疗开始后3个月采用改良MacNab标准评价总体疗效,观察记录治疗期间患者镇痛药物的使用情况和不良反应的发生情况。结果:①疼痛VAS评分。时间因素与分组因素存在交互效应( F=6.748,P =0.002);2组疼痛VAS评分总体比较,差异有统计学意义,即存在分组效应( F=6.830,P =0.013);治疗前后不同时点之间疼痛VAS评分的差异有统计学意义,即存在时间效应( F=596.189,P =0.000);2组疼痛VAS评分随时间变化均呈降低趋势,但2组的降低趋势不完全一致[(5.762±0.816)分,(2.905±0.436)分,(1.571±0.598)分, F=339.958,P =0.000;(5.952±1.011)分,(3.881±0.757)分,(1.786± 0.624)分, F=269.273,P =0.000];治疗前及治疗开始后3个月,2组疼痛VAS评分比较,差异均无统计学意义( t=-0.672Objective: To observe the clinical curative effects and safety of acupuncture therapy combined with inunction of Zheng’s Shuhuo Ding(舒活酊,SHD)for treatment of paresthesia after percutaneous endoscopic lumbar discectomy(PELD). Methods: Forty-two patients with paresthesia after PELD for treatment of lumbar disc herniation(LDH)were selected as the subjects,and were randomly divided into basic treatment group and combination treatment group by using random digits table,21 cases in each group.All patients in the 2 groups were treated with intravenous drip of 20% mannitol injection(once a day,250 mL at a time for consecutive 3 days)and dexamethasone injection(once a day,10 mg at a time for consecutive 3 days)and oral application of mecobalamin tablets(three times a day,0.5 mg at a time for consecutive 30 days),meanwhile functional exercises such as straight-leg-raise training and ankle pump training were performed in supine position.Moreover,the patients in combination treatment group were treated with acupuncture therapy(20 minutes at a time)and inunction of Zheng’s SHD(15 minutes at a time),once a day for 2 courses of treatment,5 times for each course with a 2-day rest-insertion between courses.The analgesic drugs were used in case of necessity according to the pain degree of patients during the treatment period.The lower limbs pain and numbness and the effect of paresthesia on daily living were evaluated by using visual analogue scale(VAS)and Oswestry disability index(ODI)questionnaires respectively before treatment and at 2 weeks and 3 months after the beginning of the treatment respectively,and the total curative effects were evaluated and compared between the 2 groups by using improved MacNab standard at 3 months after the beginning of the treatment.Moreover,the use of analgesic drugs and the incidence of adverse reactions were observed and recorded during the treatment period. Results: There was interaction between time factor and group factor in pain VAS scores( F=6.748,P = 0.002 ).There was statistica

关 键 词：针刺疗法 郑氏舒活酊 椎间盘切除术 经皮 手术后并发症 感觉异常 临床试验 

分 类 号：R274.9[医药卫生—中西医结合]