针刀治疗股骨头坏死镇痛机制及血管舒缩因子表达的初步研究  

A Preliminary Study on the Analgesic Mechanism of Needle-Knife and Expression of Vasomotor Factors in the Treatment of Femoral Head Necrosis

作　　者：颜炎 李泰贤 傅繁誉 朱瑞征 王荣田 韦伟 林娜[2] 陈卫衡 何海军[1] YAN Yan;LI Taixian;FU Fanyu;ZHU Ruizheng;WANG Rongtian;WEI Wei;LIN Na;CHEN Weiheng;HE Haijun(Wangjing Hospital,China Academy of Chinese Medical Sciences,Beijing 100102,China;Institute of Chinese Materia Medica,China Academy of Chinese Medical Sciences,Beijing 100700,China;The Third Affiliated Hospital of Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]中国中医科学院望京医院,北京100102 [2]中国中医科学院中药研究所,北京100700 [3]北京中医药大学第三附属医院,北京100029

出　　处：《湖南中医药大学学报》2021年第2期265-269,共5页Journal of Hunan University of Chinese Medicine

基　　金：国家自然基金面上项目(81873322);“十二五”国家科技支撑计划项目(2015BAI04B03);北京市自然科学基金面上项目(7182186);中国中医科学院特色诊疗技术与方法研究项目(ZZ070864)。

摘　　要：目的基于疼痛触发点理论,通过观察针刀治疗股骨头坏死的镇痛疗效及其对血管舒缩因子的影响,初步探究针刀疗法改善股骨头坏死“瘀痛”的机制。方法本研究以2018年8月至2019年11月在中国中医科学院望京医院接受针刀治疗的26例(26髋)股骨头坏死患者为研究对象,比较治疗前、治疗1 d后及治疗7 d后患者的VAS评分、髋关节总活动度、改良Ashworth计分,以及一氧化氮(NO)、内皮素(endothelin,ET)-1、去甲肾上腺素(norepinephrine,NE)、组胺(Histamine,HIS)的含量。结果(1)与治疗前比较,治疗1 d后及治疗7 d后的VAS评分、Ashworth计分及髋关节不同方向活动度(屈曲、内旋、外旋、外展、内收)差异均有统计学意义(P<0.05);与治疗7 d后比较,治疗1 d后的VAS评分、改良Ashworth评分及髋关节不同方向活动度(屈曲、内旋、外旋、外展、内收)差异均有统计学意义(P<0.05);(2)与治疗前比较,治疗1 d后的NO、HIS含量差异有统计学意义(P<0.05),治疗1 d后的ET-1、NE含量差异无统计学意义(P>0.05),治疗7 d后的NO、ET-1、NE及HIS含量差异均有统计学意义(P<0.05);与治疗1 d后比较,治疗7 d后的NO含量差异无统计学意义(P>0.05),治疗7 d后的ET-1、NE及HIS含量差异有统计学意义(P<0.05)。结论针刀疗法可明显降低肌张力、缓解股骨头坏死疼痛和改善关节活动功能,其作用机制可能与解除疼痛触发点病理性紧张状态、调节血管舒缩因子、改善局部血液循环有关。Objective Based on the theory of myofascial trigger points,by observing the effect of needle-knife on relieving pain of femoral head necrosis and the influence of vasomotor factors,preliminary explore the mechanism of needle-knife therapy in improving"blood stasis pain"of femoral head necrosis.Methods In this study,26 patients(26 hips)of femoral head necrosis who received needle-knife treatment at Wangjing Hospital of China Academy of Chinese Medical Sciences from August 2018 to November 2019.The VAS score,total hip joint activity,modified Ashworth score,and the contents of nitric oxide(NO),endothelin-1(ET-1),norepinephrine(NE)and histamine(HIS)of the patients before and after treatment for 1 day and 7 days were compared.Results(1)Compared with before treatment,there were statistically significant differences in VAS score,modified Ashworth score and range of motion(flexion,internal rotation,external rotation,abduction,adduction)of hip joint in different directions at 1 day and 7 days after treatment(P<0.05);compared with 7 days after treatment,there were statistically significant differences in VAS score,modified Ashworth score and range of motion of hip joint in different directions(flexion,internal rotation,external rotation,abduction,adduction)were significantly different after treatment(P<0.05);(2)Compared with before treatment,the content of NO and HIS were significantly different after treatment for 1 day(P<0.05),and the content of ET-1 and NE were not significantly different after treatment for 1 day(P>0.05),there were significant differences in the contents of NO,ET-1,NE and HIS after 7 days of treatment(P<0.05);compared with after treatment for 1 day,there was no significant difference in the contents of NO after 7 days of treatment(P>0.05),but there were significant difference in the contents of ET-1,NE and HIS after 7 days of treatment(P<0.05).Conclusion Needle-knife therapy can significantly reduce muscle tone,relieve pain of femoral head necrosis,and improve joint function.Its mechanism may be relate

关 键 词：针刀 股骨头坏死 疼痛 血管舒缩因子 疼痛触发点 VAS评分 改良Ashworth评分 髋关节活动度 

分 类 号：R245[医药卫生—针灸推拿学]