84年鼠女哪年财运最旺,857comvvv色九欧美激情|85PO_87国产精品欲av国产av资源

[1]吳忌,李越,楚福明,等.針刺配合鄭氏舒活酊涂擦治療經(jīng)皮內(nèi)鏡下腰椎間盤切除術(shù)后感覺異常的臨床研究[J].中醫(yī)正骨,2019,31(07):27-33.
　WU Ji,LI Yue,CHU Fuming,et al.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[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(07):27-33.
點擊復制

針刺配合鄭氏舒活酊涂擦治療經(jīng)皮內(nèi)鏡下腰椎間盤切除術(shù)后感覺異常的臨床研究()
分享到：

《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期數(shù):
2019年07期
頁碼:
27-33
欄目:
臨床研究
出版日期:
2019-07-20

文章信息/Info

Title:
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:
吳忌; 李越; 楚福明; 王雯; 蘇洪; 王艷杰; 唐小松; 黃子洋; 肖清清; 鄧尚
(四川省骨科醫(yī)院,四川 成都 610041)
Author(s):
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
關(guān)鍵詞:
針刺療法;  鄭氏舒活酊;  椎間盤切除術(shù); 經(jīng)皮;  手術(shù)后并發(fā)癥;  感覺異常;  臨床試驗
Keywords:
acupuncture therapy;  Zhengshi Shuhuo Ding;  diskectomy; percutaneous;  postoperative complications;  paresthesia;  clinical trial
摘要:
目的:觀察針刺配合鄭氏舒活酊涂擦治療經(jīng)皮內(nèi)鏡下腰椎間盤切除術(shù)(percutaneous endoscopic lumbar discectomy,PELD)后感覺異常的臨床療效和安全性。方法:選擇因腰椎間盤突出癥接受PELD治療后出現(xiàn)感覺異常的42例患者為研究對象。采用隨機數(shù)字表隨機分為基礎(chǔ)治療組和聯(lián)合治療組,每組21例。基礎(chǔ)治療組靜脈滴注20%甘露醇注射液(每次250 mL,每天1次,連用3 d)、地塞米松注射液(每次10 mg,每天1次,連用3 d),口服甲鈷胺片(每次0.5 mg,每天3次,連用30 d),同時進行仰臥位抬腿及踝泵等功能鍛煉。聯(lián)合治療組在基礎(chǔ)治療組治療方案的基礎(chǔ)上增加針刺治療和鄭氏舒活酊涂擦治療,針刺治療每次20 min、鄭氏舒活酊涂擦治療每次15 min,2種治療方法均每天1次,連續(xù)5次為1個療程,每個療程結(jié)束后休息2 d,共治療2個療程。根據(jù)患者治療期間的疼痛程度,必要時給予鎮(zhèn)痛藥物。分別于治療前、治療開始后2周及治療開始后3個月采用視覺模擬量表(visual analogue scale,VAS)評定患者下肢疼痛和麻木程度,采用 Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)問卷表評定感覺異常對患者日常生活的影響,治療開始后3個月采用改良MacNab標準評價總體療效,觀察記錄治療期間患者鎮(zhèn)痛藥物的使用情況和不良反應(yīng)的發(fā)生情況。結(jié)果:①疼痛VAS評分。時間因素與分組因素存在交互效應(yīng)(F=6.748,P=0.002); 2組疼痛VAS評分總體比較,差異有統(tǒng)計學意義,即存在分組效應(yīng)(F=6.830,P=0.013); 治療前后不同時點之間疼痛VAS評分的差異有統(tǒng)計學意義,即存在時間效應(yīng)(F=596.189,P=0.000); 2組疼痛VAS評分隨時間變化均呈降低趨勢,但2組的降低趨勢不完全一致[(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]; 治療前及治療開始后3個月,2組疼痛VAS評分比較,差異均無統(tǒng)計學意義(t=-0.672,P=0.506; t=-1.137,P=0.262); 治療開始后2周,聯(lián)合治療組的疼痛VAS評分低于基礎(chǔ)治療組(t=-5.121,P=0.000)。②感覺麻木VAS評分。時間因素與分組因素存在交互效應(yīng)(F=7.534,P=0.001); 2組感覺麻木VAS評分總體比較,差異有統(tǒng)計學意義,即存在分組效應(yīng)(F=15.104,P=0.000); 治療前后不同時點之間感覺麻木VAS評分的差異有統(tǒng)計學意義,即存在時間效應(yīng)(F=421.241,P=0.000); 2組感覺麻木VAS評分隨時間變化均呈降低趨勢,但2組的降低趨勢不完全一致[(5.238±0.875)分,(2.738±0.561)分,(1.357±0.854)分,F=339.958,P=0.000;(5.429±0.763)分,(3.905±0.605)分,(1.857±0.478)分,F=269.273,P=0.000]; 治療前2組感覺麻木VAS評分比較,差異無統(tǒng)計學意義(t=-0.752,P=0.457); 治療開始后2周和治療開始后3個月,聯(lián)合治療組的感覺麻木VAS評分均低于基礎(chǔ)治療組(t=-6.479,P=0.000; t=-2.342,P=0.024)。③ODI評分。時間因素與分組因素存在交互效應(yīng)(F=4.346,P=0.016); 2組ODI評分總體比較,差異無統(tǒng)計學意義,即不存在分組效應(yīng)(F=1.459,P=0.234); 治療前后不同時點之間ODI評分的差異有統(tǒng)計學意義,即存在時間效應(yīng)(F=261.210,P=0.000); 2組ODI評分隨時間變化均呈降低趨勢,但2組的降低趨勢不完全一致[(39.789±10.930)分,(19.579±8.537)分,(11.325±6.242)分,F=339.958,P=0.000;(40.471±13.929)分,(24.022±9.124)分,(17.462±10.238)分,F=269.273,P=0.000]; 治療前和治療開始后2周,2組ODI評分比較,差異均無統(tǒng)計學意義(t=0.082,P=0.935; t=-1.630,P=0.111); 治療開始后3個月,聯(lián)合治療組的ODI評分低于基礎(chǔ)治療組(t=-2.345,P=0.024)。④總體療效。按照改良MacNab標準評定總體療效,聯(lián)合治療組優(yōu)15例、良4例、可1例、差1例,基礎(chǔ)治療組優(yōu)8例、良7例、可4例、差2例。聯(lián)合治療組的總體療效優(yōu)于基礎(chǔ)治療組(R^-聯(lián)合治療組=17.81,R^-基礎(chǔ)治療組=25.19,Z=-2.158,P=0.031)。療效評定為差的3例患者,采用針刺配合鄭氏舒活酊涂擦治療(方案同前),繼續(xù)治療1個月后癥狀均緩解。⑤治療期間鎮(zhèn)痛藥物使用情況。治療期間聯(lián)合治療組2例口服氨酚曲馬多片,基礎(chǔ)治療組8例口服氨酚曲馬多片、3例肌肉注射鹽酸哌替啶注射液。聯(lián)合治療組鎮(zhèn)痛藥物使用率低于基礎(chǔ)治療組(χ2=9.024,P=0.003)。⑥安全性。2組患者均未發(fā)生暈針、針刺后疼痛、針刺后血腫、皮膚過敏、皮膚感染等針刺及中藥涂擦相關(guān)不良反應(yīng)。使用鎮(zhèn)痛藥后,聯(lián)合治療組1例出現(xiàn)惡心癥狀,基礎(chǔ)治療組2例出現(xiàn)惡心癥狀、2例出現(xiàn)眩暈、1例出現(xiàn)嗜睡、1例出現(xiàn)便秘,停藥后不良反應(yīng)均緩解,未進行特殊處理。結(jié)論:在抗炎消腫等常規(guī)治療的基礎(chǔ)上給予針刺配合鄭氏舒活酊涂擦,可有效改善PELD術(shù)后感覺異常患者的疼痛和麻木癥狀,總體療效優(yōu)于單純的常規(guī)治療,而且具有較高的安全性。
Abstract:
Objective: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 statistical difference in the pain VAS scores between the 2 groups in general,in other words,there was group effect(F=6.830,P=0.013).There was statistical difference in pain VAS scores between different timepoints before and after the treatment,in other words,there was time effect(F=596.189,P=0.000).The pain VAS scores presented a time-dependent decreasing trend in both of the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(5.762+/-0.816,2.905+/-0.436,1.571+/-0.598 points,F=339.958,P=0.000; 5.952+/-1.011,3.881+/-0.757,1.786+/-0.624 points,F=269.273,P=0.000).There was no statistical difference in pain VAS scores between the 2 groups before treatment and at 3 months after the beginning of the treatment(t=-0.672,P=0.506; t=-1.137,P=0.262).The pain VAS scores were lower in combination treatment group compared to basic treatment group at 2 weeks after the beginning of the treatment(t=-5.121,P=0.000).There was interaction between time factor and group factor in numbness VAS scores(F=7.534,P=0.001).There was statistical difference in numbness VAS scores between the 2 groups in general,in other words,there was group effect(F=15.104,P=0.000).There was statistical difference in numbness VAS scores between different timepoints before and after the treatment,in other words,there was time effect(F=421.241,P=0.000).The numbness VAS scores presented a time-dependent decreasing trend in both of the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(5.238+/-0.875,2.738+/-0.561,1.357+/-0.854 points,F=339.958,P=0.000; 5.429+/-0.763,3.905+/-0.605,1.857+/-0.478 points,F=269.273,P=0.000).There was no statistical difference in numbness VAS scores between the 2 groups before the treatment(t=-0.752,P=0.457).The numbness VAS scores were lower in combination treatment group compared to basic treatment group at 2 weeks and 3 months after the beginning of the treatment(t=-6.479,P=0.000; t=-2.342,P=0.024).There was interaction between time factor and group factor in ODI scores(F=4.346,P=0.016).There was no statistical difference in ODI scores between the 2 groups in general,in other words,there was no group effect(F=1.459,P=0.234).There was statistical difference in ODI scores between different timepoints before and after the treatment,in other words,there was time effect(F=261.210,P=0.000).The ODI scores presented a time-dependent decreasing trend in both of the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(39.789+/-10.930,19.579+/-8.537,11.325+/-6.242 points,F=339.958,P=0.000; 40.471+/-13.929,24.022+/-9.124,17.462+/-10.238 points,F=269.273,P=0.000).There was no statistical difference in ODI scores between the 2 groups before the treatment and at 2 weeks after the beginning of the treatment(t=0.082,P=0.935; t=-1.630,P=0.111).The ODI scores were lower in combination treatment group compared to basic treatment group at 3 months after the beginning of the treatment(t=-2.345,P=0.024).The total clinical curative effects were evaluated according to improved MacNab standard.Fifteen patients obtained an excellent result,4 good,1 fair and 1 poor in combination treatment group; while 8 patients obtained an excellent result,7 good,4 fair and 2 poor in basic treatment group.The combination treatment group surpassed the basic treatment group in the total clinical curative effects(R^-combination treatment group=17.81,R^-basic treatment group=25.19,Z=-2.158,P=0.031).The symptoms of 3 patients with poor clinical curative effects were relieved after treatment with acupuncture therapy and inunction of Zheng's SHD for another month.During the treatment period,2 patients in combination treatment group and 8 patients in basic treatment group were treated with oral application of tramadol hydrochloride paracetamol tablets and 3 patients in basic treatment group were treated with intramuscular injection of pethidine hydrochloride injection.The usage rate of analgesic drugs was lower in combination treatment group compare to basic treatment group(χ2=9.024,P=0.003).No acupuncture-related and TCM inunction-related adverse reactions such as acupuncture-induced fainting,post-acupuncture pain,post-acupuncture hematoma,skin allergy and skin infection were found in the 2 groups.After analgesic drugs were used,nausea was found in 1 patient in combination tretment group; while nausea(2),dizziness(2),somnolence(1)and constipation(1)were found in patients in basic treatment group.All the adverse reactions were relieved after analgesic drugs were withdrawed and no special treatment were performed.Conclusion:The combination therapy of conventional therapy such as anti-inflammation and detumescence combined with acupuncture and inunction of Zheng's SHD can effectively improve the pain and numbness symptoms of patients with paresthesia after PELD,and it surpasses the monotherapy of conventional therapy in total clinical curative effects,moreover,it has high safety.

參考文獻/References:


[1] HOOGLAND T,VAN DEN BREKEL-DIJKSTRA K,SCHUBERT M,et al.Endoscopic transforaminal discectomy for recurrent lumbar disc herniation: a prospective, cohort evaluation of 262 consecutive cases[J].Spine(Phila Pa 1976),2008,33(9):973-978.
[2] GIBSON J N,COWIE J G,IPRENBURG M.Transforaminal endoscopic spinal surgery:the future ‘Gold standard' for discectomy?—A review[J].Surgeon,2012,10(5):290-296.
[3] 徐峰,徐彬,李濤,等.經(jīng)皮內(nèi)鏡下腰椎間盤切除術(shù)圍手術(shù)期并發(fā)癥的臨床研究[J].中國矯形外科雜志,2018,26(1):17-21.
[4] 李長青,周躍,王建,等.經(jīng)皮內(nèi)窺鏡下手術(shù)治療腰椎間盤突出癥的并發(fā)癥及其防治策略[J].中國脊柱脊髓雜志,2012,22(11):969-974.
[5] 賓夢翔,張冰彬,唐本夫.中藥封包療法治療腰椎間盤突出癥椎間孔鏡術(shù)后感覺異常30例[J].湖南中醫(yī)雜志,2018,34(5):96-98.
[6] 顧麗麗,張達穎,張學學,等.骶管阻滯術(shù)聯(lián)合牛痘疫苗接種家免炎癥皮膚提取物治療透皮椎間孔鏡術(shù)后腰腿痛及麻木的臨床觀察[J].中國疼痛醫(yī)學雜志,2016,22(10):798-800.
[7] 國家中醫(yī)藥管理局.中醫(yī)病證診斷療效標準[M].南京:南京大學出版社,1994:51-52.
[8] 侯樂榮,解勇.鄭氏傷科理論與臨床[M].成都:四川科學技術(shù)出版社,2010:119.
[9] FAIRBANK J C,PYNSENT P B.The oswestry disability index[J].Spine(Phila Pa 1976),2000,25(22):2940-2952.
[10] MACNAB I.Negative disc exploration.An analysis of the causes of nerve-root involvement in sixty-eight patients[J].J Bone Joint Surg Am,1971,53(5):891-903.
[11] ZHOU C L,ZHANG G Q,PANCHAL R R,et al.Unique complications of percutaneous endoscopic lumbar discectomy and percutaneous endoscopic interlaminar discectomy[J].Pain Physician,2018,21(2):E105-E112.
[12] CHOI G,LEE S H,BHANOT A,et al.Percutaneous endoscopic discectomy for extraforaminal lumbar disc herniations:extraforaminal targeted fragmentectomy technique using working channel endoscope[J].Spine(Phila Pa 1976),2007,32(2):E93-99.
[13] JANG J S,AN S H,LEE S H.Transforaminal percutaneous endoscopic discectomy in the treatment of foraminal and extraforaminal lumbar disc herniations[J].J Spinal Disord Tech,2006,19(5):338-343. 中醫(yī)正骨2019年7月第31卷第7期 J Trad Chin Orthop Trauma,2019,Vol.31,No.7(總513) (總514)中醫(yī)正骨2019年7月第31卷第7期 J Trad Chin Orthop Trauma,2019,Vol.31,No.7
[14] 徐少克,童瑞年,童瑞龍.經(jīng)皮穿刺內(nèi)窺鏡下手術(shù)治療腰椎間盤疾患的療效分析[J].中國脊柱脊髓雜志,2009,19(5):330-335.
[15] AHN Y,LEE S H,PARK W M,et al.Posterolateral percutaneous endoscopic lumbar foraminotomy for L5-S1 foraminal or lateral exit zone stenosis.Technical note[J].J Neurosurg,2003,99(3 Suppl):320-323.
[16] CHO J Y,LEE S H,LEE H Y.Prevention of development of postoperative dysesthesia in transforaminal percutaneous endoscopic lumbar discectomy for intracanlicular lumbar disc herniation: floating retraction technique[J].Minim Invasive Neurosurg,2011,54(5-6):214-218.
[17] 趙杉,賀石生,張海龍.椎間孔鏡術(shù)后感覺異常的危險因素及處理[J].實用骨科雜志,2014,20(11):1051-1052.
[18] SIVAGANESAN A,CHOTAI S,PARKER S L,et al.Predictors of the efficacy ofepidural steroid injections for structural lumbar degenerative pathology[J].Spine J,2016,16(8):928-934.
[19] WANG K,BAO J P,YANG S,et al.A cohort study comparing the serum levels of pro- or anti-inflammatory cytokines in patients with lumbar radicular pain and healthy subjects[J].Eur Spine J,2016,25(5):1428-1434.
[20] 陳勝利,唐凱.針刺配合中藥熏蒸對腰椎間盤突出癥術(shù)后疼痛及功能的影響[J].西南軍醫(yī),2014,16(2):161-162.
[21] 賈瓊,柴旭斌,鐘煒鈺.口服獨活寄生湯治療腰椎間盤突出癥椎間孔鏡術(shù)后感覺異常[J].中醫(yī)正骨,2016,28(2):11-14.
[22] 周軍,王甫剛,劉欣,等.口服獨活寄生湯治療腰椎間盤突出癥椎間孔鏡術(shù)后感覺異常的效果觀察[J].中國骨與關(guān)節(jié)損傷雜志,2018,33(3):295-296.
[23] 楊海龍,張永臣,賈紅玲,等.針灸治療腰椎間盤突出癥臨床研究進展[J].針灸臨床雜志,2015,31(9):86-90.
[24] 荀陽洋.鄭氏舒活酊聯(lián)合鄭氏手法治療氣滯血瘀證頸型頸椎病的臨床觀察[D].成都:成都體育學院,2018.

相似文獻/References:

[1]馮榮,王平,李炳奇,等.鈹針刺絡(luò)拔罐結(jié)合中藥口服治療膝骨關(guān)節(jié)炎合并 原發(fā)性血小板增多癥1例[J].中醫(yī)正骨,2015,27(12):73.

備注/Memo

備注/Memo:
基金項目:四川省醫(yī)學會科研課題(S16064); 四川省衛(wèi)生和健康委員會科研課題(17PJ211); 四川省干部保健優(yōu)秀人才培養(yǎng)項目(川干健辦發(fā)[2017]20號)通訊作者:李越 E-mail:[email protected](收稿日期:2019-04-15 本文編輯:李曉樂)
更新日期/Last Update: 2019-07-20