中国骨伤
中國骨傷
중국골상
CHINA JOURNAL OF ORTHOPAEDICS AND TRAUMATOLOGY
2014年
6期
513-517
,共5页
肖京%朱立国%金添%陈京锋%于杰%冯敏山
肖京%硃立國%金添%陳京鋒%于傑%馮敏山
초경%주입국%금첨%진경봉%우걸%풍민산
慢性病%腰痛%肌张力%针灸疗法
慢性病%腰痛%肌張力%針灸療法
만성병%요통%기장력%침구요법
Chronic disease%Low back pain%Muscle tonus%Acupuncture moxibustion
目的：评价腰部软组织张力测定在慢性非特异性腰痛患者治疗过程中作为疗效评价客观指标的临床意义。方法：自2011年8月至2012年3月，选取慢性非特异性腰痛患者60例，以1∶1的比例分为银质针与中药熏蒸组。银质针组男17例，女13例，年龄28～55岁，平均（45．70±4．15）岁，采用银质针透热治疗；中药熏蒸组男19例，女11例，年龄27～55岁，平均（43．03±5．86）岁，采用中药熏蒸治疗。分别于治疗前，治疗后1周、3个月观察两组患者力-位移距离（FDD）、能量吸收比（S）的变化，并采用疼痛视觉模拟积分（VAS）、罗兰德-莫里斯功能障碍量表（RMDQ）进行疗效评价。结果：①治疗前，治疗后1周及3个月银质针组VAS评分分别为4．77±0．78、1．99±1．08、2．55±0．94，中药熏蒸组分别为4．43±0．61、2．48±0．71、3．05±0．86。两组治疗后VAS评分均较治疗前均明显降低（P＜0．01，P＜0．05）。治疗前两组比较差异无统计学意义，治疗后银质针组较中药熏蒸组镇痛效果更为明显（P＜0．05）。治疗前，治疗后1周及3个月时银质针组RMDQ分别为13．63±1．96、5．87±2．33、6．53±2．89；中药熏蒸组分别为13．40±2．01、6．90±2．31、9．23±2．87。组间比较，治疗前与治疗后1周两组比较差异无统计学意义（P＞0．05），与治疗后3个月比较差异有统计学意义（P＜0．01），银质针组与中药熏蒸组都能够一定程度上改善慢性腰痛所引起的功能障碍，银质针的治疗效果更为持久。②治疗后1周及3个月随访时，银质针组患侧多裂肌及竖脊肌、健侧多裂肌的FDD均明显增加（P＜0．05）；中药熏蒸组治疗后1周患侧和健侧多裂肌及竖脊肌的FDD均较治疗前增加（P＜0．05），3个月时患侧多裂肌及竖脊肌FDD与治疗前比较差异无统计学意义（P＞0．05）。组间比较，治疗前两组间比较差异不明显（P＞0．05），治疗后1周，银质针组患侧多裂肌及竖脊肌FDD增加更为明显（P＜0．05），而健侧多裂肌及竖脊肌两组间对比差异无统计学意义。治疗后3个月，银质针组患侧及健侧两组肌肉的FDD均明显较高（P＞0．01）。③患侧多裂肌与竖脊肌的FDD差值与VAS及RMDQ差值存在相关性，Spearman相关系数R分别为0．517，0．811，0．746、0．625，P值分别为0．015，0．041，0．045、0．017。腰部软组织张力指标改善的变化趋势与症状、功能、生活质量改善的变化趋势一致，具有相关性。结论：软组织张力的测试可以有效地反映慢性腰痛患者的疼痛强度和腰部功能障碍的程度，提高慢性腰痛的疗效评价的客观性。
目的：評價腰部軟組織張力測定在慢性非特異性腰痛患者治療過程中作為療效評價客觀指標的臨床意義。方法：自2011年8月至2012年3月，選取慢性非特異性腰痛患者60例，以1∶1的比例分為銀質針與中藥熏蒸組。銀質針組男17例，女13例，年齡28～55歲，平均（45．70±4．15）歲，採用銀質針透熱治療；中藥熏蒸組男19例，女11例，年齡27～55歲，平均（43．03±5．86）歲，採用中藥熏蒸治療。分彆于治療前，治療後1週、3箇月觀察兩組患者力-位移距離（FDD）、能量吸收比（S）的變化，併採用疼痛視覺模擬積分（VAS）、囉蘭德-莫裏斯功能障礙量錶（RMDQ）進行療效評價。結果：①治療前，治療後1週及3箇月銀質針組VAS評分分彆為4．77±0．78、1．99±1．08、2．55±0．94，中藥熏蒸組分彆為4．43±0．61、2．48±0．71、3．05±0．86。兩組治療後VAS評分均較治療前均明顯降低（P＜0．01，P＜0．05）。治療前兩組比較差異無統計學意義，治療後銀質針組較中藥熏蒸組鎮痛效果更為明顯（P＜0．05）。治療前，治療後1週及3箇月時銀質針組RMDQ分彆為13．63±1．96、5．87±2．33、6．53±2．89；中藥熏蒸組分彆為13．40±2．01、6．90±2．31、9．23±2．87。組間比較，治療前與治療後1週兩組比較差異無統計學意義（P＞0．05），與治療後3箇月比較差異有統計學意義（P＜0．01），銀質針組與中藥熏蒸組都能夠一定程度上改善慢性腰痛所引起的功能障礙，銀質針的治療效果更為持久。②治療後1週及3箇月隨訪時，銀質針組患側多裂肌及豎脊肌、健側多裂肌的FDD均明顯增加（P＜0．05）；中藥熏蒸組治療後1週患側和健側多裂肌及豎脊肌的FDD均較治療前增加（P＜0．05），3箇月時患側多裂肌及豎脊肌FDD與治療前比較差異無統計學意義（P＞0．05）。組間比較，治療前兩組間比較差異不明顯（P＞0．05），治療後1週，銀質針組患側多裂肌及豎脊肌FDD增加更為明顯（P＜0．05），而健側多裂肌及豎脊肌兩組間對比差異無統計學意義。治療後3箇月，銀質針組患側及健側兩組肌肉的FDD均明顯較高（P＞0．01）。③患側多裂肌與豎脊肌的FDD差值與VAS及RMDQ差值存在相關性，Spearman相關繫數R分彆為0．517，0．811，0．746、0．625，P值分彆為0．015，0．041，0．045、0．017。腰部軟組織張力指標改善的變化趨勢與癥狀、功能、生活質量改善的變化趨勢一緻，具有相關性。結論：軟組織張力的測試可以有效地反映慢性腰痛患者的疼痛彊度和腰部功能障礙的程度，提高慢性腰痛的療效評價的客觀性。
목적：평개요부연조직장력측정재만성비특이성요통환자치료과정중작위료효평개객관지표적림상의의。방법：자2011년8월지2012년3월，선취만성비특이성요통환자60례，이1∶1적비례분위은질침여중약훈증조。은질침조남17례，녀13례，년령28～55세，평균（45．70±4．15）세，채용은질침투열치료；중약훈증조남19례，녀11례，년령27～55세，평균（43．03±5．86）세，채용중약훈증치료。분별우치료전，치료후1주、3개월관찰량조환자력-위이거리（FDD）、능량흡수비（S）적변화，병채용동통시각모의적분（VAS）、라란덕-막리사공능장애량표（RMDQ）진행료효평개。결과：①치료전，치료후1주급3개월은질침조VAS평분분별위4．77±0．78、1．99±1．08、2．55±0．94，중약훈증조분별위4．43±0．61、2．48±0．71、3．05±0．86。량조치료후VAS평분균교치료전균명현강저（P＜0．01，P＜0．05）。치료전량조비교차이무통계학의의，치료후은질침조교중약훈증조진통효과경위명현（P＜0．05）。치료전，치료후1주급3개월시은질침조RMDQ분별위13．63±1．96、5．87±2．33、6．53±2．89；중약훈증조분별위13．40±2．01、6．90±2．31、9．23±2．87。조간비교，치료전여치료후1주량조비교차이무통계학의의（P＞0．05），여치료후3개월비교차이유통계학의의（P＜0．01），은질침조여중약훈증조도능구일정정도상개선만성요통소인기적공능장애，은질침적치료효과경위지구。②치료후1주급3개월수방시，은질침조환측다렬기급수척기、건측다렬기적FDD균명현증가（P＜0．05）；중약훈증조치료후1주환측화건측다렬기급수척기적FDD균교치료전증가（P＜0．05），3개월시환측다렬기급수척기FDD여치료전비교차이무통계학의의（P＞0．05）。조간비교，치료전량조간비교차이불명현（P＞0．05），치료후1주，은질침조환측다렬기급수척기FDD증가경위명현（P＜0．05），이건측다렬기급수척기량조간대비차이무통계학의의。치료후3개월，은질침조환측급건측량조기육적FDD균명현교고（P＞0．01）。③환측다렬기여수척기적FDD차치여VAS급RMDQ차치존재상관성，Spearman상관계수R분별위0．517，0．811，0．746、0．625，P치분별위0．015，0．041，0．045、0．017。요부연조직장력지표개선적변화추세여증상、공능、생활질량개선적변화추세일치，구유상관성。결론：연조직장력적측시가이유효지반영만성요통환자적동통강도화요부공능장애적정도，제고만성요통적료효평개적객관성。
Objective:To evaluate clinical significance of waist soft tissue tension detection in treating chronic nonspecific low back pain. Methods:From August 2011 to March 2012,60 patients with chronic nonspecific low back pain were divided into two groups (sliver needle group and TCM fumigation group ) according to propotion of 1∶1. In sliver needle group ,there were 17 males and 13 females aged from 28 to 55 years old with an average age of (45.70±4.15),treated with sliver needle;In TCM fumigation group,there were 19 males and 11 females aged from 27 to 55 years old with an average age of (43.03±5.86), treated with TCM fumigation. Changes of force displacement distance (FDD),specific absorption rate (S) of two groups were observed before treatment,1 week and 3 months after treatment respectively,VAS scoring and Roland-Morris disability ques-tionnaire(RMDQ) were used to access clinical effects. Results:①VAS score of silver needle group was 4.77±0.78,1.99 ±1.08 and 2.55 ±0.94,respectively before treatment,at 1week and 3 months after treatment,while VAS score in TCM fumigation group were 4.43±0.61,2.48±0.71 and 3.05±0.86,respectively. VAS score of two groups after treatment were sigificant decrease than that of before treatment(P<0.05). There was no sigificant differences between two groups before treatment,but sliver nee-dle group performed well in analgesia than TCM fumigation group,and had obvious differences(P<0.05). RMDQ score of silver needle group was 13.63±1.96,5.87±2.33 and 6.53±2.89,respectively before treatment,at 1 week and 3 months after treat-ment,while RMDQ score in TCM fumigation group were 13.40±2.01,6.90±2.31、9.23±2.87,respectively. There was no signifi-cant differences between two groups before treatment and 1 week after treatment (P>0.05),and had obvious differences be-tween two groups at 3 months after treatment (P<0.01). Both groups could obvious improve dysfunction caused by chronic low back pain,and curative effect of sliver needle groups was more endurable.②Following up at 3 months after treatment,FDD of multifidus,erector spinae of effected side and multifidus of healthy in sliver needle group were obvious increased (P<0.05);In TCM fumigation group,FDD of multifidus and erector spinae on both side were increased at 1 week after treatment (P<0.05), but had no significant meaning at 3 months after treatment on health side (P>0.05). There was no significant meaning before treatment (P>0.05),FDD of multifidus,erector spinae of effected side in sliver needle group were obvious increased at 1 week after treatment (P<0.05);but no obvious meaning on health side. FDD of both side in sliver needle group were obvious in-creased at 3 months after treatment.③There was correlation among differences of FDD in multifidus and erector spinae ,VAS score and differences of RMDQ,and Spearman correlation coefficient R was 0.517,0.811,0.746 and 0.625;There was correla-tion between items of soft tissue tension and sympotoms ,function and life quality. Conclusion:Soft tissue tension detection can effectively manifest degree of pain and dysfunction of low back ,and improve objectivity of therapeutic evaluation for chronic low back pain.
