经筋理论指导下DSA引导针刀“解结法”治疗第三腰椎横突综合征临床观察

Clinical Observation on the Treatment of the Third Lumbar Transverse Process Syndrome with“Unknotting Method”Guided by DSA Under the Guidance of Meridian Sinew Theory

目的观察在经筋理论指导下DSA引导针刀"解结法"治疗第三腰椎横突综合征的临床疗效,通过DSA引导评价传统针刀操作的准确性。方法选择75例符合第三腰椎横突综合征诊断患者,按随机数字表法随机分为3组:观察组(DSA引导经筋组,n=25),对照I组(DSA引导常规针刀组,n=25),对照II组(传统针刀组,n=25),治疗1次/周,共治疗2次(1个疗程)。统计3组在治疗前的VAS与ODI评分,在首次治疗后2 h、1个疗程结束后统计3组VAS评分,并在治疗结束后第1周和第4周随访VAS与ODI评分,以及比较3组治疗后的总显效率情况,并观察DSA引导组的针刀位置调整情况。结果3组治疗前的VAS与ODI评分差异无统计学意义(P>0.05);统计治疗后及随访的4次VAS与ODI评分,观察组均明显优于2个对照组;观察组的总显效率明显优于2个对照组;3组在治疗结束后随访的第4周VAS与ODI评分均优于随访的第1周(以上差异均P<0.05)。统计数据说明观察组疗效最优,其次为对照I组,且3组远期疗效优于近期疗效。DSA引导的两组共有76%的患者在治疗中需调整针刀位置,调整的位置频率由高到低分别是:腰3横突体部(39.47%)、腰3椎体(26.32%)、腰2横突(18.42%)、腰4横突(15.79%)。结论经筋理论指导下DSA引导针刀"解结法"治疗第三腰椎横突综合征的临床疗效优于单纯松解第三腰椎横突端部的传统针刀治疗,且远期疗效更好,DSA引导针刀操作与盲视下比较,准确性更高,疗效更好,值得临床推广应用。

Objective To observe the clinical effect of DSA guided acupotomy with“unknotting method”in the treatment of the third lumbar transverse process syndrome under the guidance of meridian sinew theory,and to observe the accuracy of traditional acupotomy operation under the guidance of DSA.Methods A total of 75 patients who met the diagnosis of the third lumbar transverse process syndrome were randomly divided into three groups according to the random number table method:the observation group(DSA guided meridional tendon group,n=25),the control group I(DSA guided conventional acupotomology group,n=25),and the control group II(traditional acupotomology group,n=25),once a week,twice a course.the VAS score of three groups before treatment and after treatment for the first time two hours,after a course of treatment,completion of treatment after the first week and the forth week were statistically analyzed;Observed the ODI score of the three groups before treatment,1 week and 4 weeks after the end of treatment;compared the total effective rate of the three groups after treatment,and observed the adjustment of needle knife position between the observation group guided by DSA and the control group I.Results There was no significant difference between VAS score and ODI score before treatment in the three groups(P>0.05);After treatment and four times of follow-up,the VAS and ODI scores of the observation group were significantly better than those of the two control groups;the total efficiency of the observation group was significantly better than that of the two control groups;the VAS and ODI scores of the fourth week of follow-up of the three groups were better than that of the first week of follow-up(P<0.05).Statistical data showed that the observation group was the best,followed by the control group I,and the long-term effect of the three groups was better than the short-term effect.76%of the patients in the DSA guided two groups were needed to adjust the acupotomy position in the treatment;In the cases of adjustment,the frequency of adjustment was from high to low:the body part of lumbar 3 transverse process(39.47%),lumbar 3 vertebral body(26.32%),lumbar 2 transverse process(18.42%)and lumbar 4 transverse process(15.79%).Conclusion Under the guidance of the theory of meridian sinew,the clinical effect of DSA guided acupotomy in the treatment of the third lumbar transverse process syndrome is better than that of the traditional acupotomy only in the end of the third lumbar transverse process,and the long-term effect is better.Compared with blind vision,DSA guided acupotomy operation has higher accuracy and better effect,which is worthy of clinical application.