刺骨调筋针法治疗腰椎术后失败综合征临床疗效

Effect of Needling Method of Touching-Periosteum and Regulating-Muscle for Failed Back Surgery Syndrome

目的:观察刺骨调筋针法对腰椎术后失败综合征(Failed Back Surgery Syndrome, FBSS)的临床疗效,探讨提高本病治疗疗效的方法。方法:将60例腰椎术后失败综合征患者随机分为对照组、常规针刺组和刺骨调筋针刺组,每组20例。对照组给予常规药物及康复治疗;常规针刺组在对照组的基础上,选择腰部夹脊穴、环跳、委中、阳陵泉、悬钟治疗;刺骨调筋组针刺基本同常规针刺组,不同的是,腰部夹脊穴选择棘突上缘旁开3 cm处为进针点,进针直刺抵骨,小幅度提插3次后留针。两组均留针30 min,每日治疗1次,每周5次,连续治疗8周。分别于治疗前、治疗后2月、治疗后3月采用视觉模拟评分法(VAS)、日本骨科学会(JOA)腰痛评估表进行疗效分析,并进行临床疗效评定,记录不良事件。结果:治疗2月后3组VAS、JOA评分均较治疗前有明显改善(P<0.01),传统针刺组和刺骨调筋组优于对照组(P<0.01或P<0.05),两组之间无显著性差异(P>0.05);治疗3月后,对照组VAS评分较治疗2月时升高(P<0.05),表明对照组患者疼痛较治疗2月时有所加重,对照组JOA评分与治疗2月时无明显改善(P>0.05),传统针刺组与刺骨调筋组VAS、JOA评分均较治疗2月时明显改善(P<0.01),刺骨调筋组VAS评分优于传统针刺组(P<0.05),两组之间JOA评分无明显统计学差异(P>0.05);3组总有效率分别为65%、95%、100%,3组有效率存在显著统计学差异(P<0.01),刺骨调筋组有效率优于对照组(P<0.0125)。结论:刺骨调筋针法治疗FBSS疗效确切,且在改善远期疼痛疗效方面优于传统针刺,但其起效机制仍待进一步揭示。

Objective: To observe the effect of needling method of touching-periosteum and regulating-muscle for failed back surgery syndrome(FBSS) and explore new method for the disease.Methods: Sixty patients with FBSS were randomly assigned to control group, traditional acupuncture group and touching-periosteum and regulating-muscle group, 20 cases in each group. Conventional medication and rehabilitation therapy were taken in thecontrol group. Based on the above treatment, 30-minute acupuncture was given in the traditional acupuncture group for 8 weeks on lumbar Jiaji acupoints,Huantiao(GB30),Weizhong(UB40),Yanglingquan(GB34),Xuanzhong(GB39), once a day, 5 times a week.Also, 30-minute acupuncture was given in the touching-periosteum and regulating-muscle group for 8 weeks on Huantiao(GB30),Weizhong(UB40),Yanglingquan(GB34) and Xuanzhong(GB39). However, the difference from the traditional acupuncture group was that the lumbar Jiaji acupoints were select 3 cm a way from the upper edge of spinous process and needles were lifted and thrusted for 3 times in small amplitude after touching periosteum, once a day, 5 times a week. Scores of VAS and JOA were analysed before and after 2-monthand 3-month treatment. Moreover, the clinical effect was evaluated and the adverse effect was described.Results:After 2-month treatment, scores of VAS and JOA in the three groups significantly improved compared with those of before treatment(P<0.01), and traditional acupuncture group and touching-periosteum and regulating-muscle group were better than the control group(P<0.01 or P<0.05) while no difference was found between the two groups. After 3-month treatment, scores of VAS scores in the control group was increased compared with that after 2-month treatment(P<0.05), which indicated that symptom of pain was worsen than that after 2-month treatment. No difference was found in the control group in terms with JOA comparedto thatafter 2-month treatment. In traditional acupuncture group and touching-periosteum and regulating-muscle group, VAS and JOA after 3-month treatment was superior to that ofafter 2-month treatment(P<0.01) and VAS scoresinthe touching-periosteum and regulating-muscle group was better than that of the traditional acupuncture group(P<0.05) while no difference was found with JOA(P<0.05). The effect rate in the control group was 65% while 95% in traditional acupuncture group and 100% in touching-periosteum and regulating-muscle group. Effect rate intouching-periosteum and regulating-muscle group was better than that of the control group(P<0.012 5).Conclusions:The method of touching-periosteum and regulating-muscle has adefinite effect for FBSS and is better than traditional acupuncture in improving the long-term effect of pain, but the onset mechanism remains to be further revealed.