乌头汤加味联合温针灸治疗肱骨外上髁炎风寒阻络证临床研究

Clinical Study on Modified Wutou Decoction Combined with Warm Acupuncture and Moxibustion in the Treatment of External Humeral Epicondylitis with Wind-chill Meridian-blocking Syndrome

目的观察乌头汤加味联合温针灸治疗肱骨外上髁炎(EHE)风寒阻络证临床疗效及对患者血清疼痛因子、β-内啡肽的影响。方法采用随机数字表法将180例患者随机分为中药组、温针组和联合组各60例。中药组予乌头汤加味,每日1剂,2次/d,口服;温针灸组予温针灸,1次/d,5次/周;联合组在中药组基础上予温针灸,方法同上。3组均连续治疗4周。观察3组临床疗效,比较3组治疗前后改良美国特种外科医院肘关节评分表(HSS)评分、Mayo肘关节功能评分(MEPS)、疼痛视觉模拟评分法(VAS)评分及血清P物质、多巴胺、β-内啡肽水平,监测3组不良反应。结果联合组、中药组及温针组总有效率分别为92.42%(61/66)、86.96%(60/69)、88.71%(55/62),联合组临床疗效优于中药组和温针组(P<0.05),中药组与温针组比较差异无统计学意义(P>0.05)。与本组治疗前比较,3组治疗后改良HSS评分、MEPS评分升高,VAS评分降低,血清P物质、多巴胺水平降低,β-内啡肽水平升高(P<0.05);3组治疗后比较,联合组上述指标均优于中药组、温针组(P<0.05)。仅中药组出现轻度不良反应1例。结论乌头汤加味联合温针灸治疗EHE风寒阻络证疗效较好,可调节患者血清疼痛因子及β-内啡肽水平。

Objective To observe the clinical efficacy of modified Wutou Decoction combined with warm acupuncture and moxibustion in the treatment of external humeral epicondylitis with wind-chill meridian-blocking syndrome and its effect on serum pain factors andβ-endorphin.Methods Totally 180 patients were randomly divided into TCM group,warm acupuncture and moxibustion group and combined group using random number table method,with 60 cases in each group.TCM group was given Wutou Decoction,1 dosage a day,twice a day,orally;warm acupuncture and moxibustion group received warm acupuncture and moxibustion,once a day,5 times each week;combined group was given warm acupuncture and moxibustion on the basis of TCM group,with the same method.The three groups were treated continuously for 4 weeks.Clinical efficacy of the three groups were observed,and the elbow scores of the New York Special Surgery Hospital(HSS),Mayo elbow function score(MEPS),pain visual analogue scale(VAS)score,serum substance P,dopamine andβ-endorphin levels before and after treatment in the three groups were compared.Adverse reactions were monitored.Results The total effective rates of combined group,TCM group and warm acupuncture and moxibustion group were 92.42%(61/66),86.96%(60/69)and 88.71%(55/62)respectively(P<0.05).The clinical efficacy of the combined group was better than that of TCM group and warm acupuncture and moxibustion group(P<0.05),without statistical significance between TCM group and warm acupuncture and moxibustion group(P>0.05).Compared with before treatment,the scores of HSS and MEPS,β-endorphin in the three groups increased(P<0.05),VAS scores,serum substance P,dopamine in serum in the three groups decreased(P<0.05).After treatment,the above indexes of the combined group were better than TCM group and warm acupuncture and moxibustion group(P<0.05).Only one case had mild adverse reactions in TCM group.Conclusion Modified Wutou Decoction combined with warm acupuncture and moxibustion has good clinical efficacy for external humeral epicondylitis with wind-chill meridian-blocking syndrome,which can adjust serum pain factors andβ-endorphin levels.