针刺背俞穴、夹脊穴治疗老年腰椎间盘突出症的临床观察

Acupuncture at Beishu Point and Jiaji Point for Treatment of Lumbar Intervertebral Disc Protrusion in the Elderly

目的观察老年腰椎间盘突出症(Lumbar disc herniation,LDH)患者经针刺背俞穴、夹脊穴后的疼痛程度及腰背肌生物力学的变化,为针刺疗法在未来LDH治疗中的应用提供依据。方法选取2018年1月—2020年1月期间于中国人民解放军联勤保障部队第九〇四医院接受治疗的92例老年LDH患者作为研究对象,按随机数字表法分为治疗组及对照组各46例。两组患者在口服双氯芬酸钠缓释片的基础上,对照组联合肌内效贴扎治疗,治疗组联合针刺背俞穴、夹脊穴治疗,两组均持续治疗4周。比较两组临床疗效,比较两组患者治疗前与治疗结束时的疼痛程度[采用视觉模拟评分法(Visual Analogue Scale,VAS)评估]、腰背屈肌/伸肌比值(Flexor/extensor,F/E)与腰背伸展状态下的平均功率(Average power,AP)、峰力矩(Peak torque,PT),记录治疗期间不良反应状况。结果治疗后治疗组的总有效率95.65%(44/46)高于对照组82.61%(38/46),两组比较,差异有统计学意义(P<0.05)。治疗后两组患者VAS评分均较治疗前降低,差异有统计学意义(P<0.05),且治疗组患者VAS评分低于对照组,两组比较,差异有统计学意义(P<0.05)。治疗后两组患者腰背F/E较治疗前减小,伸展状态下AP、PT较治疗前增大,差异有统计学意义(P<0.05),且治疗组腰背F/E小于对照组,伸展状态下AP、PT大于对照组,两组比较,差异有统计学意义(P<0.05)。治疗期间,两组皮肤过敏、头痛、局部感染、胃肠道反应的发生率比较,差异无统计学意义(P>0.05)。结论针刺背俞穴、夹脊穴治疗LDH疗效确切,能有效减轻患者疼痛程度,改善患者的腰背肌生物力学,且治疗安全性高,具有较高的临床应用价值。

Objective To observe the pain degree and biomechanical changes of the lumbar and back muscles after acupuncture at the Beishu point and Jiaji(EX-B2)in elderly patients with lumbar disc herniation(LDH),so as to provide a basis for the application of acupuncture in the future treatment of LDH.Methods From January 2018 to January 2020,92 elderly patients with LDH who were treated in our hospital were selected as the research subject,and were divided into a treatment group and a control group according to the random number table method with 46 cases in each group.On the basis of orally taken diclofenac sodium sustained-release tablets,the control group was treated with intramuscular ligation,and the treatment group was treated with acupuncture at Beishu point and Jiaji(EX-B2).Both groups continued treatment for 4 weeks.Compared the efficacy of the two groups,compared the pain degree 1 day before treatment and at the end of the treatment[assessment by visual analogue scale(VAS)],the ratio of lower back flexor/extensor muscle(F/E)and the average power(AP)and peak torque(PT)at the state of lower back extension were recorded,and the adverse reaction status during treatment was recorded between the two groups.Results After treatment,the total effective rate of the treatment group was 95.65%(44/46)higher than that of the control group 82.61%(38/46).The difference between the two groups was statistically significant(P<0.05).After treatment,the VAS scores of the two groups were lower than before treatment(P<0.05),and the VAS scores of patients in the treatment group were lower than those of the control group,and the difference between the two groups was statistically significant(P<0.05).After treatment,the lower back F/E of thetwo groups of patients was lower than before treatment,AP and PT in the stretched state were higher than before treatment(P<0.05),and the lower back F/E of the treatment group was lower than that of the control group,AP and PT in the stretched state were greater than those of the control group,and the difference between the two groups was statistically significant(P<0.05).During treatment,there was no significant difference in the incidence of skin allergies,headaches,local infections,and gastrointestinal reactions between the two groups(P>0.05).Conclusion Acupuncture at Beishu point and Jiaji(EX-B2)has a definite therapeutic effect on LDH,which can effectively reduce the pain degree of patients and improve the biomechanics of patients′lumbar and back muscles.The treatment is safety and has high clinical application value.