浮针治疗腰背肌筋膜炎的疗效观察及对血清炎症因子的影响

Efficacy observation of subcutaneous needling for lumbar and back myofascitis and its impact on serum inflammatory factors

目的观察浮针针刺红外热成像温度异常区域治疗腰背肌筋膜炎的临床疗效及对患者血清炎症因子水平的影响。方法纳入99例腰背肌筋膜炎患者并按随机数字表法随机分为A组、B组和C组,每组33例。A组为普通针刺,B组采用浮针针刺激痛点,C组采用浮针针刺红外热成像温度异常区域。在红外热成像下,观察治疗前针刺点与异常温度区的分布规律以及治疗前后高温区与低温区的温度变化。比较3组治疗前后血清炎症因子[白介素-1β(interleukin-1β,IL-1β)和P物质(substance P,SP)]水平、疼痛视觉模拟量表(visual analog scale,VAS)评分以及Oswestry功能障碍指数(Oswestry disability index,ODI)的变化。比较3组临床疗效。结果治疗前,A组穴位位置与高温区重合25例,与低温区位置重合2例;B组激痛点位置与高温区重合23例,与低温区重合3例;两组针刺点位置与异常温度区距离比较,差异无统计学意义(P>0.05);A组阿是穴针刺点与异常区域重合达93.0%,B组激痛点针刺点与异常区域重合达89.0%。治疗后,3组高温区的温度均较同组治疗前下降(P<0.05),低温区的温度均较同组治疗前升高(P<0.05);3组VAS和ODI评分以及血清IL-1β和SP水平均较同组治疗前降低(P<0.05)。治疗后,B组和C组高温区温度明显低于A组(P<0.05),B组和C组高温区温度差异无统计学意义(P>0.05),B组和C组低温区温度明显高于A组(P<0.05);B组和C组的VAS和ODI评分以及血清IL-1β和SP水平均明显低于A组(P<0.05),且C组上述指标均低于B组(P<0.05)。A组总有效率为69.7%,B组为84.8%,C组为93.9%,C组优于其余两组(P<0.01)。结论在红外热成像下,阿是穴与激痛点大多表现为局部温度升高,活化状态的激痛点与敏化状态的阿是穴具有高度一致性,二者均有一定的治疗作用,但阿是穴取穴范围更广泛。普通针刺、浮针激痛点和浮针治疗红外热成像温度异常区域3种方法均可促进高温区局部组织炎症因子的代谢,改善低温区血液循环。在红外热成像下,通过浮针直接对低温区治疗可能起到了隐形激痛点刺激作用,提高了疗效。

Objective To observe the clinical efficacy of subcutaneous needling at the abnormal temperature areas in infrared thermal imaging in treating lumbar and back myofascitis and its effects on the serum inflammatory factor levels in the patients.Method Ninety-nine patients with lumbar and back myofascitis were randomized into groups A,B,and C using the random number table method,with 33 cases in each group.Group A received the ordinary acupuncture method;group B received subcutaneous needling at trigger points;group C was treated with subcutaneous needling at the abnormal temperature region in infrared thermal imaging.The distribution rules of needling points and the abnormal temperature area and temperature changes in the high-temperature and low-temperature zones were observed using the infrared thermogram.The levels of serum inflammatory factors[interleukin-1β(IL-1β)and substance P(SP)],visual analog scale(VAS)score,and Oswestry disability index(ODI)were compared before and after the treatment.The clinical efficacy was also compared among the three groups.Result Before the treatment,group A had 25 cases with overlapped acupoints and high-temperature zone and 2 cases with overlapped acupoints and low-temperature zone;group B had 23 cases with overlapped trigger points and high-temperature zone and 3 cases with overlapped trigger points and low-temperature zone;there was no significant difference in the distance between the needling points and the abnormal temperature region between groups A and B(P>0.05);the coincidence rate of Ashi needling points and the abnormal region was 93.0%in group A,and the coincidence rate of trigger needling points and the abnormal region was 89.0%.After the treatment,the temperature dropped in the high-temperature zone in all three groups(P<0.05),and the temperature increased in the low-temperature zone(P<0.05);the VAS and ODI scores and the serum IL-1βand SP levels decreased after the intervention in the three groups(P<0.05).After the treatment,the high-temperature zone’s temperature was notably lower in groups B and C than in group A(P<0.05),while the difference between groups B and C was statistically insignificant(P>0.05);the low-temperature zone’s temperature was markedly higher in groups B and C than in group A(P<0.05);the VAS and ODI scores and the serum IL-1βand SP levels were significantly lower in groups B and C than in group A(P<0.05)and were lower in group C than in group B(P<0.05).The total effective rate was 69.7%in group A versus 84.8%in group B and 93.9%in group C,and group C outperformed the other two groups(P<0.01).Conclusion In infrared thermal imaging,most Ashi and trigger points have an increased temperature,and the activated trigger points and the sensitized Ashi points are highly consistent.Both Ashi and trigger points play important roles in treating this disease,but the range of Ashi points selection is more extensive.The three methods,ordinary acupuncture,subcutaneous needling at trigger points,and subcutaneous needling at the abnormal region in infrared thermal imaging,all can foster the metabolism of topical inflammatory factors in the high-temperature zone and improve blood circulation in the low-temperature zone.With the infrared thermogram,subcutaneous needling at the low-temperature zone may act as stimulating potential trigger points to boost the treatment efficacy.