基于“动静结合,以动为主”的清宫正骨拔戳揉捻法治疗肱骨外上髁炎临床观察

Clinical observation on the treatment of lateral epicondylitis by Qing's palace bone setting manipulation of pulling poking rubbing and twisting methods based on the theory of combining dynamic with static and taking activity as the dominant factor

目的观察基于“动静结合,以动为主”理论的清宫正骨拔戳揉捻法治疗肱骨外上髁炎(LE)的临床疗效。方法选取2020年10月—2021年12月中国中医科学院望京医院就诊的LE患者64例,随机分为手法组和对照组各32例。2组均予宣教和肘部练功法指导,手法组采用清宫正骨拔戳揉捻法治疗,3次/周,治疗4周;对照组采用双氯芬酸二乙胺乳胶剂外用并佩戴护肘制动,1次/d,治疗4周。对比2组在治疗前、治疗结束后即刻以及治疗完成后2个月的视觉模拟评分(VAS)、美国特种外科医院(HSS)评分以及肘部压痛阈值。结果与治疗前比较,2组治疗结束后即刻和完成后2个月的VAS评分、HSS评分、肘部压痛阈值均改善(P<0.05);与对照组比较,手法组治疗结束后即刻和完成后2个月的VAS评分、HSS评分及压痛阈值改善明显(P<0.05)。与治疗结束后即刻比较,手法组治疗完成后2个月的VAS评分差异无统计学意义(P>0.05),HSS评分及压痛阈值下降(P<0.05);对照组治疗完成后2个月的VAS评分升高,HSS评分及压痛阈值下降(P<0.05)。结论与外用非甾体抗炎药治疗比较,基于“动静结合,以动为主”理论的清宫正骨拔戳揉捻法可显著减轻LE患者肘关节疼痛,改善关节活动功能,治疗结束长时间后仍有较好的止痛效果。

Objective To observe the curative effect of Qing's palace bone setting manipulation of pulling,poking,rubbing and twisting methods(QPM)in the treatment of lateral epicondylitis(LE)on the basis of the theory of combining dynamic with static and taking activity as the dominant factor.Methods A total of 64 patients with LE who received treatment in Wangjing Hospital of China Academy of Chinese Medical Sciences from October 2020 to December 2021 were selected and randomly divided into manipulation group and control group with 32 cases in each group.Both two groups shad got related education and elbow exercise guidence.The manipulation group were treated with the QPM method 3 times a week for 4 weeks;and the control group was applied with Diclofenac Diethylamine Emulgel and wore elbow padsonce a dayfor 4 weeks.The visual analogue scale(VAS)score,the hospital for special surgery(HSS)elbow joint score and the elbow tenderness threshold of two groups were obtained before treatment,immediately and 2 months after complete treatment so as to compare the clinical efficacy between two groups.Results The VAS score,HSS score,and elbow tenderness threshold of immediately and 2 months after complete treatment in two groups were significantly improved than before treatment(P<0.05).Significant improvements were observed in VAS score,HSS score and tenderness threshold immediately and 2 months after complete treatment in the manipulation group compared with the control group(P<0.05).Compared with instant after complete treatment,there was no significant difference in the VAS score of 2 months after complete treatment in the manipulation group(P>0.05),but the VAS score of 2 months after complete treatment in the control group was significantly was increased,the HSS score and the tenderness threshold were significantly decreased(P<0.05)and the HSS score and the tenderness threshold were significantly decreased(P<0.05).Conclusion Based on the theory of combining dynamic with static and taking activity as the dominant factor,QPM method has a good clinical effect oneasing the pain and improving function of elbow joint than applying nonsteroidal antiinflammatory drugs(NSAIDs)externally.