针刺与拔罐不同顺序操作治疗寒湿型腰肌劳损:随机对照试验

Different operation sequences between acupuncture and cupping therapy for lumbar muscl strain with cold and dampness:a randomized controlled trial

目的:比较针刺与拔罐不同顺序操作治疗腰肌劳损(寒湿型)的临床疗效。方法:将76例腰肌劳损(寒湿型)患者随机分为针刺拔罐组(38例)和拔罐针刺组(38例,脱落1例)。针刺拔罐组在针刺治疗结束后10 min行拔罐治疗,拔罐针刺组在拔罐治疗结束后10 min行针刺治疗。针刺穴取命门、腰阳关、阿是穴,双侧肾俞、大肠俞、委中、阳陵泉,留针30 min;拔罐于腰椎两侧行闪罐3 min,于双侧肾俞、大肠俞及阿是穴留罐10 min。两组均隔日1次,每周3次,共治疗3周。比较两组患者治疗前后视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)评分、中医证候积分、腰部平均温度,并评定两组安全性和临床疗效。结果:与治疗前比较,除ODI睡眠评分外,两组治疗后VAS评分、ODI评分、中医证候积分降低(P<0.01,P<0.05),腰部平均温度升高(P<0.01);治疗后,拔罐针刺组VAS评分、ODI疼痛程度评分低于针刺拔罐组(P<0.05)。拔罐针刺组不良反应发生率低于针刺拔罐组(P<0.01)。针刺拔罐组有效率为92.1%(35/38),拔罐针刺组有效率为94.6%(35/37),两组比较差异无统计学意义(P>0.05)。结论:针刺与拔罐不同顺序操作治疗腰肌劳损(寒湿型)疗效相当,但先拔罐后针刺在改善疼痛及安全性方面具有一定优势。

Objective To compare the clinical efficacy on lumbar muscle strain with cold and dampness between the different operation sequences of acupuncture and cupping therapy.Methods Seventy-six patients with lumbar muscle strain with cold and dampness were randomly divided into an acupuncture+cupping group(A+C group,38 cases)and a cupping+acupuncture group(C+A group,38 cases,1 case dropped off).In the A+C group,cupping therapy was delivered 10 min after the end of treatment with acupuncture,while in the C+A group,acupuncture therapy was exerted 10 min after the end of treatment with cupping.Acupuncture was applied to Mingmen(GV 4),Yaoyangguan(GV 3),ashi point and bilateral Shenshu(BL 23),Dachangshu(BL 25),Weizhong(BL 40)and Yanglingquan(GB 34),and the needles were retained for 30 min in each intervention.Flash cupping was operated along the bilateral sides of the lumbar spine for 3 min,and the cups were retained for 10 min at bilateral Shenshu(BL 23),Dachangshu(BL 25)and ashi points.The intervention was delivered once every two days,3 times weekly,for 3 weeks totally in each group.The scores of visual analogue scale(VAS)and Oswestry disability index(ODI),TCM syndrome score and the mean temperature of the lumbar region before and after treatment were compared between the two groups.The safety and the clinical efficacy were assessed for the interventions of the two groups.Results Compared with the values before treatment,except for the sleep score of ODI,the VAS scores,ODI scores and TCM syndrome scores were decreased after treatment(P<0.01,P<0.05);while the mean temperature of the lumbar region was increased(P<0.01)in both groups.After treatment,the VAS score and the pain score of ODI in the C+A group were lower than those in the A+C group(P<0.05).The incidence rate of adverse reactions of the C+A group was lower than that of the A+C group(P<0.01).The effective rate in the A+C group was 92.1%(35/38),that in the C+A group was 94.6%(35/37),there was no statistical difference between the two groups(P>0.05).Conclusion Different operation sequences between acupuncture and cupping therapy obtain the similar efficacy on lumbar muscle strain with cold and dampness,but cupping therapy delivered prior to acupuncture has certain advantages in relieving pain and improving safety.