超声剪切波弹性成像评价不同针刺取穴法干预慢性非特异性腰痛患者临床研究

Clinical Study of Ultrasound Shear Wave Elastography in Evaluating the Effect of Acupuncture at Different Acupoints on Chronic Nonspecific Low Back Pain

目的观察不同针刺取穴法干预慢性非特异性腰痛(CNLBP)患者腰骶部多裂肌的杨氏模量值,根据其差异性为超声剪切波弹性成像(SWE)评价CNLBP的临床应用提供理论依据。方法将64例患者随机分为观察组(32例)和对照组(32例)。其中对照组给予常规针刺配穴干预,观察组在对照组的基础上根据本地五运六气配穴针刺干预。各组每日治疗1次,连续治疗6 d后休息1 d,共治疗2周。观察两组患者干预前后及治疗结束4周后(随访期)的日本骨科协会腰椎功能评分(JOA)、视觉模拟疼痛评分(VAS)。应用SWE评价两组患者干预前后双侧腰骶部多裂肌(俯卧位)杨氏模量值。比较两组患者干预前后血清β-内啡肽(β-EP)水平。结果治疗后,两组患者多裂肌杨氏模量值均较治疗前降低(P<0.05),组间对比差异无统计学意义(P>0.05);两组血清β-EP水平较治疗前均升高(P<0.05),观察组高于对照组(P<0.05);两组患者JOA评分较治疗前均升高(P<0.05),观察组高于对照组(P<0.05);两组患者VAS评分均较治疗前降低(P<0.05),组间对比差异无统计学意义(P>0.05)。随访时,两组患者JOA评分较治疗前均升高(P<0.05),观察组高于对照组(P<0.05);VAS评分较治疗前降低(P<0.05),组间对比差异无统计学意义(P>0.05)。结论SWE可为临床CNLBP针刺治疗方案提供评价依据。运气理论指导下的取穴针刺能够降低腰骶部多裂肌杨氏模量值,上调血清β-EP水平,改善患者临床症状,疗效优于常规针刺。

Objective To observe Young's modulus of multifidus muscle in the lumbosacral region of patients with chronic nonspecific low back pain(CNLBP)treated with different acupuncture points,and provide a theoretical basis for the clinical application of ultrasonic shear wave elastography(SWE)in evaluating the CNLBP based on their differences.Methods 64 patients were randomly divided into an observation group(32 cases)and a control group(32 cases).Among them,the control group received routine acupuncture and acupoint matching intervention,while the observation group received acupuncture intervention based on the local five movements and six Qi matching points based on the control group.Each group received treatment once a day and rested for 1 day after continuous treatment for 6 days,for a total of 2 weeks.To observe the Japanese Orthopedic Association Lumbar Function Score(JOA)and Visual Analogue Pain(VAS)scores of two groups of patients before and after intervention and after 4 weeks of treatment(follow-up period).SWE was used to evaluate Young's modulus values of bilateral lumbar-sacral multifidus muscles(prone position)before and after intervention in two groups of patients.And compare the serum of two groups of patients before and after interventionβ-endorphin(β-EP)level.Results After treatment,Young's modulus of the multifidus muscle in both groups of patients decreased compared to before treatment(P<0.05),and there was no significant difference between the groups(P>0.05);Two sets of serumβ-EP increased compared to before treatment(P<0.05);Observation group serumβ-EP was higher than that of the control group(P<0.05);JOA score in both groups was higher than that before treatment(P<0.05),and JOA score in observation group was higher than that in control group(P<0.05).VAS scores in both groups were lower than before treatment(P<0.05),and there was no significant difference between groups(P>0.05).At follow-up,JOA score in both groups was higher than that before treatment(P<0.05),and JOA score in observation group was higher than that in control group(P<0.05).VAS score was lower than before treatment(P<0.05),but there was no difference between groups(P>0.05).Conclusion SWE can provide an evaluation basis for the acupuncture treatment and regimen of clinical CNLBP.Acupuncture guided by the theory of luck can reduce the Young's modulus of the lumbar sacral multifidus muscle and upregulate serum levelsβ-EP level improves patients'clinical symptoms and has a better therapeutic effect than conventional acupuncture.