超微针刀治疗臀上皮神经卡压综合征临床观察

目的观察超微针刀综合疗法治疗臀上皮神经卡压综合征的临床疗效。 方法选取2015年6月至2017年8月阜阳市肿瘤医院康复医学科收治的120例臀上皮神经卡压综合征患者,采用完全随机试验方法随机分为治疗组和对照组,每组各60例。治疗组中男38例,女22例,平均年龄(41.30±5.75)岁,平均病程(5.40±2.30)月。对照组中男43例,女17例,平均年龄(42.70±7.85)岁,平均病程(6.80±3.10)月。治疗组采用超微针刀于腰、臀部位的筋结点进行松解治疗,并配合推拿及中药热敷,对照组予毫针在同样部位进行针灸治疗并配合推拿和中药热敷。在治疗前和治疗后,采用下腰痛评分量表(JOA)进行疗效评定。采用秩和检验比较2组患者临床疗效;采用配对t检验比较2组患者治疗前后JOA评分;采用两独立样本t检验比较2组患者治疗前和治疗后JOA评分。 结果治疗组治疗前后、对照组治疗前后和2组治疗后JOA评分比较,差异均有统计学意义(t＝47.49、19.72、13.65,P均<0.05)。治疗1个疗程后,治疗组总有效率93.33%(56/60),对照组总有效率76.67%(46/60),2组疗效比较,差异具有统计学意义(Z＝2.731,P<0.05)。 结论超微针刀治疗臀上皮神经卡压综合征疗效确切,值得临床推广。     

针刀疗法对第三腰椎横突综合征模型大鼠成纤维细胞增殖与凋亡的影响

目的：观察针刀疗法对L3横突综合征模型大鼠软组织中成纤维细胞增殖与凋亡的影响。方法：建立L3横突综合征大鼠模型。68只SD大鼠随机分为针刀组、封闭组、模型组、正常对照组,每组17只大鼠。第15天对相应组别进行针刀和封闭干预。于第21、30天时,每组各处死8只大鼠,取材后,行HE染色,及免疫组化和凋亡的检测,并计算成纤维细胞的增殖和凋亡指数。结果：第21天和第30天时,针刀干预组的增殖指数、凋亡指数与模型对照组相比较有非常显著的差异（P<0.01）;针刀干预组与封闭对照组在第21天时无显著差异（P＞0.05）,在第30天时有显著差异（P<0.05）。结论：针刀干预对L3横突综合征模型大鼠的组织修复有效,可能是通过调节成纤维细胞增殖与凋亡的平衡,从而防止了组织瘢痕挛缩的形成,印证了中医微观阴阳平衡理论。     

超微针刀网点状松解法对腰椎间盘突出症患者VAS评分和JOA腰椎疾患评分的影响

目的:比较常规针刺与超微针刀网点状松解法对腰椎间盘突出症(LDH)患者视觉模拟评分法(VAS)和日本骨科学会(JOA)腰椎疾患评分的影响。方法:选取90例LDH患者,随机分为对照组给予传统针刺治疗和观察组给予超微针刀网点状松解法治疗,两组各45例。比较两组患者治疗效果、治疗前和治疗后1个月VAS及JOA腰椎疾患评分的差异。结果:观察组治疗总有效率较对照明显升高(P<0.05)。两组治疗后VAS评分均下降,且观察组的降低幅度较为显著(P<0.05)。JOA腰椎疾患评分上,两组治疗后均显著提高,且观察组的提高幅度较为显著(P<0.05)。结论:相比常规针刺治疗,超微针刀网点状松解法治疗可明显减轻LDH患者疼痛感,改善临床症状及体征,同时可有效改善腰椎功能活动状况,最终有助于提高患者生活质量。     

针刀疗法结合普通针刺及结构化心理干预治疗腰椎间盘突出症合并恐动症

目的:观察针刀疗法结合普通针刺及结构化心理干预治疗腰椎间盘突出症合并恐动症的临床疗效。方法:所有病例均为2018年5月至2019年3月在安徽中医药大学第二附属医院康复二科住院的患者,共50例,随机分为对照组和治疗组各25例。两组患者均采用结构化心理干预治疗。对照组给予氟哌噻吨美利曲辛片联合双氯芬酸钠缓释片口服治疗,1周为1个疗程,连续治疗2个疗程。治疗组采用针刀疗法结合普通针刺治疗,6 d为1个疗程,中间休息1 d,治疗2个疗程。治疗前及治疗1个疗程、2个疗程后,观察两组患者JOA、TSK评分。结果:对照组治疗前JOA评分为(6.96±1.72)分,治疗1个疗程后JOA评分为(17.40±1.66)分,治疗2个疗程后JOA评分为(24.36±1.87)分;治疗组治疗前JOA评分为(7.24±1.67)分,治疗1个疗程后JOA评分为(18.44±1.90)分,治疗2个疗程后JOA评分为(25.76±1.42)分。治疗1个疗程及2个疗程后,两组患者JOA评分较前升高(P<0.05),且组间比较,差异有统计学意义(P<0.05)。对照组治疗前TSK评分为(45.08±2.48)分,治疗1个疗程后TSK评分为(28.84±1.65)分,治疗2个疗程后TSK评分为(25.60±1.35)分;治疗组治疗前TSK评分为(44.92±2.66)分,治疗1个疗程后TSK评分为(27.36±1.71)分,治疗2个疗程后TSK评分为(24.68±1.60)分。治疗1个疗程及2个疗程后,两组患者TSK评分均较前降低(P<0.05),且组间比较,差异有统计学意义(P<0.05)。结论:针刀疗法结合普通针刺及结构化心理干预治疗腰椎间盘突出症合并恐动症,能有效改善患者下腰部功能及恐动症程度。     

Current Usage of Terminologies Related to Acupotomy: A Literature Research and Standardization Suggestion

Objective: To investigate the current usage of terminologies related to acupotomy through systematic search and analyze the pros and cons of each for proposing a standard terminology. Methods: Seven medical journal databases were searched including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Oriental Medicine Advanced Searching Integrated System, KoreaMed, and Korean studies Information Service System using 10 candidate terminologies as searching terms. All studies published from their inception to July 26, 2017 were collected. Articles were included if the title stated one of the 10 candidate terminologies consistent with the definition of acupotomy. Priorly established frequency and consistency of each candidate terminology from medical databases were calculated and evaluated. Moreover, the pros and cons of each were analyzed to propose a standard terminology. Results: A total of 112 studies in English databases, 1,129 studies in Chinese database, and 44 studies in Korean databases were included. The most frequently used terminologies were needle knife (35.71%), acupotomy (48.54%) and acupotomy (90.90%) in English, Chinese and Korean database, respectively. Overall, acupotomy and needle knife were the most frequently used. Others like acupotomology, needle scalpel, miniscalpel acupuncture and miniscalpel needle were used within 10% of the total searched literature. Acupotome, stiletto needle, sword like needle, and Xiaozhendao were rarely used. Acupotomy had the advantages of high frequency and consistency but lacked representativeness. Needle knife also showed a high frequency, but the consistency was poor. Though miniscalpel acupuncture and miniscule needle were used less frequently, they had advantages of inclusiveness and clarity. Conclusions: A debate for standardization of the terminology is necessary. This preliminary research can provide a basic outline for the standardization consensus process, and we believe it is noteworthy to discuss miniscalpel needle and miniscalpel acupuncture along with acupotomy and needle knife on the subject.     

中国穴位埋线疗法系列(114) 长效针灸之埋线针刀技术操作规范(5)

埋线针刀疗法是长效针灸,是针灸疗法的发展和延伸,具有穴位埋线、针刀松解、穴位注射的作用,完全解决了埋线的过敏反应和线软的难题,避免或者降低了神经、血管等特殊部位的操作风险,融合了速效和长效的思路与方法,不仅显著提高了临床疗效,而且还扩大了疾病谱。发布《埋线针刀技术操作规范》的目的是规范技术操作、保障临床安全和临床疗效。本规范规定了埋线针刀疗法的术语和定义、操作步骤与要求、适用范围、注意事项、适宜病证、禁忌和施术过程中可能出现的不良反应及处理措施。     

射频针刀治疗血瘀型膝关节骨性关节炎的临床疗效

目的:观察射频针刀治疗血瘀型膝关节骨性关节炎的临床疗效,探讨治疗前后关节痛点红外热像变化规律。方法:选取天津中医药大学第一附属医院骨伤科2016年1月—2018年12月就诊的膝关节骨性关节炎患者98例,随机分为观察组及对照组,每组49例,观察组采用射频针刀治疗,每周1次,共治疗2次,对照组采用常规针刺治疗,1次/d,连续治疗2周。比较两组治疗前后VAS评分、WOMAC评分、Lysholm评分、总有效率以及膝关节周围痛点红外绝对温度及温差值(△T)。结果:观察组治疗后在VAS评分、WOMAC评分、Lysholm评分的改善方面优于对照组,具有统计学差异(P0.05),观察组总有效率89.79%,优于对照组的77.55%,具有统计学差异(P0.05)。观察组治疗后膝关节周围痛点红外热像绝对温度改善程度优于对照组,患侧-健侧温差值(△T)改善程度观察组优于对照组,以上两项均具有统计学差异(P0.05)。结论:射频针刀治疗血瘀型膝骨性关节炎具有较好的临床疗效,关节痛点红外热像绝对温度及温差变化可以作为评价病变改善程度的指标。     

针刀治疗颈型颈椎病研究进展

针刀治疗颈型颈椎病的优势在于起效快、疗效好、并发症少、复发率低。然而,针刀治疗颈型颈椎病也存在诸多缺陷:(1)多数施术者仅凭感觉和经验来判断针刀治疗到达的组织层,缺乏客观的准确定位指标,不利于评定是否是这层组织得到了治疗而收获疗效,盲目的刺入行刀存在一定的风险,能否借助影像仪器进一步提高精准度和安全性;(2)虽然针刀治疗颈型颈椎病效果显著,但缺乏统一的治疗点,有的医师治疗点多达18处,有的只有3~5处,不能说明治疗点数量及位置与疗效的相关性;(3)颈型颈椎病病例量偏少,诊断明确性不够,不同医师对于疗效的评判标准不同,随访时间或长或短,因而疗效结果评定的真实性和严密性值得商榷;(4)针刀进入人体,再细小的微创切割也是要经历炎症肉芽瘢痕组织修复的过程,增加新病灶,以小的损伤治疗相对大的疾病,是否会出现因小失大的不利局面,还有待系统的大样本来分析考量。     

Treatment of 90 patients with scapulohumeral periarthritis in different phases by combining therapy centering on Fu's subcutaneous needling

ObjectiveTo observe the efficacy of combining therapy in treatment of 90 patients with scapulohumeral periarthritis in different phases.MethodNinety patients with scapulohumeral periarthritis were treated with Fu's subcutaneous needling (FSN) combined with physiotherapy in painful phase, acupotomology and massage in adhesion phase, and appropriate functional exercise in rehabilitation phase. Seven days were considered as one course of treatment, and efficacy evaluation was performed after three courses. Function evaluation of shoulder joint was made.ResultThe total effective rate was 100% (38/38) in acute phase, 93.5% (29/31) in adhesion phase, and 100% (21/21) in rehabilitation phase. After treatment, the range of motion (ROM) of shoulder joint, pain, muscle force, activities of daily living (ADL) and joint local morphology of the patient have been improved obviously.ConclusionBetter clinical efficacy is achieved in treatment of scapulohumeral periarthritis in different phases by combining therapy centering on FSN.     

针刀整体松解术配合微波治疗类风湿肘关节僵硬的临床观察

目的:对比观察针刀整体松解术配合微波治疗类风湿肘关节僵硬临床疗效。方法:将60例类风湿肘关节僵硬患者按随机数字表法随机分为针刀加微波组和针刀组,每组各30例。针刀加微波组采用针刀整体松解术配合微波治疗,针刀组单纯采用针刀治疗,疗程结束后进行疗效评定。结果:两组临床疗效比较,针刀加微波组中,显效20例,总有效率为93.3%;针刀组显效12例,总有效率为67.7%。两组总有效率经统计学分析(P0.05),有显著性差异;治疗前,两组患者Mayo肘关节功能评分比较,无显著性差异(P0.05),表明两组具有可比性;治疗后2周两组Mayo肘关节功能评分呈上升趋势,且针刀加微波组上升更明显,较治疗前有显著性差异(P0.05)。治疗后半年两组Mayo肘关节功能评分比较,针刀加微波组Mayo功能呈持续性改善,较治疗后2周,差异具有显著性意义(P0.05);与针刀组比较,差异具有显著性意义(P0.05)。而针刀组治疗后半年与治疗后2周,患者Mayo肘关节功能评分改善不明显,差异无显著性意义(P0.05)。治疗前,两组患者疼痛综合评分(含PRI总分、VAS评分、PPI积分)比较,无显著性差异(P0.05),表明两组具有可比性;治疗后2周,两组疼痛问卷(MPQ)评分呈下降趋势,针刀加微波组下降更明显,与治疗前相比较,有显著性差异(P0.05)。与针刀组治疗后比较,差异具有显著性意义(P0.05)。治疗后半年两组MPQ评分持续下降,与治疗后2周相比较,有显著性差异(P0.05)。与同一时间点针刀组比较,差异具有显著性意义(P0.05)。结论:针刀整体松解增加了关节活动度,微波治疗能快速缓解术后的疼痛肿胀,起到镇痛消肿之效,避免针刀治疗后再发粘连,两种方法相互结合,相互补充,共同发挥治疗作用,值得在临床上广泛推广。