针刀松解法对第3腰椎横突综合征局部软组织张力的影响

目的:探讨针刀治疗第3腰椎横突综合征的作用机制。方法:180例第3腰椎横突综合征患者随机分为针刀组和电针组,每组90例。针刀组在第3腰椎横突尖部(即压痛点处)进行针刀治疗,配合腰部过伸过屈手法,每周1次,共3周;电针组取双侧肾俞、腰阳关、阿是穴(局部压痛点)、患侧委中进行电针治疗,每周3次,共3周。采用JZL-Ⅱ软组织张力计测量两组治疗前、治疗后及治疗后6个月随访时第3腰椎横突局部软组织500g压力位移和能量吸收比的变化,采用日本骨科协会(JOA)下腰痛评分表评价两组的临床疗效。结果:针刀组500g压力位移在治疗后和随访时较治疗前升高(均P<0.01),而电针组较治疗前降低(P<0.05,P<0.01);针刀组组织能量吸收比在治疗后和随访时均较治疗前升高(均P<0.01),而电针组治疗后与治疗前比较差异无统计学意义(P>0.05),仅随访时较治疗前升高(P<0.01)。治疗后和随访时两组总体疗效等级分布,针刀组优于电针组(P<0.05,P<0.01)。结论:针刀治疗能显著提高第3腰椎横突局部软组织的500g压力位移和能量吸收比,降低局部软组织的张力,从而改善或减轻疼痛,且临床疗效优于电针。

Effects of acupotomy lysis on local soft tissue tension in patients with the third lumbar vertebrae transverse process syndrome

Objective To explore the mechanism of acupotomy lysis in treatment of the third lumbar vertebrae transverse process syndrome.Methods One hundred and eighty patients were randomly assigned into an acupotomy group and an electroacupuncture(EA) group,90 cases in each group.The acupotomy group was treated with acupotomy on the tip of the 3rd lumbar vertebrae transverse process(tender point) combination with massage manipulation of hyperflexion and hyperextension on the waist,once a week for 3 weeks.The EA group was treated with EA at bilateral Shenshu(BL 23),Yaoyangguan(GV 3),Ashi point(local tender point) and ipsilateral Weizhong(BL 40),3 times a week for 3 weeks.The 500 g pressure displacement and the energy absorption ratio were measured by JZL-Ⅱsoft tissue tension meter and the clinical effect was evaluated by JOA low back pain scale before treatment,after treatment and 6 months after treatment.Results After treatment and at follow-up visit,the 500 g pressure displacement in the acupotomy group increased significantly(both P<0.01),but it was decreased significantly in the EA group(P<0.05,P<0.01).The energy absorption ratio in the acupotomy group after treatment and at follow-up visit increased significantly(both P<0.01),and in the EA group,there was no significant difference after treatment as compared with that before treatment(P>0.05),but it was increased significantly at follow-up visit(P<0.01).The total therapeutic level distribution in the acupotomy group was better than that in the EA group after treatment and 6 months after treatment(P<0.05,P<0.01).Conclusion Acupotomy therapy can significantly increase the 500 g pressure displacement and the energy absorption ratio of thelocal soft tissue around the third lumbar vertebrae transverse process,decrease the local soft tissue tension so as to alleviate pain.The clinical effect of the acupotomy is superior to that of electroacupuncture.