银质针和中药熏蒸治疗慢性腰痛前后椎旁软组织张力变化的对比分析

目的：评价腰部软组织张力测定在慢性非特异性腰痛患者治疗过程中作为疗效评价客观指标的临床意义。方法：自2011年8月至2012年3月,选取慢性非特异性腰痛患者60例,以1∶1的比例分为银质针与中药熏蒸组。银质针组男17例,女13例,年龄28~55岁,平均（45.70±4.15）岁,采用银质针透热治疗;中药熏蒸组男19例,女11例,年龄27~55岁,平均（43.03±5.86）岁,采用中药熏蒸治疗。分别于治疗前,治疗后1周、3个月观察两组患者力-位移距离（FDD）、能量吸收比（S）的变化,并采用疼痛视觉模拟积分（VAS）、罗兰德-莫里斯功能障碍量表（RMDQ）进行疗效评价。结果：①治疗前,治疗后1周及3个月银质针组VAS评分分别为4.77±0.78、1.99±1.08、2.55±0.94,中药熏蒸组分别为4.43±0.61、2.48±0.71、3.05±0.86。两组治疗后VAS评分均较治疗前均明显降低（P〈0.01,P〈0.05）。治疗前两组比较差异无统计学意义,治疗后银质针组较中药熏蒸组镇痛效果更为明显（P〈0.05）。治疗前,治疗后1周及3个月时银质针组RMDQ分别为13.63±1.96、5.87±2.33、6.53±2.89;中药熏蒸组分别为13.40±2.01、6.90±2.31、9.23±2.87。组间比较,治疗前与治疗后1周两组比较差异无统计学意义（P〉0.05）,与治疗后3个月比较差异有统计学意义（P〈0.01）,银质针组与中药熏蒸组都能够一定程度上改善慢性腰痛所引起的功能障碍,银质针的治疗效果更为持久。②治疗后1周及3个月随访时,银质针组患侧多裂肌及竖脊肌、健侧多裂肌的FDD均明显增加（P〈0.05）;中药熏蒸组治疗后1周患侧和健侧多裂肌及竖脊肌的FDD均较治疗前增加（P〈0.05）,3个月时患侧多裂肌及竖脊肌FDD与治疗前比较差异无统计学意义（P〉0.05）。组间比较,治疗前两组间比较差异不明显（P〉0.05）,治疗后1周,银质针组患侧多裂肌及竖脊肌FDD增加更为明显（P〈0.05）,而健侧多裂肌及竖脊肌两组间对比差异无统计学意义。治疗后3个月,银质针组患侧及健侧两组肌肉的FDD均明显较高（P〉0.01）。③患侧多裂肌与竖脊肌的FDD差值与VAS及RMDQ差值存在相关性,Spearman相关系数R分别为0.517,0.811,0.746、0.625,P值分别为0.015,0.041,0.045、0.017。腰部软组织张力指标改善的变化趋势与症状、功能、生活质量改善的变化趋势一致,具有相关性。结论：软组织张力的测试可以有效地反映慢性腰痛患者的疼痛强度和腰部功能障碍的程度,提高慢性腰痛的疗效评价的客观性。

Comparison of paravertebral soft tissue tension changes in patients with chronic lower back pain treated by sliver needle and traditional Chinese medicine fumigation

Objective： To evaluate clinical significance of waist soft tissue tension detection in treating chronic nonspecific low back pain. Methods：From August 2011 to March 2012,60 patients with chronic nonspecific low back pain were divided into two groups （sliver needle group and TCM fumigation group） according to propntion of 1：1. In sliver needle group, there were 17 males and 13 females aged from 28 to 55 years old with an average age of （45.70±4.15）, treated with sliver needle;In TCM fumigation group,there were 19 males and 11 females aged from 27 to 55 years old with an average age of （43.03±5.86）, treated with TCM fumigation. Changes of force-displacement distance （FDD）, specific absorption rate （S） of two groups were observed before treatment, 1 week and 3 months after treatment respectively, VAS scoring and Roland-Morris disability ques- tionnaire（RMDQ） were used to access clinical effects. Results：@ VAS score of silver needle group was 4.77±0.78,1.99 ±1.08 and 2.55 ±0.94,respectively before treatment,at lweek and 3 months after treatment,while VAS score in TCM fumigation group were 4.43±0.61,2.48±0.71 and 3.05±0.86, respectively. VAS score of two groups after treatment were sigifieant decrease than that of before treatment （P〈0.05）. There was no sigificant differences between two groups before treatment, but sliver nee- dle group performed well in analgesia than TCM fumigation group, and had obvious differences （P〈0.05）. RMDQ score of silver needle group was 13.63±1.96,5.87±2.33 and 6.53±2.89,respectively before treatment,at 1 week and 3 months after treatment ,while RMDQ score in TCM fumigation group were 13.40±2.01,6.90±2.31,9.23±2.87, respectively. There was no significant differences between two groups before treatment and 1 week after treatment （P〉0.05）, and had obvious differences be- tween two groups at 3 months after treatment （P〈0.01）. Both groups could obvious improve dysfunction caused by chronic low back pain, and curative effect of sliver needle groups was more endurable. ① Following-up at 3 months after treatment, FDD of multifidus, erector spinae of effected side and multifidus of healthy in sliver needle group were obvious increased （P〈0.05） ; In TCM fumigation group, FDD of multifidus and erector spinae on both side were increased at 1 week after treatment （P〈0.05）, but had no significant meaning at 3 months after treatment on health side （/9〉0.05）. There was no significant meaning before treatment （P〉0.05）, FDD of muhifidus, erector spinae of effected side in sliver needle group were obvious increased at 1 week after treatment （P〈0.05） ;but no obvious meaning on health side. FDD of both side in sliver needle group were obvious increased at 3 months after treatment. ② There was correlation among differences of FDD in multifidus and erector spinae, VAS score and differences of RMDQ, and Spearman correlation coefficient R was 0.517,0.811,0.746 and 0.625 ;There was correlation between items of soft tissue tension and sympotoms, function and life quality. Conclusion：Soft tissue tension detection can effectively manifest degree of pain and dysfunction of low back, and improve objectivity of therapeutic evaluation for chronic low back pain.