针药结合治疗腰背肌筋膜炎临床研究

目的:观察电针联合复方南星止痛膏治疗腰背肌筋膜炎寒湿瘀阻证的近期和远期疗效。方法:将110例患者采用随机数字表法分为西医组和中医组各55例。西医组采用特定电磁波治疗器照射联合吡罗昔康凝胶的西医方案;中医组采用电针联合复方南星止痛膏的中医方案。疗程均为21 d。并进行12周的随访。于治疗前、治疗后3 d、7 d、21 d和随访4周、8周、12周进行疼痛视觉模拟评分(visual analogue scale,VAS)、日本骨科协会下腰痛评价量表(japanese orthopaedic association scores,JOA)、身体损害指数评定量表(PⅡ量表)和寒湿瘀阻证评分。结果:中医组临床疗效优良率为85.45%,高于西医组的65.45%,差异有统计学意义(χ2=5.939,P0.05);中医组中医证候疗效有效率为96.36%,优于西医组的81.82%,差异有统计学意义(χ2=5.986,P0.05);中医组在治疗后7 d和21 d的VAS评分均低于同期西医组(P0.01);中医组在随访4周、8周、12周VAS评分均低于西医组(P0.01);与西医组比较,治疗后中医组JOA量表各维度评分(主观症状、运动障碍、日常功能活动受限)、总分和寒湿瘀阻证评分均低于西医组(P0.01);治疗后中医组腰前屈、腰后伸、腰侧屈、单腿直腿抬高、脊柱触痛、双侧主动直腿抬高、仰卧起坐评分和总分,较西医组均显著改善(P0.01)。结论:电针联合复方南星止痛膏治疗腰背肌筋膜炎寒湿瘀阻证,能显著改善患者下腰痛,提高腰的活动范围,恢复其功能,减轻症状,临床疗效和中医证候疗效均显著,且作用持久,减少复发。

Clinical Study of Acupuncture Combined with Medicine Treatment of Lumbar Myofasciitis

Objective:To observe recent and long-term efficacy of electroacupuncture and compound Nanxing Zhitong Paste treatment of lumbar myofascitis with cold dampness stagnation syndrome.Methods:One hundred and ten patients were randomly divided into western medicine group(55 cases) and traditional Chinese medicine group(55 cases).Patients in western medicine group got specific electromagnetic wave therapy device for irradiation and piroxicam gel,and patients in Chinese medicine group got electroacupuncture and compound Nanxing Zhitong Paste.And 21 days were a course of treatment.12 weeks of follow-up were made.Before treatment and at the 3th day,7th day,21th day after treatment,4th week,8th week and 12th week during the follow-up,visual analogue scale(VAS) was evaluated,scores of japanese orthopaedic association scores(JOA),body damage index rating scale,and cold stasis syndrome were graded.Results:The excellent rate of disease efficacy in traditional Chinese medicine group was 85.45％ higher than 65.45％ in western medicine group(x2 =5.939,P ＜ 0.05).Effectiveness of TCM syndrome was 96.36％ higher than 81.82％ in western medicine grouP(x2 =5.986,P ＜0.05).Scores of VAS in traditional Chinese medicine group were lower than those in western medicine group at the 7th day and 21 th day and 4th week,8th week and 12th week during the follow-up (P＜0.01).Dimension score(subjective symptoms,dyskinesia,daily functional activity limitation),total score and cold stasis syndrom in traditional Chinese medicine group were all lower than those in western medicine group(P ＜ 0.01).And scores of lumbar flexion,lumbar extension,lumbar flexion,one leg straight leg raising,spine tenderness,bilateral active straight leg raising,sit-ups in traditional Chinese medicine group and total score were lower than those in western medicine group(P ＜ 0.01).Conclusion:Electroacupuncture and compound Nanxing Zhitong Paste treatment of lumbar myofascitis with cold dampness stagnation syndrome can ameliorate patients with low back pain,improve the scope of activities of the waist,restore its function,reduce symptom,obvious disease efficacy and TCM syndrome,and it has lasting effect,and can reduce the recurrence.