【作者】 叶金福；

【导师】 柴铁劬；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2012， 博士

【摘要】 目的在经络辨证理论指导下,结合现代医学对腰椎间盘突出症的定位诊断,观察和评价辨经取穴治疗腰椎间盘突出症的临床疗效,为临床治疗腰椎间盘突出症所提供一种安全有效的方法。方法根据1994年国家中医药管理局制定的《中医病症诊断疗效标准制定》中腰椎间盘突出症症的诊断标准及中医疗效评价标准。将符合纳入标准的180例腰椎间盘突出症患者采用随机对照分组的方法分为治疗组90例和对照组90例。根据经络辨证,结合现代医学对腰椎间盘突出症的定位诊断,治疗组给予针刺加灸法,对照组只给予针刺。每次针刺30分钟,隔日一次,10次为一个疗程。治疗完成一个疗程后,通过视觉模拟评分法(VAS), Oswestry功能障碍指数问卷表(ODI),腰椎疾患综合评分标准(JOA评分)、McGill疼痛问卷及Prolo功能和经济结果评定量表的客观评价,得出数据后经spss17.0统计软件处理,比较两组症状改善情况及腰椎功能改善情况。观察指标：①中医证状临床疗效评价；②视觉模拟评分法(VAS)前后评分变化；③Oswestry功能障碍指数问卷表(ODI)前后总分变化；④腰椎疾患综合评分标准(JOA评分)前后评分变化；⑤McGill疼痛问卷前后评分变化；⑥Prolo功能和经济结果评定量表前后平分变化。结果①治疗组与对照组的临床疗效比较,差异有统计学意义(P<0.05)。治疗组：痊愈72例(80.00%)、有效12例(13.33%)、无效6例(6.67%),总有效率为93.33%。对照组：痊愈48例(53.33%)、有效24例(26.67%),无效18例(20.00%),总有效率80.00%。②视觉模拟评分法(VAS)：治疗后的VAS评分与治疗前比较,两组患者的评分均有明显下降,具有统计学意义(P<0.01)；治疗后两组VAS评分比较,差异有统计学意义(P<0.05)。③两组患者治疗前后的Oswestry功能障碍指数评分比较,差异有统计学意义(P<0.05)。④腰椎疾患综合评分标准(JOA评分)两组患者治疗后的JOA评分分别与治疗前相比,均有显著下降,差异有统计学意义(P<0.01)；治疗后JOA评分两组之间比较,差异有统计学意义(P<0.01)。⑤McGill疼痛问卷前后评分变化：两组治疗后与治疗前S、A、T、PPI的比较,差异有统计学意义(P<0.05, P<0.05, P<0.01, P<0.05),疼痛指数有显著改善;治疗后两组S、A、T比较,均有统计学意义(P<0.05,P<0.05,P<0.05)。⑥两组患者治疗后的Prolo评分比较,功能评分治疗组与对照组比较,差异有统计学意义(P<0.01),说明治疗组优于对照组：经济评分治疗组与对照组比较,差异无统计学意义(P<0.05)。结论在经络辨证理论指导下,结合现代医学对腰椎间盘突出症的定位诊断,采用辨经取穴治疗腰椎间盘突出症是一种安全、有效、简易的疗法,疗效显著。针刺结合灸法在改善患者疼痛症状、腰椎功能及提高牛活质量等方面优于单纯针刺组,该方法值得推广及运用。更多还原

【Abstract】 ObjectiveBase on theory of differentiation of meridians, combined with the positioning of the modern medicine of lumbar intervertebral disk protrusion diagnosis, combined with lumbar disc herniation positioning diagnosis, observation and evaluation of acupuncture combined with moxibustion for treatment of lumbar intervertebral disk protrusion clinical curative effect, for clinical treatment of lumbar intervertebral disk protrusion by providing a safe and effective method.MethodsAccording to the1994state administration of traditional Chinese Medicine made "Chinese disease diagnosis curative effect of standards" in prolapse of lumbar intervertebral disc disease diagnosis standard and the Chinese medicine classification standards. Will meet the criteria180cases of lumbar intervertebral disc protrusion were treated by randomized controlled group method divided into90cases of the treatment group and90cases of the control group. According to the meridian the method of dialectics, combined with the modern medical prolapse of lumbar disc protrusion niveau diagnosis. Treatment group were given the acupuncture and moxibustion, and the control group was given only to acupuncture. Acupuncture time for30minutes. Tertian.10times for a period of treatment. After a period of treatment, through the visual analogue scale method (VAS), Oswestry dysfunction index questionnaire (ODI), lumbar disease integrated assessment standard (JOA rating), McGill pain questionnaire, Prolo functional and economic outcome rating scale, obtains the objective evaluation, the conclusion that the spss17.0statistics data processing, compare two groups of symptoms improved and lumbar function improved. Outcome:(1) the evaluation of clinical curative effect of TCM syndrome;(2) the visual analogue scale method (VAS) score changes before and after;(3) Oswestry dysfunction index questionnaire (ODI) total score changes before and after;(4) the lumbar spine disease integrated assessment standard (JOA score) score changes before and after;(5) McGill pain score changes before and after questionnaire;(6) Prolo function and economic results before and after rating scale changes divide.Results(1)The treatment group and control group the clinical curative effect of the difference was statistically significant (P<0.05). The treatment group: cured72cases (80.00%), effective in12cases (13.33%), invalid in6cases (6.67%), the total effective rate was93.33%. The control group:well in48cases (53.33%), effective24cases (26.67%), invalid18cases (20.00%). The total effective rate of80.00%.(2) Two visual analogue scale method (VAS):after treatment with the VAS score before treatment comparison, the ratings of two groups of patients were significantly decreased, with statistical significance (P<0.01); VAS score after two groups treatment, the difference was statistically significant (P<0.05).(3)The two groups of patients before and after treatment of Oswestry dysfunction index score is compared, the difference was statistically significant (P<0.05).(4)The lumbar spine disease integrated assessment standard (JOA score) two groups of patients before and after treatment. Two groups of patients treated JOA evaluation and treatment compared respectively before, the difference was statistically significant, all have significantly (P<0.01); after treatment, the two groups comparison between JOA rating, the difference was statistically significant (P<0.01).(5)McGill pain score changes before and after questionnaire:two groups after treatment with before treatment, S, A, T, PPI comparison, the difference was statistically significant (P<0.05, P<0.05, P<0,01, P<0.05);pain index had obvious improvement; two groups after the treatment, S, A, T, there was statistical significance (P<0.05, P<0.05,P<0.05). (6)Two groups of patients after treatment Prolo score, the score treatment group compared with the control group, the difference was statistically significant (P<0.01), the treatment group than in control group; economic score treatment group compared with controls, the difference was not statistically significant (P>0.05).ConelusionUnder the guidance of the syndrome differentiation in meridian theory, combined with the modern medical prolapse of lumbar intervertebral disc positioning diagnosis, acupuncture combined with moxibustion on differentiation of meridians for treatment of lumbar disc protrusion is a safe, effective, simple and easy treatment. Acupuncture combined with Moxibustion in improving symptoms, pain in patients with lumbar function and improve the quality of life are superior to that of simple acupuncture group, this method is worthy of popularization and application.更多还原