红外热图技术与腰椎间盘突出症中医证型的相关性研究

【作者】 刘肖瑜；

【导师】 王正；

【作者基本信息】 湖北中医学院 ， 中医骨伤科学， 2007， 硕士

【摘要】 腰椎间盘突出症是骨科的常见病和多发病，是腰腿痛最常见的原因。有统计资料表明，腰痛在轻劳动者中发病率为53％，重劳动者发病率为64％；患腰痛者35％发展为椎间盘突出症。目前已经认识到大部分腰痛合并坐骨神经痛是由腰椎间盘突出症引起的。本病发病人群主要集中在青壮年，患者痛苦大，症状严重，给患者的生活和工作造成了很大的影响。另外中华骨科学会脊柱外科学组于1996年统计资料表明在1986—1996年10年中14个省市608所医院进行各种腰椎间盘突出症手术为48.5万次。以此推断，全国每年约有100万例人次进行各种腰椎间盘突出症手术，即每100万人中约有120人由于患有腰椎间盘突出症而进行手术治疗。但是经过腰椎间盘突出症手术治疗因破坏了腰椎及周围的组织结构，在早期易出现椎间盘炎，椎管内形成血肿等并发症；中远期易出现神经根粘连、医源性椎管狭窄、病变椎间盘或其上下椎间盘的再次突出以及腰椎不稳等并发症。相比较而言，运用中医药治疗腰椎间盘突出症具有痛苦小，并发症少，易被患者接受，并且疗效肯定的优点，目前已经被广泛用于临床。虽然中医药目前已经被广泛用于腰椎间盘突出症的治疗，但中医由于其自身的特点，在其进行诊断和治疗的时候往往存在很大的主观性，通常会出现同一个症状在不同的医师面前进行诊断和治疗时会出现不同的结果。因此给予传统的中医诊断一个客观的依据进行规范显得犹为重要。我们这个实验主要是探讨红外热图技术与腰椎间盘突出症证型之间的关系，从而为中医辨证论治腰椎间盘突出症提供一个客观依据，以提高腰椎间盘突出症中医辨证的准确性和中医治疗的疗效。2004年9月——2006年8月共收集病例200例作为观察组，全部来自湖北中医学院附属襄樊医院颈肩腰腿痛科门诊患者。其中男性132例，女性68例，年龄34—65岁，平均52.4岁。同期随机选择200例健康人作为对照组，所选人群均无腰腿痛病史，均为来我院健康体检人员。其中男性126例，女性74例，年龄32—67岁，平均53.6岁。两组间人群的性别、年龄经两独立样本t检验，无显著性差异（P＞0.05），具有可比性。观察组与对照组的受检者均通过PFK-800医用红外热像仪（宁波医疗仪器厂）进行扫描。受检查者暴露肢体，调整好距离，医生操作仪器，观察屏幕彩色图像，以图像清晰、线条分明为原则。扫描范围包括腰背部、股后区、小腿后区。主要记录相同区域的两侧体表温度差值。其中CT证实L₄-L₅腰椎间盘突出患者测量股后区体表温度；L₅-S₁腰椎间盘突出患者测量小腿后侧体表温度；两者均有，两者均测，取温差较大者。然后双下肢进行对比，测出体表温差最大的部位，并记录其差值（观察组△t=患侧温度一对侧温度；对照组△t=左下肢温度—右下肢温度）。同时受检时必须在上午9—10点接受红外热像仪的检查同时接受红外热像仪检查的房间必须保持在24℃的温度，受检者必须在房间里处于安静状态休息30分钟后才进行检查。通过上述方法对各个受检者进行检查后，分别按照无差异、微差异、高差异的标准进行分类，以了解受检者双下肢温度差异的程度。1、中医各证型与对照组之间双下肢温度差异程度有显著性差异（P＜0.01），而中医各证型之间双下肢温度差异程度均无显著性差异（P＞0.05）。2、对照组中的健康人群双下肢温度高低不是非常明显；气滞血瘀型与湿热痰滞型患者的患侧温度要比对侧温度高；而风寒湿滞型与肝肾亏虚型患者的患侧温度要比对侧温度低。1、通过红外热图技术结合相应的临床体征能够很好的对腰椎间盘突出症进行诊断（双下肢温度差异程度有显著性差异）。2、对于腰椎间盘突出症的患者，通过红外热图技术能够较为准确的判断出中医八纲辨证中的寒、热证型，为中医在辨证过程中判断寒、热证型提供了一个较为可靠的客观依据。更多还原

【Abstract】 ObjectiveLDH is a common and frequently-occurring disease in orthopedics, It is the most common reason of lumbar and leg pain. Statistics demonstrated that 53% of light workers and 64% of heavy workers had lumbar pain in Sweden. 35% of patients had lumbar pain expanded to LDH. Now we know that almost lumbar pain and sciatica due to LDH. Most of the people on LDHwere young and middle-aged people. The patients of LDH suffered from the serious symptom. LDH maked the quiet influence on the patients’ life and work. In 1996 statistics of the group of spine surgery in COA demonstrated that there are 485,000 operation of LDH in 608 hospitals of 14 provinces and cities among 1986 to 1996. We can infer that there are 1,000,000 operation of LDH every year in whole nations. 120 Persons of 1,000,000 people get the operation due to the LDH. But the operation of LDH have many complications in early periods. Such as, inflammation of intervertebral disk, and hematoma of vertebral canal, etal. In middle and further periods, the complications were the adhesion in root of nerve, the narrow of vertebral canal in treatment, re-herniation of the lumbar disc, and unstable of the lumbar vertebra. Comparatively, the treatment of LDH with TCM have small pain, less complications, easy acceptance and affirmative effects. Just now the treatment of TCM is applied to the clinic popularly.Even though, the treatment of TCM is applied to the clinic popularly Just now, the TCM duo to the characteristic by itself often have quiet subjectivity on diagnosis and treatments. Usually, the same symptom which is on diagnosis and treatments of different doctor with TCM appears different results. So there is importance that giving a objective basis to the diagnosis of TCM. The experiment mainly investigates the relation between the technology of infrared thermograph to the classification of TCM on LDH. And it offers a objective basis to the diagnosis and treatments of TCM, improves the accuracy of the diagnosis of TCM on LDH and the curative effect of TCM. MethodsFrom September 2004 to august 2006, we gathered 200 cases which were observe group. These cases were patients who came from the hospital of XiangFan affiliated to the Hubei College of TCM, including 132 males and 68 females. The patients were from 34 to 65 years old, and the mean age was 52.4 years old. At the same time, we randomly selected 200 cases who were healthy people as control group. These people were no history of lumbar and leg pain, including 126 males and 74 females. The patients were from 32 to 67 years old, and the mean agewas 53.6 years old. The sex and age were no significant statistical difference between the two groups. Two groups were comparative. All cases were scanned through PFK-800 instrument of medical infrared thermograph. The people who inspected were exposed body. The operater adjusted the distance and observed the colour image from screen. The image must be clear. The range of scanning was spine, back of thigh and back of lower leg. We mainly record the deviation of temperature which were both sides of surfaces at the same place. The patients of L₄- L₅LDH were measured temperature of the surfaces on back of thigh. The patients of L₅-S₁LDH were measured temperature of the surfaces on back of lower leg. The patients of L₄- L₅and L₅-S₁LDH were measured temperature of the surfaces on back of thigh and lower leg. Then, we record the greater one. We compared the temperature of two low limb, measured the greatest deviation of temperature, and record thedeviation. （Observe Group△t = temperature of abnormal—temperature of normal; Control Group△t = temperature of left lower limb—temperature of right lower limb）. The people who inspected must be inspected at 9-10 o’ clock in the morning. At the same time, the room of inspected must be kept 24℃. Before inspected, The people who inspected must have a rest 30 minutes at the room of inspected.All data were divided into the no difference, tiny difference and high difference in accordance with the criterion we formulate. It help us find out the level of difference with two low limb.Results1、The temperature of two low limb in the people with LDH are more different than the control group. There was significant statistical difference between the two group （P＜0.01）. The temperature of two low limb in the people of each classification of TCM are different. However There was no significant statistical difference among them （P＞0.05）2、The temperature of two low limb in the healthy people are normal. The temperature of the abnormal low limb was higher than normal low limb with patients of the classification with qizhixueyu and shiretanzhi. The temperature of the abnormal low limb was lower than normal low limb with patients: of the classification with fenghanshizhi and ganshenkuixu.Conclusion1、We can give the patients with LDH a better clinical diagnose through the technology of infrared thermograph and clinical symptom.2、We can exactly recognize the classification of cold and hot in the bagang of TCM through the technology of infrared thermograph, It offers a objective basis to recognize the classification of cold and hotin the diagnosis and treatments of TCM.更多还原