【作者】 万甜；

【导师】 吴明霞；

【作者基本信息】 福建中医学院 ， 针灸推拿学， 2008， 硕士

【摘要】 目的:比较针刺加骨肽注射液穴位注射、单纯针刺两种方法治疗腰椎间盘突出症的临床效果;观察针刺加骨肽注射液穴位注射对血浆β-内啡肽(β-EP)、降钙素基因相关肽(CGRP)代谢的影响,探讨其治疗腰椎间盘突出症的机理。方法:选择符合诊断标准的L4～L5、L5～S1单节段和双节段腰椎间盘突出或膨隆,且有腰腿痛症状(McGill疼痛评分中疼痛强度(PPI)评分≥2分)的患者64例,随机分为治疗组(针刺加骨肽注射液穴位注射组)和对照组(单纯针刺组),每组各32例,两组在进行针刺时的取穴及针刺方法均一样。针刺取穴为大肠俞(双侧)、关元俞(双侧)、小肠俞(双侧)、秩边(患侧)、阳陵泉(患侧)、委中(患侧)。治疗组:针刺完毕后,取双侧关元俞进行穴位注射,抽取骨肽注射液1ml,每穴注射入0.5ml。对照组:单纯按治疗组的针刺穴位和针刺方法进行针刺,不进行穴位注射。两组均为每天治疗1次,10天为1疗程,疗程间休息3天。治疗前及治疗两个疗程结束后,分别对两组用《临床疗效判断标准》、“下腰痛评分标准”(JOA评分)和McGill疼痛评分标准进行临床症状积分的评定,并测定患者体内血浆β-EP、CGRP的含量。对临床疗效判断、JOA评分、McGill疼痛评分和血浆β-EP、CGRP含量的变化进行统计学分析。结果:(1)治疗1个疗程后,治疗组总有效率为83.9%,对照组总有效率为82.8%;2个疗程后,治疗组总有效率为90.3%;对照组总有效率为86.2%。两组均能取得较为理想的疗效,但两组在1个疗程后、2个疗程后比较,组间疗效无明显差异(P＞0.05)。(2)二个疗程治疗后,两组的JOA评分均有升高,且两组JOA评分改善指数之间比较有显著性差异(P＜0.05)。相比之下,治疗组JOA评分的改善好于对照组;二个疗程治疗后,两组的McGill疼痛评分均有降低,且两组的降低水平之间比较有非常显著性差异(P＜0.01);治疗组下降幅度大于对照组。(3)治疗前后血浆β-EP含量的变化:两组治疗后均能使血浆β-EP含量升高,两组升高幅度比较有显著差异(P＜0.05),治疗组升高幅度大于对照组;治疗前后血浆CGRP含量的变化:两组治疗后均能使血浆CGRP含量降低,两组降低的幅度比较无明显差异(P＞0.05)。结论:(1)针刺加骨肽注射液穴位注射和单纯针刺两种方法均能明显改善腰椎间盘突出症患者的临床症状,而针刺加骨肽注射液穴位注射法更优于单纯针刺法,尤其在缓解疼痛方面。(2)腰椎间盘突出症患者疼痛缓解程度与其体内血浆β-EP、CGRP含量的变化有关,疼痛缓解程度分别与血浆β-EP含量的升高、CGRP含量的降低呈正相关。更多还原

【Abstract】 PURPOSECompare the result treating protrusion of lumbar intervertebral disc with two treatment.These two treatment include the treatment of acupuncture combined with acupoint-injection of Ossotide injection and the treatment of simple acupuncture;Observe the effects Of acupuncture combined with acupoint-injection of Ossotide injection on concentration Of Plasmaβ-EP、CGRP,and discuss the mechanism of the treatment on lumbar disc herniation.METHOD64 cases of protrusion of lumbar intervertebral disc were selected with certain diagnostic standard.These patients were all single or double intervertebral disc protrusion which between the fourth and fifth lumbar vertebrae or between the fifth lumbar vertebrae and the first sacral vertebrae,moreover,all the patients selected had symptoms of acute lumbago and scelalgia(short-form mcgill pain questionnaire,PPI≥2).They were randomly divided into two groups:the group of acupuncture combined with acupoint-injection of Ossotide injection (Therapy group)and another of simple acupuncture(Control group);There were 32 cases in each group.The two groups applied the same points and the same method of the needling.The points were dachangshu(EX-B2,double sides),guanyuanshu(EX-B2,double sides),Zhibian(BL54,sick side),Yanglinquan(GB34,sick side),Weizhong(BL40,double side). Therapy group:After the acupuncture and when we applied the acupoint-injection,we drawed 1ml Ossotide injection.Then we inserted into the double guanyuanshu Points of the fifth lumbar Vertebrae of the Patient and inject 0.5ml injections slowly in each Point.Control group:The Patients were needled the same Points and the same method as therapy group but had no acupoint-injection.The patients of two groups were all treated once a day,and 10 times constituted a course of treatment.They had taken a rest of three days between courses. Before the first treatment and on the first day after 2 courses of treatment,we evaluated respectively the clinic symptoms of two groups with "clinicalcurative effect judge standard"、 "Lower Back Pain Assessment Standard"(JOA evaluation sheet)、"short-form mcgill pain questionnaire",then determinate the content change of blood plasmaβ-EP and CGRP in patients and analyse the result.RESULT(1)Observation of the curative effect:Atday 10,the total effective rate in therapy group was 83.9%and the control group was82.8%;Atday20,the total effective rate in therapy group was 90.3%and control group was86.2%.Two groups have good efficacy in the treatment of LIDP,but there was no significant difference between the clinical efficacy rates of the two groups Atday10 or day20(P＞0.05).(2) After treatment of 2 courses,JOA scores were all increased in both two groups,There was significant difference between increasing degree of JOA scores of therapy group and control group(P＜0.05).The increasing tendency of JOA scores in therapy group were higher than that of control group.After treatment of 2 courses, pain scores were all descended in both two groups,There was significant difference between falling degree of pain scores of therapy group and control group(P＜0.05).The falling tendency of pain scores in therapy group were higher than that of control group.(3)The change of the concentration of Plasmaβ-EP between pre-treatment and post- treatment: after treatment of 2 courses,the concentration of Plasmaβ-EP were all increased in both two groups and the change of it in therapy group is greater than in control group.The change of the concentration of Plasma CGRP between pre-treatment and post- treatment:after treatment of 2 courses,the concentration of Plasma CGRP were all descended in both two groups and the change of it has no significant difference in two groups.CONCLUSION(1)Both acupuncture combined with acupoint injection of Ossotide injection and simple acupuncture could ameliorate the symptom,especially in pain relief,and the effect of therapy group was superior to control group significantly.(2) Pain relieves in lumbar intervertebral disc protrusion patients is related to the change of the concentration of Plasmaβ-EP and CGRP.The increasing tendency of the concentration of Plasmaβ-EP was positive correlation with pain alleviation.The falling tendency of the concentration of Plasma CGRP was positive correlation with pain alleviation.更多还原