【作者】 刁吉亭；

【导师】 董福慧；

【作者基本信息】 中国中医科学院 ， 中西医结合临床， 2010， 博士

【摘要】 本文选择国家中医药管理局重点学科建设中关于“项痹病·肩胛提肌劳损”中的一个症状-肩胛提肌止点张力性疼痛作为研究目标,通过临床两种针法的对比及动物实验研究,探索在筋膜层进行减张减压治疗的疗效及机理。肩胛提肌起自上位四个颈椎横突的后结节,止于肩胛骨内上角,当起点固定时具有向上提拉肩胛骨的作用,起止点异位后,则具有参与颈部肌群固定颈椎,维持头部姿势的作用。长期处于潮湿、阴冷的工作环境中或从事会计、文书工作或长期操作电脑等长期低头工作姿势会造成颈肌包括肩胛提肌起点的劳损、肌肉紧张痉挛、深筋膜增厚、炎性渗出、粘连而刺激局部感觉神经末梢,产生神经支配区域的酸胀、疼痛、不适感。属于中医“颈部伤筋”的范畴。近年来,由于人们生产生活方式的改变,这类疾病的发病率有不断上升及年轻化的趋势。本课题临床研究部分选取肩胛提肌止点张力性疼痛病例作为切入点,来探讨软组织张力与疼痛的相关性.采取对照连续治疗的方法,三个月以上随访,对铍针和毫针两种治疗效果进行对比研究,并借助压痛仪和软组织张力仪对疗效进行客观、量化的评估,为颈肩腰腿痛形成客观的、规范的诊疗标准而进行探索性研究。100例病历资料全部来自于马来西亚吉亭中医药专科中心,男性37例,女性63例；年龄14-59岁,平均35.72岁；本次发病病程3-7天,平均4.89天。所有病例均通过病例选择标准后,按照首次就诊时间顺序随即选入铍针治疗组和毫针对照组,进行相应的治疗和观察。结果显示铍针治疗组的优良率分别为88.00%和96.00%,毫针对照组的优良率分别为38.00%和58.00%,两组优良率的差异在α=0.05水准上均有显著的统计学意义(P<0.05),可以认为试验组具有较好的疗效。重复测量方差分析结果显示,在症状体征评分、VAS疼痛评分、压痛值和软组织张力值四项指标上,两组间的差异均在α=0.05水准上均有显著的统计学意义(P<0.05),通过轮廓分析图分析表明,铍针治疗组的效果优于毫针对照组,因而可以认为使用铍针具有较好的疗效。动物实验部分共使用家兔16只,分为三组,统一采用绷带结扎的方法制作形成下肢筋膜腔内高压状态。其中第一组6只,用于观察直视下铍针与毫针、针刀对小腿筋层的松解效果；第二组5只,用于对比观察结扎后铍针松解与否所致小腿局部实验点的软组织张力值的差异情况；第三组5只,用于观察结扎后1小时以及铍针松解后1小时小腿局部实验点的软组织张力值随时间推移而变化的趋势。第一组实验结果显示,铍针既能够有效地在下肢筋膜腔内高压状态下制造出一定的刃口,又不至于造成刃口过大而导致局部出血过多,说明铍针刺法能够有效地降低筋膜局部的张力,且在治疗的同时又不至造成较大的损伤,是一种安全、有效的疗法；第二组实验结果显示,铍针松解后,测得局部软组织张力明显缓解,并随时间推移而下降,这种现象考虑为局部皮肤和筋膜存在铍针刃口,随着其他部位软组织张力增高,刃口在一定程度内扩大所造成的减张效果所致；第三组实验结果显示,以松解前一时间点为协变量,松解后实验点处的软组织张力变化相对于松解前存在统计学差异,说明铍针松解作用明显。从轮廓分析图来看,在结扎后2小时,即铍针松解后1小时观测指标基本恢复到正常水平。综合分析临床和家兔实验测试结果表明,铍针通过对皮下组织、筋膜和肌肉的切割,使筋膜腔内压力减低,筋膜表面张力降低,松解粘连,消除瘢痕,从而消除感觉神经末梢所受的刺激和压迫,缓解疼痛。对于需要局部减压减张的治疗来说,铍针疗法是一种安全、有效的治疗方法。更多还原

【Abstract】 The levator scapula muscle is named for its function of scapular elevation. It is covered entirely by the trapezius muscle. It arises from the transverse processes of C1 through C4 and attaches on the vertebral border of the scapula between the superior angle and the spine. This muscle can aslo help maintianing the position of head when it’s original point and attaching point are interconverting. The people who are often working in stting and bowing head position such as accountant, paperwork, and computer operator, etc. are easier to have harassment from chronic injuries of attaching points of neck muscles. Though being shoulder muscle, The attaching point of levator scapula muscle especially on its original point is also easy to get hurt caused by constant strain as it keeps bowing head for a long time.To objectively evaluate the clinical effect of Pi needle on cutaneous nerve entrapment syndrome (CNES),100 cases suffering from pains of the levator scapula muscle’s attaching points were treated with Pi needle. There are 37 male and 63 female in 100 patients, age from 14 to 59 and the average is 35.72, the course of diseases from 3 to 7days and the average is 3.89 days. All cases came from Jiting medical care center in Malaysia were randomly divided into two groups, Pi needle and Hao needle therapy were applied to one group respectively. The results showed that the excellent ratio is 88.00% and the good ratio is 96.00% in Pi neddle group while 38.00% and 58.00% in Hao needle group. Statistic analysis to changing trends of symptom-signs score, Vas score, the value of compressive pain and local soft tissue tension showed there was a singnificant difference (P<0.05) between two groups at the level a= 0.05. The figure of data profile analysis suggested that the clinical effect of Pi needle group is much better than contral group. In following animal experiment,16 rabbits were used to evaluate the safety and validity of Pi needle therapy. The results supported the idea that Pi needle was more validity than Hao needle while less hruts than Zhen Dao (needle shaped bistoury).In the end, there is sufficient evidence that the Pi needle therapy is safety, ease, convenient, cheap, effective and provide a new therapy for the treatment of CNES.更多还原