中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (36): 5852-5857.doi: 10.12307/2024.685

• 骨与关节图像与影像 bone and joint imaging • 上一篇    下一篇

超声引导下输刺夹脊穴治疗腰椎间盘突出症的随机对照试验

朱  曦1,陶宇洪2,黄  鹏3,李  丹1   

  1. 1北京中医药大学第三附属医院针灸科,北京市   100029;2解放军医学院,北京市   100853;3解放军总医院第四医学中心骨科医学部,北京市   100853
  • 收稿日期:2023-09-11 接受日期:2023-10-21 出版日期:2024-12-28 发布日期:2024-02-28
  • 通讯作者: 李丹,博士,主任医师,硕士生导师,北京中医药大学第三附属医院针灸科,北京市 100029
  • 作者简介:朱曦,女,1998年生,北京市人,汉族,在读硕士,主要从事针灸推拿学研究。
  • 基金资助:
    陆军后勤科研项目(BLJ19J010),项目负责人:黄鹏

A randomized controlled trial of acupuncture at Jiaji points for treatment of lumbar disc herniation under ultrasonic guidance

Zhu Xi1, Tao Yuhong2, Huang Peng3, Li Dan1   

  1. 1Department of Acupuncture, Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing 100029, China; 2Chinese PLA Medical School, Beijing 100853, China; 3Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing 100853, China
  • Received:2023-09-11 Accepted:2023-10-21 Online:2024-12-28 Published:2024-02-28
  • Contact: Li Dan, MD, Chief physician, Master’s supervisor, Department of Acupuncture, Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing 100029, China
  • About author:Zhu Xi, Master candidate, Department of Acupuncture, Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing 100029, China
  • Supported by:
    Army Logistics Research Project, No. BLJ19J010 (to HP)

摘要:


文题释义:

输刺:古刺法,为《灵枢》五刺之一,出《黄帝内经·灵枢·官针》:“输刺者,直入直出,深内之至骨,以取骨痹,此肾之应也。”输刺的刺法特点是直刺进针,进针时针尖与皮肤垂直,进针路径与皮肤垂直,进针深度靠近骨骼或接触到骨骼。此次研究利用超声引导确定进针位点,引导进针路径,以期提高针刺的精准性和安全性。
夹脊穴:又称华佗夹脊,位于T1-L5棘突下两侧,后正中线旁开0.5寸。针刺时通常直刺或向后正中线方向斜刺,可用于治疗心肺、消化、泌尿及腰痛、坐骨神经痛等病症。此次研究选择腰夹脊穴治疗腰椎间盘突出症引起的腰部及下肢症状,利用超声定位夹脊穴下方对应的神经根出口对神经根进行刺激。


背景:在腰椎间盘突出症的研究中大多数针刺治疗由CT引导或非引导,对位点的精准控制及针刺有效部位不够明确。

目的:观察超声引导下输刺夹脊穴治疗腰椎间盘突出症的临床疗效。
方法:选择于解放军总医院及北京中医药大学第三附属医院就诊的腰椎间盘突出症患者70例,男36例,女34例,年龄18-65岁,采用随机数表法分成试验组与对照组,每组35例。对照组患者予输刺夹脊穴治疗,试验组患者在超声引导下予输刺夹脊穴治疗,于就诊当天及就诊后4,7 d各治疗1次。治疗前后进行目测类比评分、Oswestry功能障碍指数、日本骨科协会(JOA)评分及健康调查简表(SF-36)评估。

结果与结论:①与治疗前相比,两组患者治疗后的目测类比评分均降低(P < 0.01);与对照组比较,试验组患者治疗第2,3,6,7天及治疗结束后1,2周的目测类比评分降低(P < 0.05,P < 0.01)。②与治疗前相比,两组患者治疗后的Oswestry功能障碍指数均降低(P < 0.01);与对照组相比,试验组患者治疗第1-7天及治疗结束后1,2周的Oswestry功能障碍指数降低(P < 0.01)。③与治疗前相比,两组患者治疗后的JOA评分均升高(P < 0.01);与对照组相比,试验组患者治疗等3,7天及治疗结束后1,2周的JOA评分升高(P < 0.05,P < 0.01)。④与治疗前相比,两组患者治疗后的SF-36评分均升高(P < 0.01);两组间治疗后的SF-36评分比较差异无显著性意义(P > 0.05)。⑤结果表明,输刺夹脊穴对腰椎间盘突出症具有疗效,并且超声引导能够提升输刺夹脊穴治疗腰椎间盘突出症的疗效。

https://orcid.org/0009-0006-1532-1562 (朱曦) 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 腰椎间盘突出症, 超声引导, 针刺, 夹脊穴, 临床观察, 针灸治疗

Abstract: BACKGROUND: In the research on acupuncture treatment for lumbar disc herniation, most acupuncture treatments are performed under CT guidance or without guidance. The precise control of the target site and the effective acupuncture location are not clear. 
OBJECTIVE: To observe the clinical effects of acupuncture at Jiaji points under ultrasonic guidance in treating lumbar disc herniation.
METHODS: A total of 70 cases of lumbar disc herniation, 36 males and 34 females aged 18-65 years old, were selected from Chinese PLA General Hospital and Third Affiliated Hospital of Beijing University of Chinese Medicine. They were divided into trial group and control group by random number table method, with 35 cases in each group. The control group received acupuncture at Jiaji points. The trial group received acupuncture at Jiaji points under ultrasonic guidance. The patients were treated once on the day of treatment and 4, 7 days after treatment. Visual analog scale score, Oswestry disability index, Japanese Orthopaedic Association score, and MOS 36-Item Short-Form Health Survey (SF-36) were evaluated before and after treatment.
RESULTS AND CONCLUSION: (1) Compared with before treatment, the visual analog scale scores of both groups were decreased after treatment (P < 0.01). Compared with the control group, the visual analog scale scores of the trial group were decreased on days 2, 3, 6, 7 of treatment and 1, 2 weeks after the end of treatment (P < 0.05, P < 0.01). (2) Compared with before treatment, Oswestry disability index after treatment was decreased in both groups (P < 0.01). Compared with the control group, Oswestry disability index of the trial group was decreased from days 1 to 7 of treatment and 1, 2 weeks after treatment (P < 0.01). (3) Compared with before treatment, the Japanese Orthopaedic Association scores of both groups were increased after treatment (P < 0.01). Compared with the control group, the Japanese Orthopaedic Association scores of the trial group were increased on days 3, 7 of treatment and 1, 2 weeks after treatment (P < 0.05, P < 0.01). (4) Compared with before treatment, SF-36 scores in both groups were increased after treatment (P < 0.01). There was no significant difference in SF-36 scores between the two groups after treatment (P > 0.05). (5) These results show that acupuncture at Jiaji points has curative effect on lumbar disc herniation, and ultrasonic guidance could improve the clinical curative effect of acupuncture at Jiaji points for lumbar disc herniation.  

Key words: lumbar disc herniation, ultrasonic guidance, acupuncture, Jiaji points, clinical observation, acupuncture-moxibustion treatment

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