[1]陈波平 许金海 徐华 王国栋 姚若愚王雅 陈妮△ 叶洁△.体外冲击波循经取穴治疗跟痛症的随机对照研究[J].中国中医骨伤科杂志,2022,30(07):26-31.
　CHEN Boping XU Jinhai XU Hua WANG GuodongYAO RuoyuWANG Ya CHEN Ni YE Jie.Randomized Controlled Study of Extracorporeal Shock Wave Acupoint Selection on the Treatment of Calcaneodynia[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2022,30(07):26-31.
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体外冲击波循经取穴治疗跟痛症的随机对照研究()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第30卷
期数:
2022年07期
页码:
26-31
栏目:
临床研究
出版日期:
2022-07-15

文章信息/Info

Title:
Randomized Controlled Study of Extracorporeal Shock Wave Acupoint Selection on the Treatment of Calcaneodynia
文章编号:
1005-0205(2022)07-0026-06
作者:
陈波平1 许金海1 徐华1 王国栋1 姚若愚1王雅1 陈妮1△ 叶洁1△
1上海中医药大学附属龙华医院(上海,200032)
Author(s):
CHEN Boping1 XU Jinhai1 XU Hua1 WANG Guodong1YAO Ruoyu1WANG Ya1 CHEN Ni1△ YE Jie1△
1Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China.
关键词:
冲击波;  循经取穴;  跟痛症;  随机对照;  临床研究
Keywords:
shock wave;  meridian acupoint selection;  calcaneodynia;  randomized control;  clinical research
分类号:
R681.8
文献标志码:
A
摘要:
目的:探讨体外冲击波在循经取穴理论指导下治疗跟痛症的疗效及安全性。方法:选取72例跟痛症患者为研究对象,采用完全随机对照的方法,按照随机编码表将患者分为对照组和试验组,每组36例。两组均采用中药熏洗方外洗配合功能锻炼,并联合采用瑞士制造的体外冲击波治疗仪(EMA,Swiss Dolor Clast)治疗,对照组患者足底跖筋膜痛区进行常规冲击波治疗,试验组在对照组基础上再在患足同侧循经取穴进行冲击波治疗,选取足少阴肾经、足太阴脾经、足阳明胃经及足太阳膀胱经上的涌泉、太溪、三阴交、丰隆和委中作为主要的治疗穴位。冲击波治疗频率为20 Hz,治疗探头直径为15 mm,冲击总次数均为2 000次,2次/周,2周为一个疗程。治疗前、第2次治疗后(1周后)、第4次治疗后(2周后)、6周后和14周后使用疼痛视觉模拟评分法(VAS)评分、AOFAS踝-后足评分及SF-36健康调查简表评分,记录患者临床症状及体征变化情况,评价疗效,同时观察并记录患者的不良反应,评价安全性。结果:试验组纳入36例,实际完成36例; 对照组纳入36例,实际完成36例。两组患者在年龄、性别、病程等基线资料方面差异无统计学意义(P>0.05)。足底疼痛VAS评分,时间因素和分组因素不存在交互效应(F=2.350,P=0.076)。两组患者足底疼痛VAS评分总体比较,组间差异有统计学意义,即存在分组效应(F=4.468,P=0.038)。两组治疗前VAS评分差异无统计学意义(P>0.05),治疗后不同时间点疼痛VAS评分的差异有统计学意义,即存在时间效应(F=179.443,P<0.001)。AOFAS踝-后足评分,时间因素和分组因素存在交互效应(F=2.966,P=0.036)。两组患者AOFAS踝-后足评分总体比较,组间差异有统计学意义,即存在分组效应(F=4.761,P=0.032)。治疗前两组患者AOFAS踝-后足评分差异无统计学意义,治疗后不同时间点评分的差异有统计学意义,即存在时间效应(F=176.955,P<0.001)。SF-36生活质量评分,时间因素和分组因素不存在交互效应(F=1.508,P=0.219)。两组患者SF-36生活质量评分总体比较,组间差异无统计学意义,即不存在分组效应(F=0.208,P=0.650)。治疗前两组患者SF-36生活质量评分差异无统计学意义,治疗后不同时间点评分的差异有统计学意义,即存在时间效应(F=102.176,P<0.001)。研究干预过程中未出现明显不良事件。结论:体外冲击波循经取穴治疗跟痛症能更有效地缓解患者疼痛症状并改善足部功能,其临床疗效优于传统的体外冲击波冲击足底跖筋膜痛区的方法,并且操作简便、安全性高,充分显示了现代医学结合传统医学技术的特色及优势,值得临床推广应用。
Abstract:
Objective:To explore the efficacy and safety of extracorporeal shock wave on the treatment of calcaneodynia under the guidance of meridian acupoint selection theory through clinical trial study.Methods:72 patients with calcaneodynia in hospital were selected as the research objects,and the patients were divided into control group and experimental group according to the random coding table,with 36 cases in each group.Both groups were treated with traditional Chinese medicine(TCM)fumigation washing formula for external washing combined with functional exercise and combined with the extracorporeal shock wave therapy instrument(EMA,Swiss Dolor Clast,Switzerland).The difference was that the control group was treated with conventional shock wave therapy in plantar fascia pain area,while the experimental group was treated with shock wave therapy in ipsolateral side of the affected foot based on the control group.The Yongquan,Taixi,Sanyinjiao,Fenglong and Weizhong on the kidney meridian of foot Shaoyin,spleen meridian of foot Taiyin,stomach meridian of foot Yangming and bladder meridian of foot sun were selected as the main treatment points.The frequency of shock wave treatment was 20 Hz,the treatment probe diameter was 15 mm,and the total number of impacts was 2 000,with 2 times per week,2 weeks as a course of treatment.The VAS scores,AOFAS ankle-hind scores,SF-36 health survey touting grade system were used to record the change of the patient’s clinical symptoms and signs and evaluated the curative efficacy before treatment,after 2nd(after 1 week)and 4th(after 2 weeks)treatment,6 weeks after treatment,14 weeks after treatment.At the same time,the adverse reaction of patients,safety evaluation was observed and recorded.Results:General conditions:36 cases were included in the experimental group,and 36 cases were actually completed; there were 36 in the control group and 36 in the actual completion.There was no significant difference in baseline data such as age,gender and course of disease between the two groups(P>0.05).VAS scores of plantar pain:there was no interaction between time factor and group factor(F=2.350,P=0.076).The overall comparison of VAS scores of plantar pains between the two groups showed statistically significant difference,that is,there was grouping efficacy(F=4.468,P=0.038)...

参考文献/References:

[1] 冯成安,孙俊,李明.跟痛症的病因及相关应用解剖研究进展[J].四川解剖学杂志,2009,17(4):33-34.
[2] THOMAS J L,CHRISTENSEN J C,KRAVITZ S R,et al.A clinical practice guideline-revision 2010[J].The Journal of Foot and Ankle Surgery,2010,49(3):S1-S19.
[3] ROSENBAUM A J,DIPRETA J,MISENER D.Plantar heel pain[J].Medical Clinics of North America,2014,98(2):339-352.
[4] 马木提·阿木丁,张旭.跟痛症的中西医研究进展[J].新疆中医药,2020,38(2):108-111.
[5] 王炯,吴永光.钻孔减压结合镜下磨削术治疗跟痛症29例[J].中国中医骨伤科杂志,2021,29(2):64-66.
[6] 王和鸣.中医骨伤科学[M].北京:中国中医药出版社,2007:291.
[7] 龚志贤,吴泳蓉,凌上清,等.体外冲击波循经取穴治疗慢性跖筋膜炎随机对照研究[J].中国中医骨伤科杂志,2019,27(2):21-23.
[8] 郑青山,孙瑞元,陈志扬.新药临床非劣性及等效性试验中的例数估计和等效标准[J].中国新药杂志,2003(5):368-371.
[9] KELLY A M.The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain[J].Emerg Med J,2001,18(3):205-207.
[10] KITAOKA H B,ALEXANDER I J,ADELAAR R S,et al.Clinieal rating systems for the ankle-hind foot,mildfoot,hallux,and lesser toes[J].Foot Ankle Int,1994,15:349-393.
[11] WARE J E,SHERBOURNE C D.The MOS 36-item short form health survey conceptual frame work and item selection[J].Medical Care,1992,30(6):473-480.
[12] 海因里希·埃佛尔克,李钊译.体外冲击波针灸——对一种新方法的首次总结[J].中国针灸,2006,26(12):893-895.
[13] 王磊,彭金林,张恤.体外冲击波在经络理论指导下治疗颈腰腿疼痛性疾病的应用现状[J].江苏中医药,2018,49(11):78-80.
[14] 刘芳,吕客,宋一平.放散式冲击波循经取穴治疗颈肩腰腿痛的临床疗效观察[J].颈腰痛杂志,2015,36(3):233-235.
[15] 刘西纺,孙银娣,于晓彤.发散式冲击波循经取穴治疗腰椎间盘突出症疗效观察[J].中国疼痛医学杂志,2013,19(10):592-595.
[16] 赵志,陈齐平,闵星星,等.体外冲击波治疗跟痛症的研究进展[J].中医正骨,2019,31(6):35-37.
[17] MELESE H,ALAMER A,GETIE K,et al.Extracorporeal shock wave therapy on pain and foot functions in subjects with chronic plantar fasciitis:systematic review of randomized controlled trials[J].Disability and Rehabilitation,2021,26:1-8.
[18] 陈海斌,杨志焕.冲击波技术在医学领域的应用[J].力学进展,2012,42(2):186-195.
[19] GATZ M,SCHWEDA S,BETSCH M,et al.Line- and point-focused extracorporeal shock wave therapy for achilles tendinopathy:a placebo-controlled RCT study[J].Sports Health,2021,13(5):511-518.
[20] JEON J H,JUNG Y J,LEE J Y,et al.The effect of extra-corporeal shock wave therapy on myofascial pain yndrome[J].Ann Rehabil Med,2012,36(5):665-674.
[21] 尹萌辰,莫文.体外震波治疗跟痛症的Meta分析和系统评价[J].中国中医骨伤科杂志,2014,22(1):15-19.
[22] 徐梦鸽,谭朝坚.传统针灸疗法治疗跟痛症随机对照试验Meta分析[J].实用中医内科杂志,2021,35(4):34-38.
[23] 陈永成.亚甲蓝穴位注射配合针刀治疗跟痛症72例[J].现代中医药,2017,37(6):48-49.
[24] 陈春花,雷丽芳,肖芳,等.针刺结合艾炷直接灸治疗跟痛症[J].吉林中医药,2018,38(2):230-233.

备注/Memo

备注/Memo:
基金项目:上海市进一步加快中医药事业发展三年行动计划项目(ZY(2018-2020)-ZYBZ-11)
△通信作者 E-mail:yejie1977@126.com(叶洁)cn02027@126.com(陈妮)
更新日期/Last Update: 1900-01-01