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2000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。
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 2000,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 2 nd(after 1 week)and 4 th(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).There was no statistically significant difference in VAS scores between the two groups before treatment,but there was statistically significant difference in VAS scores at different time points after treatment,that is,there was time efficacy(F=179.443,P<0.001).AOFAS ankle-hind foot scores:there was an interaction between time factor and grouping factor(F=2.966,P=0.036).The overall comparison of AOFAS ankle-hind foot scores between the two groups showed statistically significant difference,indicating grouping efficacy(F=4.761,P=0.032).There was no statistically significant difference in ankle-hind foot AOFAS scores before treatment,but there was statistically significant difference in scores at different time points after treatment,that is,there was time efficacy(F=176.955,P<0.001).SF-36 quality of life scores:there was no interaction between time factor and grouping factor(F=1.508,P=0.219).Overall comparison of SF-36 quality of life scores between the two groups showed no statistically significant difference,that is,there was no grouping efficacy(F=0.208,P=0.650).There was no statistically significant difference in SF-36 quality of life scores before treatment,but there was statistically significant difference in scores at different time points after treatment,that is,there was time efficacy(F=102.176,P<0.001).There were no significant adverse events during the study intervention.Conclusion:The extracorporeal shock wave tired on the treatment of calcaneodynia can more effectively relieve the pain in patients with symptoms and improve the function of the foot,the clinical curative efficacy is superior to the traditional extracorporeal shock wave impact the way of a foot plantar fascia pain area,and has advantages of simple operation and high safety.It adequately shows the features and advantages of modern medicine combined with the traditional medical technology,which is worthy of clinical popularization and application.
作者
陈波平
许金海
徐华
王国栋
姚若愚
王雅
陈妮
叶洁
CHEN Boping;XU Jinhai;XU Hua;WANG Guodong;YAO Ruoyu;WANG Ya;CHEN Ni;YE Jie(Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China)
出处
《中国中医骨伤科杂志》
CAS
2022年第7期26-31,共6页
Chinese Journal of Traditional Medical Traumatology & Orthopedics
基金
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)。
关键词
冲击波
循经取穴
跟痛症
随机对照
临床研究
shock wave
meridian acupoint selection
calcaneodynia
randomized control
clinical research
