摘要
【目的】观察“腹髋同调”针法联合悬吊训练对慢性非特异性腰背痛(CNLBP)的临床疗效。【方法】选取2023年6月至2025年2月期间在广州中医药大学东莞医院针灸推拿门诊及住院部收治的90例明确诊断为CNLBP的患者为研究对象。依据随机数字表法将患者随机分为观察组与对照组,每组45例。2组患者均给予悬吊训练(SET),观察组给予“腹髋同调”针法治疗,对照组给予常规针刺治疗。治疗10次为1个疗程,在4周内完成治疗。治疗1个月后,评价2组临床疗效。观察2组患者治疗前后中医证候积分、疼痛视觉模拟量表(VAS)评分、疼痛灾难化量表(PCS)评分和改良中文版Oswestry功能障碍指数(ODI)评分的变化情况,以及肱二头肌和竖脊肌的肌肉-神经反应时间的情况。比较2组患者治疗前后体感诱发电位(SEP)的变化情况。【结果】(1)研究过程中,观察组脱落4例,对照组脱落5例,最终观察组41例,对照组40例纳入疗效统计。(2)观察组总有效率为87.80%(36/41),对照组总有效率为75.00%(30/40),观察组疗效优于对照组,差异有统计学意义(P<0.05)。(3)治疗后,2组患者的中医证候积分明显改善(P<0.05),且观察组在改善中医证候积分方面明显优于对照组,差异有统计学意义(P<0.05)。(4)治疗后,2组患者的VAS、PCS、ODI评分明显改善(P<0.05),且观察组在改善VAS、PCS、ODI评分方面明显优于对照组,差异有统计学意义(P<0.05)。(5)治疗后,2组患者患侧竖脊肌肌电振幅达峰与起始收缩的时间差(Δ1)和肱二头肌与患侧竖脊肌起始收缩时间差(Δ2)均明显改善(P<0.05),且观察组在改善时间差Δ1和Δ2方面明显优于对照组,差异有统计学意义(P<0.05)。(6)治疗后,2组患者的N20潜伏期、P25潜伏期、N20振幅及P25振幅均明显改善(P<0.05),且观察组在改善N20潜伏期、P25潜伏期、N20振幅及P25振幅方面明显优于对照组,差异有统计学意义(P<0.05)。【结论】“腹髋同调”针法联合悬吊训练治疗慢性非特异性腰背痛,可缩短体感诱发电位潜伏期的幅度与振幅,优化中枢神经系统疼痛信号处理,抑制中枢敏化,同时激活腰部核心稳定肌群,提高运动控制能力,从而缓解慢性非特异性腰背痛患者的疼痛及功能障碍,临床疗效显著。
Objective To observe the clinical efficacy of“Abdominal-Hip Coordinating”Acupuncture combined with sling exercise therapy(SET)in treating chronic non-specific low back pain(CNLBP).Methods Ninety patients diagnosed with CNLBP were enrolled from the Acupuncture and Tuina outpatient and inpatient departments of Dongguan Hospital of Guangzhou University of Chinese Medicine between June 2023 and February 2025.They were randomly divided into an observation group and a control group using a random number table method,with 45 patients in each group.Both groups received SET.The observation group received“Abdominal-Hip Coordinating”Acupuncture combined with SET,while the control group received conventional acupuncture combined with SET.The treatment consisted of 10 sessions completed within 4 weeks.After one month of treatment,the clinical efficacy was evaluated.Changes in traditional Chinese medicine(TCM)syndrome scores,Visual Analogue Scale(VAS)scores,Pain Catastrophizing Scale(PCS)scores,and the modified Chinese version of the Oswestry Disability Index(ODI)scores were observed before and after treatment in both groups,along with the muscle-nerve reaction times of the biceps brachii and erector spinae muscles.Changes in somatosensory evoked potentials(SEP)were also compared before and after treatment in both groups.Results(1)During the study,4 patients dropped out in the observation group and 5 in the control group,resulting in 41 in the observation group and 40 patients in the control group being included in the final efficacy analysis,respectively.(2)The total effective rate was 87.80%(36/41)in the observation group and 75.00%(30/40)in the control group,with the observation group showing superior efficacy,and the difference was statistically significant(P<0.05).(3)After treatment,TCM syndrome scores were significantly improved in both groups(P<0.05),and the improvement in the observation group was significantly greater than that in the control group,with a statistically significant difference(P<0.05).(4)VAS,PCS,and ODI scores were significantly improved in both groups after treatment(P<0.05),and the improvements in the observation group were significantly superior to those in the control group,with statistically significant differences(P<0.05).(5)After treatment,the time difference between the peak electromyographic amplitude and the onset of contraction in the affected-side erector spinae(Δ1)and the time difference between the onset of contraction of the biceps brachii and the affected-side erector spinae(Δ2)significantly improved in both groups(P<0.05),and the improvements inΔ1 andΔ2 in the observation group were significantly greater than those in the control group,with statistically significant differences(P<0.05).(6)After treatment,the N20 latency,P25 latency,N20 amplitude,and P25 amplitude of SEP significantly improved in both groups(P<0.05),and the improvements in the observation group were significantly superior to those in the control group,with statistically significant differences(P<0.05).Conclusion“Abdominal-Hip Coordinating”Acupuncture combined with SET exerts certain effect in treating CNLBP.It can shorten the latency and enhance the amplitude of somatosensory evoked potentials,optimize pain signal processing in the central nervous system,and inhibit central sensitization in patients with CNLBP.Simultaneously,it activates the core lumbar stabilizing muscles and improves motor control,thereby alleviating pain and dysfunction,demonstrating significant clinical efficacy.
作者
叶小琳
李银娣
李悦
黎杰轩
利铸均
黎少文
薛爱国
李红儿
YE Xiaolin;LI Yindi;LI Yue;LI Jiexuan;LI Zhujun;LI Shaowen;XUE Aiguo;LI Honger(Dongguan Hospital of Guangzhou University of Chinese Medicine,Dongguan 523127 Guangdong,China;The Seventh School of Clinical Medicine,Guangzhou University of Chinese Medicine,Shenzhen 518133 Guangdong,China;Shenzhen Bao’an Traditional Chinese Medicine Hospital,Shenzhen 518133 Guangdong,China)
出处
《广州中医药大学学报》
2026年第2期401-408,共8页
Journal of Guangzhou University of Traditional Chinese Medicine
基金
广东省医学科研基金资助项目(编号:A2022461)
薛爱国广东省名中医传承工作室资助项目(编号:粤中医办函[2023]108号)
东莞市社会发展科技资助项目(编号:20231800936952)。
关键词
腹髋同调针法
悬吊训练
慢性非特异性腰背痛
表面肌电
临床观察
Abdominal-Hip Coordinating Acupuncture
sling exercise therapy(SET)
chronic non-specific low back pain(CNLBP)
surface electromyography
clinical observation
