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彩色多普勒超声在宫廷理筋术治疗肱骨外上髁炎中的应用探讨

发布时间:2019-01-11 11:11  文章来源:笔耕文化传播
【摘要】:第一部分:文献研究本文通过近十年来对于肱骨外上髁炎诊断及治疗的相关文献,分别从病因病机、发病机制、声像图特点及推拿治疗等方面,进行综合评述。第二部分:临床研究目的:探讨彩色多普勒高频超声在宫廷理筋术治疗肱骨外上髁炎中的应用价值。宫廷理筋术是治疗肱骨外上髁炎的一种非常有效方式,而其治疗重点是对于病灶的诊断及定位分析。而超声检查因其成像特点成为诊断肌肉软组织损伤性疾病的首选方法。本研究尝试将彩色多普勒高频超声与传统中医手法按摩宫廷理筋术相结合,为传统治疗法的定位提供更为准确的方式,从而提高诊疗效果,并探讨其对治疗效果的指导作用,为推拿可视化和临床机制研究提供客观依据。材料方法:对经临床诊断的70例肱骨外上髁炎患者进行随机分为两组,分别进行灰阶图像扫查和CDFI扫查。实验组利用超声定位病灶后,指导临床以宫廷理筋术手法治疗;对照组利用传统按压定位法,以宫廷理筋术手法治疗。治疗前后观察两组资料的VAS评分变化及彩色多普勒超声声像图的改变(包括:伸肌总腱厚度、血流信号情况,伸肌总腱撕裂状况),并进行统计学分析。治疗后对两组资料的临床综合疗效、治疗次数进行对比,并进行统计学分析。对伸肌总腱的厚度、撕裂范围、血流评分与VAS评分做相关性分析。结果:1.疼痛度评分(VAS):治疗前两组间对比无明显差异(P0.05);治疗7天、14天后实验组与对照组比较具有显著性差异(P0.01);治疗后21天两组间无明显差异(P0.05);两组内治疗前后对比,VAS评分具有显著性差异(P0.01)。2.利用Ridit检验,实验组疗效优于对照组(R实验组=0.435,R对照组=0.568,P0.05)。3.两组间在治疗次数上存在明显差异(P0.01),实验组(5.97±2.34次)明显少于对照组(7.67±1.36次)。4.伸肌总腱厚度变化:两组内治疗前后对比,存在显著性差异(P0.01);两组间对比,治疗前后伸肌总腱厚度无明显差异(P0.05)。5.伸肌总腱撕裂范围:两组内治疗前后对比,具有显著差异(P0.01);两组间对比,治疗前无明显差异(P0.05),治疗后存在差异(P0.05)。6.CDFI血流情况:治疗前后两组间比较,无明显差异(P0.05)。治疗前后两组内比较,均有显著性差异(P0.01)。7伸肌总腱厚度与VAS评分无明显相关性(P0.05,);CDFI血流评分与VAS评分呈正相关(P0.01,R=0.449);伸肌总腱撕裂范围与VAS评分呈正相关(P0.05,R=0.454,)。结论1.利用超声定位痛点的宫廷理筋术与传统定位法相比较,治疗肱骨外上髁炎的疗效更好,并且对于患者疼痛的改善更为快速有效。在治疗次数上,也明显减少。2.肱骨外上髁炎的患者中,其伸肌总腱的厚度与症状无相关性,而CDFI血流计数评分高低及伸肌总腱的撕裂与患者疼痛程度有一定相关性。3.宫廷理筋术手法治疗肱骨外上髁炎中,能帮助增厚肿胀的肌腱恢复,能改善损伤处急性炎症的情况。4.超声观察指标中,伸肌总腱的厚度不能做为疗效评价的指标,CDFI血流计数评分及伸肌总腱撕裂范围可做为评价疗效的参考指标。
[Abstract]:The first part: The literature studies the literature on the diagnosis and treatment of the external humeral epicondylitis in the last ten years, and makes a comprehensive review from the aspects of the etiology, the pathogenesis, the characteristics of the image and the treatment of the massage. Part 2: The purpose of clinical study: To study the application value of color Doppler high-frequency ultrasound in the treatment of external humeral epicondylitis. It is a very effective way to treat the epicondylitis of the external humeral epicondylitis, and its treatment is focused on the diagnosis and location analysis of the focus. and the ultrasound examination is the preferred method for diagnosing the soft tissue injury disease of the muscle due to its imaging characteristics. The study attempts to combine the color Doppler high-frequency ultrasound with the traditional Chinese medicine technique to massage the royal treatment of the court and provide a more accurate way for the positioning of the traditional treatment, so as to improve the diagnosis and treatment effect, and to explore the guiding role of the color Doppler high-frequency ultrasound in the treatment effect. and provides an objective basis for the research of the massage visualization and the clinical mechanism. Methods: 70 patients with external humeral epicondylitis diagnosed by clinical diagnosis were randomly divided into two groups, and the gray-scale image scanning and CDFI scanning were performed. The experimental group, after using the ultrasound to locate the focus, guided the clinical treatment with the technique of the court of the court; the control group used the traditional pressing and positioning method to treat with the manipulation of the court. The VAS scores of the two groups of data and the change of the color Doppler ultrasound were observed before and after the treatment (including the total tendon thickness of the extensor, the condition of the blood flow signal, the total tendon tear of the extensor), and the statistical analysis. After the treatment, the clinical comprehensive curative effect and the number of treatment times of the two groups of data were compared, and the statistical analysis was carried out. The thickness, tear range, blood flow score and VAS score of the extensor total tendon were analyzed. Results: 1. Pain degree score (VAS): There was no significant difference between the two groups before treatment (P0.05); after the treatment for 7 days and 14 days, the experimental group had a significant difference with the control group (P0.01); there was no significant difference between the two groups after the treatment (P0.05); and the two groups were compared before and after treatment. There was a significant difference in the VAS scores (P0.01). The efficacy of the experimental group was superior to that of the control group (R group = 0.435, R control group = 0.568, P0.05). There was a significant difference between the two groups in the number of treatment (P0.01), and the experimental group (5.97% 2.34 times) was significantly less than that in the control group (7.67% 1.36 times). The change of total tendon thickness of extensor muscle: There was a significant difference between the two groups before and after treatment (P0.01). There was no significant difference between the two groups (P0.05). There was no significant difference between the two groups (P0.05). There was no significant difference between the two groups (P0.05). There was a significant difference between the two groups before and after the treatment (P0.01). The total tendon thickness of the extensor was not significantly correlated with the VAS score (P0.05); the CDFI flow score was positively correlated with the VAS score (P0.01, R = 0.449); the tear range of the extensor total tendon was positively correlated with the VAS score (P0.05, R = 0.454,). Conclusion 1. Compared with the traditional positioning method, the effect of the treatment of the epicondylitis on the external humeral epicondylitis is better, and the improvement of the pain of the patient is more rapid and effective. the number of treatment was also significantly reduced. In the patients with external humeral epicondylitis, the thickness of the total tendon of the extensor was not related to the symptoms, and the score of the CDFI blood flow and the tear of the total tendon of the extensor muscle had a certain correlation with the degree of pain of the patient. In the treatment of the external epicondylitis of the humerus, the method of the court of the court can help to increase the tendon recovery of the swelling and improve the condition of the acute inflammation at the lesion. In the ultrasonic observation index, the thickness of the total tendon of the extensor can not be the index of the evaluation of the curative effect, and the CDFI blood flow counting score and the total tendon tear range of the extensor can be used as the reference index for evaluating the curative effect.
【学位授予单位】:北京中医药大学
【学位级别】:硕士
【学位授予年份】:2015
【分类号】:R681.7

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