安军伟 吴海波 段敬瑞 张云飞 张继伟 詹红生 陈东煜

摘要：目的 观察针刀经筋层整体松解治疗第三腰椎横突综合征（TLTPS）临床疗效。方法 采用随机数字表法将66例TLTPS患者分为试验组和对照组各33例。于患者L3棘突旁开3 cm寻找压痛点，对照组采用L3横突压痛点针刀松解，试验组在对照组基础上予针刀经筋层整体松解，均治疗1次。观察2组治疗前后及治疗后1、2、3个月患者视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI），评价临床疗效，观察不良反应及并发症。结果 试验组、对照组分别脱落1、2例。与本组治疗前比较，2组治疗后各时点VAS、ODI均明显降低（P<0.05）。试验组治疗后各时点VAS、ODI低于对照组，2组比较差异有统计学意义（P<0.05）。试验组总有效率为96.88%（31/32），对照组为93.55%（29/31），试验组优于对照组（Z=-2.756，P=0.006）。2组均无不良反应及并发症。结论 针刀经筋层整体松解联合L3横突压痛点针刀松解可显著提高TLTPS患者临床疗效，作用持久。

关键词：第三腰椎横突综合征；针刀；经筋层松解术

DOI：10.3969/j.issn.1005-5304.2018.03.007

中图分类号：R274.915.33 文献标识码：A 文章编号：1005-5304（2018）03-0030-04

Abstract： Objective To observe the clinical efficacy of tendons layer overall release treatment by needle knife for the third lumbar transverse process syndrome （TLTPS）. Methods Totally 66 cases of TLTPS patients were divided into control group and experimental groups by using random number table method， with 33 cases in each group. L3 spinous process opened 3 cm looking for tenderness. Control group received lumbar transverse pressure tender point knife release treatment. On the basis of control group， experimental group received tendons layer overall release treatment by needle knife. Both control group and experimental group received treatment once. VAS and ODI before treatment and after treatment of 1， 2 and 3 months were observed. Clinical efficacy was evaluated. Adverse reactions and complications were observed. Results The experimental group and control group lost 1 and 2 cases， respectively. Compared with before treatment， the VAS and ODI in both groups after treatment decreased （P<0.05）. After treatment， the VAS and ODI in the experimental group were lower than those of the control group， with statistical significance （P<0.05）. The total effective rate of clinical efficacy was 96.88% （31/32） in the experimental group and 93.55% （29/31） in the control group， with experimental group better than the control group （Z=-2.756， P=0.006）. There were no adverse reactions or complications in both groups. Conclusion Tendons layer overall release treatment combined with lumbar transverse pressure tender point knife release treatment for TLTPS can significantly improve the clinical efficacy of TLTPS， with long effects.

Keywords： third lumbar transverse process syndrome； needle knife； tendons layer overall release treatment

第三腰椎橫突综合征（third lumbar transverse process syndrome，TLTPS）发病原因复杂，如感受外邪、急性损伤或慢性劳损等。目前临床有手术和非手术治疗。非手术治疗手段主要包括封闭、推拿、针灸。单纯的横突针刀松解治疗疗效虽显著，但治愈率较低，易复发[1]。石氏伤科将经筋理论与针刀医学有机结合，提出针刀“经筋层”松解术，操作过程即是对皮下筋膜层的疏通（解结）[2]。通过针刀松解激活“经筋层”，继而调控周身，恢复自身调节功能，达到治疗目的。本研究观察针刀经筋层整体松解疗法治疗TLTPS临床疗效，现报道如下。

1 资料与方法

1.1 一般资料

选择2015年12月-2016年12月上海中医药大学附属曙光医院骨伤科病房66例TLTPS患者，采用随机数字表法分为2组各33例。试验组男性7例，女性26例；年龄22～75岁，平均（55.15±13.00）岁；病程4～48个月，中位病程7.41个月。对照组男性11例，女性22例；……