卓书喜　何军雷　李顺　李勤勇　王春虎　陈大乐　张俊浩

摘要 目的：探討针刀松解夹脊穴治疗L5椎体中度滑脱症的临床效果。方法：选取2019年1月至2020年1月琼海市中医院收治的L5椎体中度滑脱症患者90例作为研究对象，按照随机数字表法分为对照组和观察组，每组45例。对照组采用针刺夹脊穴治疗，观察组采用针刀松解夹脊穴进行治疗。比较2组患者的临床疗效、疼痛程度、腰椎障碍程度、椎间隙高度、椎体滑移度。结果：观察组总有效率为91.11%，对照组总有效率为80.00%，差异有统计学意义（P<0.05）。治疗结束后，2组患者日本骨科协会评估治疗分数（JOA）评分升高（P<0.05），且观察组高于对照组（P<0.05）;2组患者视觉模拟评分（VAS）、现时疼痛强度（PPI）评分、椎间隙高度和椎体滑移度均降低，观察组的VAS和PPI评分显著低于对照组（P<0.05）。治疗前后2组患者椎间隙高度、椎体滑移度比较，差异均无统计学意义（均P>0.05）。结论：采用针刀松解夹脊穴对L5椎体中度滑脱症患者进行治疗，能有效减轻患者痛苦，改善患者躯体功能性障碍，值得临床推广应用。

关键词 L5椎体滑脱症;针刀松解;针刺;夹脊穴;日本骨科协会评估治疗分数;视觉模拟评分法;现时疼痛强度;疗效

Abstract Objective：To explore the clinical effect of acupotomy loosening Jiaji points on treating L5 vertebral body moderate spondylolisthesis.Methods：A total of 90 patients with moderate spondylolisthesis of the L5 vertebra who were admitted to the Qionghai Hospital of Traditional Chinese Medicine from January 2019 to January 2020 were selected as the research objects and divided into a control group and an observation group according to a random number table method，with 45 in each group.The control group was treated with acupuncture at Jiaji points，and the observation group was treated with acupotomy loosening at Jiaji points.The clinical efficacy，pain degree，lumbar spine disorder，intervertebral space height，and vertebral slip degree were compared between the 2 groups of patients.Results：The total effective rate of the observation group was 91.11%，and the total effective rate of the control group was 80.00%.The difference between the groups was statistically significant（P<0.05）.After treatment，the Japanese Orthopaedic Association Evaluation Treatment Score（JOA） score increased in the 2 groups（P<0.05），and the observation group was higher than the control group（P<0.05）; the visual analogue score（VAS） and current pain in the two groups Intensity（PPI） score，intervertebral space height，and vertebral slippage were all reduced.The VAS and PPI scores of the observation group were significantly lower than those of the control group（P<0.05）.There was no statistically significant difference in the height of the intervertebral space and the degree of vertebral slip between the two groups before and after treatment（all P>0.05）.Conclusion：The use of needle knife to release Jiaji points to treat patients with moderate spondylolisthesis of the L5 vertebra can effectively relieve the pain of the patient and improve the physical dysfunction of the patient.It is worthy of clinical application.

Keywords L5 vertebra spondylolisthesis; Acupotomy release; Acupuncture; Jiaji points; Japanese Orthopaedic Association Evaluation Treatment Score; Visual analogue score; Current pain intensity; Curative efficacy

中图分类号：R245;R684文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.18.019

椎体滑脱一般表现为脊椎下位椎体相对于上位椎体的前凸，而后上部椎弓根并未受损。引发椎体滑脱原因包括椎板峡部断裂、椎体发育不良、反复长期微骨折以及小关节退行性改变等[1-2]。L5椎体由于前倾和直立均承受很大的轴向、旋转及剪切应力而更易发生损伤及滑脱[3]，进而出现相应的疼痛与活动受限，对患者工作和生活都造成严重影响。以中医经络学说为基础的针灸、推拿可迅速缓解椎体滑脱患者的症状并能长期稳定患者病情，故在临床上日益受到重视。针刀医学作为结合中医针灸与西医手术的治疗方法，具有针灸刺激穴位、调理经络的功能，同时能发挥刀具解除粘连，切割疏通的作用[4]。……