针刀疗法在青少年特发性脊柱侧凸治疗中的应用与效果探讨

Application and Effect of Acupotomy in the Treatment of Adolescent Idiopathic Scoliosis

摘要: 目的：本研究通过对轻中度特发性脊柱侧凸青少年进行针刀疗法治疗，比较治疗前后VAS、ODI评分、Cobb角的变化情况，验证针刀疗法对于轻中度青少年特发性脊柱侧凸患者的脊柱功能康复效果。方法：收集2018年5月~2024年6月间确诊为AIS的门诊患者60例。按照随机开放实验方法，按就诊序号遇双数分入试验组，遇单数分入对照组。对照组30例，男18例，女12例，年龄10~14岁，平均10.25 ± 3.75岁；病程2~4年，平均2.12 ± 0.23年。试验组30例，男11例，女17例。年龄10~14岁，平均12.33 ± 1.67岁；病程2~3年，平均2.31 ± 0.32年。两组基线资料比较，无显著性差异(P > 0.05)。试验组采用针刀松解。针刀松解的方法为：患者俯卧床上，以侧凸凹侧肌肉压痛点(伴或不伴远处放射痛，或触及皮下有条索状、硬结、板样硬化的痛点)以及关节突关节(顶椎上下2个关节突)作为治疗点。术区消毒及局部麻醉后，严格无菌操作，采用小针刀刺破治疗点皮肤、浅筋膜及深筋膜，并在深筋膜表面散在点刺3~5针进行筋膜层减张，若触及条索状硬结，可沿纵轴方向进行线性划拨，针刀下有松动感时出针；改用圆头针刀沿穿刺通道抵及关节突关节，沿关节囊表面划拨进行钝性松解，针刀下松动时出针。手术后压迫止血1~2 min，以无菌纱布外敷针眼。针刀松解治疗1次/周(症状明显缓解后可暂停该项治疗)。对照组采用支具矫正治疗。采用Boston胸腰骶矫形支具，每天佩戴时间需超过20 h。每隔3~6个月复查1次脊柱侧弯程度及矫正情况，并评估矫正器的性能、矫正参数及患者脊椎生长发育情况，每6~12个月替换矫形器或对其进行修整。两组随访时间为2年，定期到院复查。应用SPSS 25.0统计软件进行统计分析，以α = 0.05为检验标准，显著性P < 0.05为差异有统计学意义，P > 0.05为差异无统计学意义。计量资料采用Mean ± SD进行统计描述，组间比较选用独立样本t检验进行统计表达，组内比较若满足正态性和方差齐性，采用one-way ANOVA方差分析，若计量资料不满足正态性和方差齐性，采用非参数检验(Kruskal Wallis检验)；计数资料选用χ²检验或轶和检验进行统计表达。结果：两组患者治疗后治疗后VAS、ODI评分、Cobb角的组间比较差异均有统计学意义(P < 0.05)，提示对于青少年特发性脊柱侧凸患者，针刀疗法治疗效果明显优于对照组(支具组)。在组内比较中，两组患者在治疗后6、12、24三个时间点进行比较，差异均有统计学意义(P < 0.05)，表明两种治疗方法在VAS评分、ODI评分及Cobb角三个方面均有治疗意义。结论：对于青少年脊柱侧凸患者，针刀松解术能有效缓解疼痛、改善患者的生活质量，并具有一定的矫正畸形作用。

Abstract: Purpose: This study uses acupuncture therapy to treat adolescents with mild to moderate idiopathic scoliosis, compares the changes in VAS, ODI scores, and Cobb angle before and after treatment, and verifies the effect of acupuncture therapy on adolescents with mild to moderate idiopathic scoliosis. Functional rehabilitation effects of the spine in patients with scoliosis. Methods: 60 outpatients diagnosed with AIS from May 2018 to June 2024 were collected. According to the random open experiment method, patients with even numbers were divided into the experimental group and those with odd numbers were assigned to the control group. The control group consisted of 30 males, 18 females, and 12 females, aged 10 to 14 years old, with an average age of 10.25 ± 3.75 years; the disease duration ranged from 2 to 4 years, with an average age of 2.12 ± 0.23 years. There were 30 males, 11 females and 17 females in the experimental group. The age range was 10 to 14 years old, with an average of 12.33 ± 1.67 years; the disease duration was 2 to 3 years, with an average of 2.31 ± 0.32 years. Comparing the baseline data of the two groups, there was no significant difference (P > 0.05). The experimental group used acupotomy for release. The method of acupuncture release is as follows: the patient lies prone on the bed, and the tender points of the muscles on the convex and concave sides of the scoliosis (with or without distant radiating pain, or the pain points with cord-like, induration, and plate-like sclerosis under the skin) and facet joints (The two upper and lower facet joints of the apical vertebra are used as treatment points). After disinfection of the surgical area and local anesthesia, strict aseptic operation is performed. A small needle knife is used to puncture the skin, superficial fascia and deep fascia of the treatment point, and 3 to 5 needles are scattered on the surface of the deep fascia to reduce tension of the fascial layer, if the cord-like induration is touched, linear transfer can be performed along the longitudinal axis, and the needle can be removed when looseness is felt under the needle knife; instead, a round-headed needle knife can be used to touch the facet joint along the puncture channel, and blunt loosening can be performed along the surface of the joint capsule. Solution: Remove the needle when the needle becomes loose under the knife. After the operation, apply pressure to stop bleeding for 1 to 2 minutes, and apply sterile gauze to the needle hole externally. Acupotomy release treatment once a week (this treatment can be suspended after the symptoms are obviously relieved). The control group received brace correction treatment. The Boston thoracolumbosacral orthopedic brace is used and needs to be worn for more than 20 hours a day. The degree of scoliosis and correction should be reviewed every 3 to 6 months, and the performance of the orthosis, correction parameters, and the growth and development of the patient’s spine should be evaluated, and the orthosis should be replaced or modified every 6 to 12 months. The two groups were followed up for 2 years, with regular visits to the hospital for review. SPSS 25.0 statistical software was used for statistical analysis. α = 0.05 was used as the test standard. P < 0.05 meant that the difference was statistically significant, and P > 0.05 meant that the difference was not statistically significant. Measurement data were statistically described using Mean ± SD. Comparisons between groups were performed using independent sample t-test for statistical expression. Comparisons within groups were performed using one-way ANOVA if normality and homogeneity of variances were met. If the measurement data did not meet normality, for homogeneity of variances, a non-parametric test (Kruskal Wallis test) was used; for count data, the χ² test or the sum test was used for statistical expression. Results: There are statistically significant differences in post-treatment VAS, ODI scores and Cobb angle between the two groups of patients (P < 0.05), suggesting that acupotomy therapy has significantly better therapeutic effects for adolescent idiopathic scoliosis patients. in the control group (brace group). In the intra-group comparison, the two groups of patients were compared at three time points: 6, 12, and 24 after treatment, and the differences were statistically significant (P < 0.05), indicating that the two treatment methods had significant differences in VAS score, ODI score, and Cobb angle. All three aspects have therapeutic significance. Conclusion: For adolescents with scoliosis, needle-knife release therapy can effectively relieve pain, improve patients’ quality of life, and provide a certain corrective effect on deformity.