摘要
目的 探讨影响中医经皮微创松解术治疗狭窄性腱鞘炎疗效的因素。方法 回顾性分析2014年6月－2017年4月北京中医药大学东直门医院推拿疼痛科门诊接受1次中医经皮微创松解术治疗的119例屈肌肌腱狭窄性腱鞘炎患者的临床资料，按第27周随访时的治疗结果将患者分为痊愈组94例、非痊愈组25例，以痊愈率为因变量，以社会人口学资料（年龄、性别），临床特征（干预措施、病程、患手、患指、活动受限程度及疼痛评分）8个变量及以上变量与干预措施（推割刀/传统针刀）交互后的7个变量为自变量，采用Logistic回归分析探讨影响中医经皮微创松解术治疗狭窄性腱鞘炎疗效的相关因素。结果 2组年龄、病程、干预措施（推割刀/传统针刀）和疼痛评分比较，差异有统计学意义，在此基础上进一步进行多因素Logistic回归分析。确认以上4个因素与中医经皮微创松解术治疗狭窄性腱鞘炎疗效相关（P＜0.05）；推割刀经皮微创松解术治疗狭窄性腱鞘炎的有效例数比传统针刀疗法高5.85倍（OR＝5.853，95% CI为1.853～18.485；P＝0.003）；年龄≥60岁（OR＝6.170，95% CI为1.890～20.141；P＝0.003）、病程≥6个月（OR＝4.696，95% CI为1.371～16.085；P＝0.014）、疼痛数字评价量表6～7分（OR＝5.184，95% CI为1.416～18.975；P＝0.013）等情况下接受中医经皮微创松解术治疗狭窄性腱鞘炎的有效例数较低。结论 推割刀中医经皮微创松解术1次治疗狭窄性腱鞘炎后随访27周的痊愈率明显优于传统针刀疗法，且年龄越大、病程越长、疼痛越明显的患者行中医经皮微创松解术的疗效越差，鉴于样本量问题以上结论仍需进一步验证。
Objective The aim of this study is to analyze the factors influencing the outcomes of the traditional Chinese medicine （TCM） percutaneous release treatment for the stenosal tendosynovitis. Methods A total of 119 eligible participants, from outpatient of Dongzhimen Hospital during June, 2014 to April, 2017, were included into the study. The participants received TCM percutaneous release treatment, and were followed-up and assessed outcomes at 27 w. Responders were defined as participants with normal movement in week 27 compared with the baseline period. The NRS assessment in both groups was described, and the baseline characteristics of participants potentially related to cure response were mainly analyzed using Logistic regression analysis. Results Cure group and non-cure group were determined according to the cure response. And the outcomes of pain relief along the timeframe showed the feasibility of criteria of cure response. The uni-factor Logistic regression analysis showed that the factors age, course of disease, interventions and pain severity were significantly different between the cure and non-cure groups, and the multi-factor Logistic regression confirmed the four factors influenced the cure response of the TCM percutaneous release treatment for the stenosal tendosynovitis. The cutting knife was 5.85 fold than the traditional needling knife at increasing the cure response （OR=5.853, 95% CI 1.853-18.485; P=0.003）. All the factors that age equal to or older than 60 years （OR=6.170, 95% CI 1.890-20.141; P=0.003）, course of disease more than six months （OR=4.696, 95% CI 1.371-16.085; P=0.014） and pain severity from 6 to 7 （OR=5.184, 95% CI 1.416-18.975; P=0.013） were negatively associated with clinical response. Conclusions The patients with increasing age, long course of disease and distinct pain severity may be less likely to respond to the TCM percutaneous release treatment. These findings contribute to guiding clinical practice in terms of pretreatment patient selection. Further research is needed to confirm the association.
作者
于长禾
罗涛
翁志文
刘长信
赵宇捷
王锡友
刘景
王福
张洋
Yu Changhe, Luo Tao, Weng Zhiwen, Liu Changxin, Zhao Yujie, Wang Xiyou, Liu Jing, Wang Fu, Zhang Yang(Department of Tuina and Pain Management, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, Chin)
出处
《国际中医中药杂志》
2018年第4期314-318,共5页
International Journal of Traditional Chinese Medicine
基金
首都市民健康培育项目（Z141100002114008）
关键词
腱鞘炎
扳机指病症
中医经皮微创松解术
推割列
针刀
影响因素
回归分析
Tenosynovitis
Trigger finger disorder
TCM Percutaneous release treatment
Cuttingknife
Needling knife
Influencing factors
Regression analysis
