Application and Effect of Acupotomy in the Treatment of Adolescent Idiopathic Scoliosis
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.
Traditional Chinese Medicine Orthopedics
青少年特发性脊柱侧弯(Adolescent Idiopathic Scoliosis, AIS)是一种脊柱三维畸形,发生在青春期前至青春期期间,通常在10至16岁之间。其特征为脊柱出现侧向弯曲,并伴有一定程度的旋转,同时可能存在冠状面和矢状面平衡的失调。该病的确切病因仍未明确,是特发性脊柱侧弯中最常见的类型,占所有脊柱侧弯病例约80%
收集2018年5月~2024年6月间确诊为AIS的门诊患者60例。
参照脊柱侧凸研究学会(scoliosis research society, SRS)标准:① 年龄介于10至18岁之间。② 经由放射学检查确诊为特发性脊柱侧弯,排除其他病理因素,且Cobb角界于10˚至45˚区间,以此聚焦于适宜非手术干预的群体。③ 患者应处于骨骼发育未完全成熟的阶段(Risser征≤2),确保研究结果的生长相关性。④ 本研究经本院医学伦理委员会审核批准,所有参与者及其法定代理人需详尽理解研究详情,自愿签署知情同意书,并承诺良好的依从性,以完成整个研究流程,包括必要的影像学复查与数据追踪。
① 患有严重的心血管、呼吸系统、神经系统疾病,或任何可能影响治疗安全或结果评估的未控制慢性疾病。② 不符合AIS诊断和纳入标准者。③ 无法理解研究程序、提供知情同意,或依从性差的患者,以及存在严重精神健康问题的个体。④ 存在可能影响研究结果解读或增加治疗风险的其他疾病或症状,如血液病、严重过敏史、局部皮肤感染等。⑤ 正在使用可能与针刀疗法相互作用或影响结果评估的特定药物。⑥ 对类似治疗方式有过严重不良反应或过敏历史的患者。⑦ 因地理或时间限制无法保证完成整个研究过程的随访要求的患者。
所选患者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)。
本研究的设计、实施、评估均由本文作者完成。采用盲法评估,参加人员均需经过培训并考核合格,以确保实施方案和评价标准的一致性。
针刀松解术的操作步骤如下:患者俯卧位,治疗区域定位于脊柱侧凸凹侧的肌肉压痛点(可能伴有放射痛、硬结、条索状结节或板样硬化)及邻近的关节突关节。首先对术区进行消毒和局部麻醉,确保无菌操作。随后,使用小针刀刺入治疗点,穿透皮肤、浅筋膜和深筋膜,并在深筋膜表面进行3至5次散点刺,以实现筋膜减张。若触及条索状硬结,则沿其纵轴方向进行线性划拨,直至感觉松动,然后拔出针刀。最后,用圆头针刀沿原穿刺通道插入,直达关节突关节,并在关节囊表面进行钝性松解。直到感到松动后再拔出针刀。手术结束后,进行1到2分钟的压迫止血,并在针眼处覆盖无菌纱布。针刀松解治疗一般每周进行一次,症状明显缓解后可暂停治疗。
在研究中,对照组采用支具矫正疗法,具体实施方式为:患者每日佩戴Boston胸腰骶矫形支具至少20小时。治疗过程中,每3至6个月对患者的脊柱侧弯程度及支具的矫正效果进行一次全面评估,包括矫形器的性能检测、矫正效果分析以及患者脊椎生长发育状况的监测。根据评估结果,每6至12个月对矫形器进行必要的更换或调整,以确保治疗效果。两组患者均设定为2年的随访期,在此期间,患者需定期回院进行复查,以监控病情进展和治疗反应。
(1) 采用数字评分法(Visual Analogue Scales, VAS)
在本研究中,采用SPSS 25.0统计软件进行数据分析,设定显著性水平α为0.05。若P值小于0.05,则认为差异具有统计学意义;若P值大于0.05,则差异无统计学意义。对于计量资料,采用均数 ± 标准差(Mean ± SD)进行描述。组间比较使用独立样本t检验,而组内比较则根据数据是否满足正态性和方差齐性选择分析方法:若满足条件,采用单因素方差分析(one-way ANOVA);若不满足条件,则使用非参数检验(如Kruskal-Wallis检验)。对于计数资料,采用卡方检验(χ2检验)或秩和检验进行统计分析。
组间比较:两组患者治疗前的VAS评分,经配对样本t检验分析,P > 0.05,表明两组患者治疗前的VAS评分差异无统计学意义;两组患者治疗后6、12、24个月,经配对样本t检验,VAS评分差异均有统计学意义(P < 0.05)。
组内比较:试验组和对照组组内患者治疗前、治疗后6、12、24个月四个时间点的VAS评分经非参数检验(Kruskal Wallis检验)分析,四个时间点的VAS评分差异均有统计学意义(P < 0.05)。
组别 |
治疗前 |
治疗后6个月 |
治疗后12个月 |
治疗后24个月 |
Χ2/F |
P |
试验组(n = 30) |
7.63 ± 0.57 |
2.85 ± 0.54*△ |
1.51 ± 0.40*△ |
1.34 ± 0.07*△ |
78.955 |
0.000 |
对照组(n = 30) |
7.42 ± 0.55 |
3.82 ± 0.76△ |
3.51 ± 0.68△ |
2.96 ± 0.46△ |
315.900 |
0.000 |
t |
2.415 |
9.741 |
3.299 |
2.686 |
||
P |
0.095 |
0.000 |
0.000 |
0.000 |
注:*与对照组相比,P < 0.05;△与同组治疗前相比,P < 0.05。
组间比较:两组患者治疗前的ODI评分,经配对样本t检验分析,P > 0.05,表明两组患者治疗前的ODI评分差异无统计学意义;两组患者治疗后6、12、24个月,经配对样本t检验,ODI评分差异均有统计学意义(P < 0.05)。
组内比较:试验组和对照组组内患者治疗前、治疗后6、12、24个月四个时间点的ODI评分经单因素方差分析分析,四个时间点的ODI评分差异均有统计学意义(P < 0.05)。
组间比较:两组患者治疗前的Cobb角,经配对样本t检验分析,P > 0.05,表明两组患者治疗前的Cobb角差异无统计学意义;两组患者治疗后6、12、24个月,经配对样本t检验,Cobb角差异均有统计学意义(P < 0.05)。
组内比较:试验组和对照组组内患者治疗前、治疗后6、12、24个月四个时间点的Cobb角经单因素方差分析分析,四个时间点的Cobb角差异均有统计学意义(P < 0.05)。
组别 |
治疗前 |
治疗后6个月 |
治疗后12个月 |
治疗后24个月 |
Χ2/F |
P |
试验组(n = 30) |
18.26 ± 3.68 |
15.81 ± 5.99*△ |
12.43 ± 6.52*△ |
11.79 ± 7.29*△ |
34.679 |
0.000 |
对照组(n = 30) |
18.15 ± 4.43 |
16.58 ± 4.52△ |
15.45 ± 5.77△ |
13.28 ± 5.14△ |
24.847 |
0.000 |
t |
0.201 |
3.162 |
3.581 |
2.171 |
||
P |
0.818 |
0.000 |
0.000 |
0.000 |
注:*与对照组相比,P < 0.05;△与同组治疗前相比,P < 0.05。
组别 |
治疗前 |
治疗后6个月 |
治疗后12个月 |
治疗后24个月 |
Χ2/F |
P |
试验组(n = 30) |
44.61 ± 3.22 |
15.81 ± 2.95*△ |
10.95 ± 2.88*△ |
9.48 ± 2.75*△ |
54.800 |
0.000 |
对照组(n = 30) |
45.39 ± 3.48 |
20.07 ± 2.30△ |
15.80 ± 2.10△ |
11.20 ± 1.48△ |
78.080 |
0.000 |
t |
0.590 |
5.922 |
4.930 |
6.511 |
||
P |
0.757 |
0.000 |
0.000 |
0.000 |
注:*与对照组相比,P < 0.05;△与同组治疗前相比,P < 0.05。
两组患者治疗前的VAS评分、ODI评分及Cobb角在统计分析中符合正态分布和方差齐性,经过配对样本t检验后,P > 0.05,表明治疗前两组在VAS评分、ODI评分、Cobb角上没有显著差异,具有可比性。
治疗后,VAS评分、ODI评分和Cobb角的组间差异均具有统计学意义(P < 0.05),这表明针刀疗法在治疗青少年特发性脊柱侧弯方面效果明显优于支具治疗。组内比较显示,在治疗后的6、12、24个月,VAS评分、ODI评分及Cobb角的差异也均具有统计学意义(P < 0.05),表明两种治疗方法在改善这三项指标方面均具有显著的疗效。
特发性脊柱侧弯的发病机制目前仍未完全明了
特发性脊柱侧弯在中医学中被归为“龟背”范畴,其病因病机与经筋的功能失调密切相关。《灵枢·经筋》提出“以痛为腧”的治疗原则,主张通过调理痛点来缓解筋病。此外,《灵枢·刺节真邪》进一步指出:“一经上实下虚而不通者,必有横络盛加于大经,令之不通,视而泻之,所谓解结也。”这一理论强调了经络不通时,需通过疏通经络、解除结滞来恢复气血运行,从而改善病症。这些中医经典理论为特发性脊柱侧弯的治疗提供了重要的理论依据,提示通过调理经筋、疏通经络和解除结滞,可以达到缓解症状、恢复功能的目的
针刀疗法是一种结合中西医理念的微创治疗方法,旨在通过精准松解肌肉、筋膜等软组织,减轻软组织的张力,促进修复,并恢复动静力平衡。该疗法操作简便、效果显著且具有较高的经济性,能够有效弥补其他治疗方法的不足。通过针对性地松解受损组织,针刀疗法能够改善经筋的功能,促进气血流畅,从而帮助恢复脊柱的正常结构和功能,适用于多种软组织损伤和疾病的治疗
脊柱侧凸疼痛的发生主要与肌肉紧张亢进密切相关。肌肉过度紧张会引发筋膜增厚,增加筋膜腔内压力和表面张力,进而造成局部组织缺血、缺氧,最终导致疼痛。同时,紧张的肌肉可能牵引并压迫脊神经,诱发神经卡压性疼痛。针对这些病理变化,我们采取了结合小针刀与圆头针刀的治疗方法。小针刀通过精准松解紧张的软组织与筋膜,降低局部张力;而圆头针刀则用于深层肌肉和神经压迫区域的进一步松解,达到缓解疼痛、恢复功能的效果,有助于脊柱结构和运动功能的恢复
治疗开始时,首先利用小针刀在脊柱侧弯凹侧对明显压痛或肌肉紧张的区域进行切割与松解,主要针对皮下组织、筋膜以及紧绷的肌肉。这一过程能够有效减轻筋膜张力和肌肉的压力,减少对感觉神经末梢的压迫和刺激,从而缓解疼痛。接下来,通过圆头针刀对顶椎凹侧上下关节突周围的关节囊进行钝性松解,减轻脊神经后内侧支的压迫。这一治疗步骤不仅进一步缓解疼痛,还能促进脊柱功能的恢复,帮助恢复正常的运动功能
总体而言,针刀松解术在青少年脊柱侧凸患者中展现了显著的治疗效果,能够有效缓解疼痛、改善生活质量,并在一定程度上矫正脊柱畸形。然而,由于本研究的样本量较为有限,未来可通过增加样本量,深入探讨针刀松解术在治疗青少年特发性脊柱侧弯中的疗效,以便得出更加可信且全面的结论。
该病例报道已获得病人的知情同意。
*通讯作者。