目的:观察"出痧"刮痧、"不出痧"刮痧与针刺治疗慢性非特异性下腰痛(NLBP)的临床疗效差异。方法:通过中央网络随机分组系统,将150例符合纳入标准的NLBP患者随机分为出痧组、不出痧组和针刺组,每组50例。出痧组在受试者腰部(肾俞、志室到次髎、秩边)、下肢(从承扶过委中至承山)进行刮痧,每个部位刮8-10次,并且要求"刮致出痧",每次刮痧治疗间隔4d,总共治疗7次。不出痧组操作方法与出痧组相同,但要求"不出痧",每次刮痧治疗间隔2d,总共治疗7次。针刺组针刺患者肾俞和委中,直刺进针,施平补平泻手法至局部出现酸麻肿重感,每次治疗30min,每次针刺间隔2d,总共治疗7次。比较3组受试者治疗前、治疗结束后及1个月与3个月的随访时视觉模拟量表(VAS)、自拟临床症状积分和Oswetery功能障碍指数(ODI)。根据M5P决策树算法,使用Weka Explorer 3.6软件计算刮痧治疗NLBP疗效预测方程。结果:1治疗结束时,出痧组脱落7例,不出痧组脱落6例,针刺组脱落8例,最终完成129例。3组受试者在治疗过程中未发生不良反应。2治疗结束后,3组NLBP患者VAS、临床症状积分、ODI指数均明显降低(P〈0.05),且随访1个月、3个月随访疗效稳定;出痧组3个指标的改善均优于不出痧组和针刺组,针刺组3个指标的改善亦优于不出痧组(均P〈0.05)。3根据M5P决策树算法,提出刮痧治疗NLBP疗效预测方程,且使用ODI作为因变量方程拟合度较高。结论:刮痧治疗NLBP疗效明显,安全性高,且中短期疗效优于"不出痧"刮痧和针刺治疗,表明刮痧"出痧"是临床疗效的重要影响因素;同时ODI可以作为刮痧治疗腰痛的敏感指标之一。
Objective: To observe the clinical efficacy differences between scrape therapy with sha symptom, scrape therapy without sha symptom and acupuncture for nonspecific low back pain (NLBP). Methods: By using center network system for randomization, one hundred and fifty patients of NLBP who met the inclusive criteria were randomly divided into a sha symptom group, a non-sha symptom group and an acupuncture group, 50 cases in each group. The patients in the sha symptom group were treated with scrape therapy in the back and low extremity, 8-10 scrapings on each area, and sha symptom was mandatory; scrape therapy was given every 4 days for totally 7 sessions. The patients in the non-sha symptom group received identical scrape therapy as sha symptom group, but sha symptom was not mandatory; the scrape therapy was given every 2 days for totally 7 sessions. The patients in the acupuncture group were vertically needled at Shenshu (BL 23) and Weizhong (BL 40) with mild reinforcing-reducing method till the arrival of qi, the acupuncture was given 30rain per session, once every two days for totally 7 sessions. The VAS (visual analogue scale), self-made symptom score and Oswestry disability index (ODI) were compared before and after treatment as well as in the 1-month and 3-month follow-up visit. Weka Explorer 3.6 software was applied to evaluate the predictive formula of Guasha for NLBP. Results: (1)When the treatment finished, 7 cases in the sha symptom group, 6 cases in the non-sha symptom group and 8 cases in the acupuncture dropped out; 129 cases finished the treatment. There was no adverse event during the treatment among three groups. (2)The VAS, self-made symptom score and ODI were all significantly reduced after treatment (P〈0.05), which was also stable in the 1-month and 3-month follow-up. The improvement in the sha symptom group was superior to that in the non-sha symptom group and acupuncture group (P〈0.05), and the improvement in the acupuncture group was superior to th