华西医学

华西医学

高频超声对传统盲法针刀松解术治疗肩周炎定位及操作准确度的观察研究

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目的采用高频超声观察传统盲法针刀松解术在肩周炎治疗中定位及操作的准确度,探讨传统盲法针刀治疗存在的缺陷及可能的改进措施。方法选取 2018 年 2 月—4 月在新疆医科大学第一附属医院和乌鲁木齐市中医医院确诊为肩周炎的患者 42 例,选取针刀治疗肩周炎时常用的 4 个位点进行盲法操作,采用高频超声对进针点定位及施针操作过程进行观察。结果采用高频超声观察并确认徒手定位点及针刀操作点后发现,对 42 例患者使用徒手定位进针点的准确率高,可达 100.0%(42/42)。在施针操作过程中,肱骨小结节点及三角肌下滑囊点进针操作准确率均较高,分别为 95.2%(40/42)和 100.0%(42/42)。但喙突点和肱骨结节间沟点因施针深度及方向存在偏差导致进针准确率低,分别为 45.2%(19/42)和 4.8%(2/42)。结论传统盲法针刀松解术是目前临床普遍使用的针刀治疗方法。采用高频超声观察发现,具备多年治疗经验的针刀医师使用盲法操作仍可能出现进针位置偏差。由于临床针刀可视化操作受时间、技术的限制很难普遍开展,因此建议在针刀操作培训中借助高频超声作为可视化教学工具,辅助进行针刀盲法操作技术的培训,可能对提高盲法针刀操作准确度有一定价值。

ObjectiveTo observe the accuracy of location and operation of traditional blind acupotomy lysis in the treatment of scapulohumeral periarthritis by using the high-frequency ultrasound.MethodsForty-two patients with scapulohumeral periarthritis diagnosed in the First Affiliated Hospital of Xinjiang Medical University and Urumqi Hospital of Traditional Chinese Medicine from February to April 2018 were selected. Four common sites of needle knife in the treatment of scapulohumeral periarthritis were operated blindly, and the process of the needle insertion points location and needle perform were both observed by high-frequency ultrasound.ResultsUsing high-frequency ultrasound to observe and confirm the bare-handed positioning point and needle-knife operating point, we found that the accuracy rate of bare-handed positioning needle-point was 100.0% (42/42). In the process of needling, the accuracies of needle insertion at the point of small tubercle of humerus and the point of bursa of deltoid muscle were high, which was 95.2% (40/42) and 100.0% (42/42), respectively. However, because of the deviation of the needle depth and direction, the accuracies of needle insertion at the coracoid point and the sulcus point between the humeral tubercles were low, which was 45.2% (19/42) and 4.8% (2/42), respectively.ConclusionsTraditional acupotomy lysis is a commonly used method of needle knife treatment. Using high-frequency ultrasound, it is found that even by experienced needle knife doctors, there may still be positioning deviation when using blind method to insert needles. Because the visualization of clinical needle knife is difficult to be carried out universally due to the limitations of time and technology, it is suggested that high-frequency ultrasound could be used as a visualization teaching tool in the training of needle knife operation to assist the training of blind needle knife operation technology, which may improve the accuracy of blind needle knife operation.

关键词: 盲法; 针刀; 肩周炎; 高频超声

Key words: Blind method; Acupotomy; Scapulohumeral periarthritis; High-frequency ultrasound

引用本文: 陈祢, 沈红, 王宝兰. 高频超声对传统盲法针刀松解术治疗肩周炎定位及操作准确度的观察研究. 华西医学, 2018, 33(10): 1262-1266. doi: 10.7507/1002-0179.201805180 复制

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