| BackgroundThoracic facet joint disorders are mainly causes by the dislocation of thoracic facet joints and rib-vertebral joint due to various reasons, stretching the soft tissue to stimulate the nerves and leading to the main symptoms of thoracodorsal pain, in general, it mainly occurs in the upper or middle thoracic vertebral and more common.in the athletes. The thoracic spine is more stability than the lumber spine, because of the reinforced protective effect of its inherent characteristics. But the human spine is an organic whole, in the biomechanics of a dynamic equilibrium, Therefore, regardless of biomechanical imbalance of the cervical or lumbar will cause the thoracic corresponding change in position to adapt to the mechanical equilibrium. Thoracic facet joint disorder makes that soft tissue are oppressed, stimulation, resulting in inflammation, edema, hemorrhage, and even calcification, while the surrounding soft tissue injury would lead to thoracic facet joint dislocation, thus creating a vicious cycle. Joint disorders and soft tissue pathological changes lead to spinal nerve and sympathetic nerve secondary diseases, which together with the corresponding clinical symptoms. Therefore, the main method of the relieve symptoms is to correct thoracic facet joint disorders.Thoracic facet joint disorders in Chinese medicine attributed to the tendons out of the slot, areas to which the bone staggered joint. So-called "bone staggered joint is normal phalangeal joint clearance or relative position of subtle abnormal changes, and cause the joint activity limitation. Tendons tank "refers to the morphological structure of the tendons, the spatial location or functional status abnormalities, can the performance of coarse ribs, tendons, tendons walk, muscle contraction and other forms.In present, the conservative therapy is the main treatment method for thoracic facet joint disorders. Massage techniques can improve the local tissue blood circulation, relax tension muscles and promote the absorption of damaged tissue repair. It also can correct the anatomical location of the abnormal, adjust the vertebral body to the anatomical location, so as to reduce or eli分é'Ÿate the mechanical compression of the nerves and blood vessels. Acupuncture has the release and analgesic effect. It can produce a lot of neurobiology massages when stimulate the tissue. When the massages passed to the brain, it can not only regulation the tension muscular to relieve pain, but also increase the systemic stress ability and the immune modulator capacity, so that body through self-regulation to achieve pain relief purposes. In addition, acupuncture can also through the nerve regulation to promotion the pain caused material absorption and analgesic substances release, such as accelerated excretion of5-HT and HE the and release p, in order to relieve pain.Objectiveto observe the clinical effect and relieve pain to observe the clinical effect of acupuncture combined with massage manipulation in treating the thoracic facet joints disorder, and analysis the relation among of gender, age, therapeutic effect, provide clinical evidence for acupuncture and massage treat the thoracic facet joints disorder.Methods64cases, from nan fang hospital, were randomly divided into the treatment group and control group, each group are32cases. The treatment group were treated acupuncture combined with massage manipulation, the control group were treated simple massage manipulation as treatment group,2days1time,3times to be a period of treatment, total treatment6times, and in before and after treatment used McGill scale to evaluation.Result1. In this study, all patients finish completed clinical research.2. Baseline Compared:treatment group,22males and10females, age20-47years, mean32.16±7.18years, duration of1-24months, an average of7.97±5.54months; control group of18males,14females, aged21-47years old, average31.94±7.21years, duration of1-20months, an average of7.28±4.19months. The two groups of gender, age and disease duration were no significant differences (P>0.05).3. Clinical effect:After the treatment, the treatment group cure in7cases, better22cases, invalid in3, the total effective rate was90.4%and the control group cure in7cases, better20cases, invalid in5, the total effective rate was84.4%. Two groups by Mann-Whitney test, the difference has significant significance (P<0.05).4. Simplified McGill scale evaluation:Before the treatment, the PRI of the treatment group was8.78±4.61and the control group was10.13±4.88; the VAS of the treatment group was3.38±1.21and the control group was6±1.21; the PPI of the treatment group was2.06±0.72and the control group was2.53±0.76. After the treatment, PRI of the treatment group was1.50±0.98and the control group was1.69±0.69; the VAS of the treatment group was3.38±1.21and the control group was4.69±2.10; the PPI of the treatment group was0.91±0.47and the control group was1.13±0.34. Both groups patient after the treatment, the PRI, VAS and PPI were significantly lower (P<0.001), and the dropped degree have significant difference (P<0.05).5. Correlation:the efficacy of male and female patients no significant difference (Z=0.247, P=0.805). The longer the duration of efficacy in patients with the worse (rank correlation coefficient rs=-0.525, P<0.001), older patient outcomes is the worse (rs=-0.333, P=0.007). PPI, VAS, PRI decreased the degree has nothing to do with sex (P>0.05), but there are significant negative correlation (with age and duration of age-correlation coefficient rs=-0.259, P=0.039, duration of the correlation coefficient rs=-0.418, P<0.001), older patients with longer duration of the PPI after treatment, the VAS, the PRI decreased less, but the correlation is not very close.6. Safety:There were no adverse reactions.Conclusion1. Acupuncture combined with massage manipulation can relief pain and improved the clinical symptoms of thoracic facet joint disorders; it is sgnificant difference than massage manipulation.2Clinical efficacy and pain relieve has relationship with patient’s age and disease progression but not matter with the patient’s gender. |
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