[1]范志鸿,张贤,周鑫,等.刘氏骨伤手法联合导引功法治疗腰椎间盘突出症临床应用专家推荐意见的调查研究[J].中医正骨,2023,35(11):44-47,52.
　FAN Zhihong,ZHANG Xian,ZHOU Xin,et al.A survey of expert recommendations for clinical application of Liu's orthopedic manipulation combined with Chinese Daoyin therapy in treatment of lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(11):44-47,52.
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刘氏骨伤手法联合导引功法治疗腰椎间盘突出症临床应用专家推荐意见的调查研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期数:
2023年11期
页码:
44-47,52
栏目:
调查研究
出版日期:
2023-11-20

文章信息/Info

Title:
A survey of expert recommendations for clinical application of Liu's orthopedic manipulation combined with Chinese Daoyin therapy in treatment of lumbar disc herniation
作者:
范志鸿1; 张贤1; 周鑫2; 李超1
1.无锡市中医医院,江苏 无锡 214000; 2.上海中医药大学附属岳阳中西医结合医院,上海 200437
Author(s):
FAN Zhihong1; ZHANG Xian1; ZHOU Xin2; LI Chao1
1.Wuxi Hospital of Traditional Chinese Medicine,Wuxi 214000,China 2.Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China
关键词:
椎间盘移位;  腰椎;  手法;  导引;  调查问卷;  德尔菲法
Keywords:
intervertebral disc displacement;  lumbar vertebrae;  manipulation;  daoyin;  surveys and questionnaires;  delphi method
摘要:
目的:确立刘氏骨伤手法联合导引功法治疗腰椎间盘突出症(lumbar disc herniation,LDH)的临床应用专家推荐意见。方法:结合文献和刘氏骨伤手法治疗LDH的临床经验,经小组讨论和专家咨询,构建刘氏骨伤手法联合导引功法治疗LDH的临床应用问题条目池,遴选中医骨伤、推拿、康复专业的相关专家,采用德尔菲法进行专家问卷调查。第1轮问卷调查完成后,根据专家意见修改或删除部分条目,形成下一轮专家调查问卷。每轮问卷调查周期均为1周。根据问卷调查的结果确立专家推荐意见。结果:构建的刘氏骨伤手法联合导引功法治疗LDH的临床应用问题条目池共有18条相关条目。共经2轮专家问卷调查。第1轮专家问卷调查共遴选出专家33位,发放问卷33份,回收有效问卷33份; 第2轮专家问卷调查共遴选出专家28位,发放问卷28份,回收有效问卷28份; 两轮问卷调查专家积极性均为100%,专家权威系数分别为0.91、0.96,专家权威性较高。两轮专家问卷调查,各条目的专家认同度均较高。第1轮问卷调查共删除专家意见不一致的导引功法相关条目3条,修改手法相关条目2条; 第2轮问卷调查共删除专家意见不一致的导引功法相关条目1条。调查结束后,共保留专家认同度较高、意见较一致的条目14条。结论:对于刘氏骨伤手法联合导引功法治疗LDH的临床应用,专家推荐LDH的手法治疗应强调“筋”的重要性,以“筋强则骨坚,筋顺则骨正”为指导,重理筋、微调骨; 手法操作应遵循“松解-整复”的顺序进行,松解类手法以“按、揉、点”为主,针对不同的病变节段整复手法应有所变化; 对于合并严重骨质疏松的LDH患者及巨大型LDH患者应慎用整复类手法; LDH急性期治疗以松解类手法为主,缓解期和恢复期宜选择手法结合导引功法治疗; 联合应用的导引功法动作有八段锦中的五劳七伤往后瞧、太极拳中的云手及五禽戏中的虎举和鹿奔。
Abstract:
Objective:To establish the expert recommendations for the clinical application of Liu's orthopedic manipulation combined with Chinese Daoyin therapy in treatment of lumbar disc herniation(LDH).Methods:According to the available articles and clinical experience of Liu's orthopedic manipulation in treating LDH,seminars and experts consultation were conducted to build a question pool for the clinical application of Liu's orthopedic manipulation combined with Chinese Daoyin therapy in treating LDH.The experts in traditional Chinese medicine orthopedics,Tuina and rehabilitation were selected,and a questionnaire survey was conducted among them by using the Delphi method.After the first round of questionnaire survey was finished,the questionnaire was modifed with some items adjusted or deleted based on expert opinions to form a new questionnaire for the next round of expert survey.Each round of questionnaire survey lasted for one week,and the expert recommendations were established based on the results of the questionnaire survey.Results:There were 18 items in the question pool for the clinical application of Liu's orthopedic manipulation combined with Chinese Daoyin therapy in treating LDH.Two rounds of expert questionnaire surveys were conducted.In the first round of expert questionnaire survey,33 experts were selected,and 33 questionnaires were handed out,all of which were returned and valid.In the second round of expert questionnaire survey,28 experts were selected,and 28 questionnaires were handed out,all of which were returned and valid.The experts showed the participation rates of 100% in both rounds of questionnaire surveys,with the expert authority coefficients of 0.91 and 0.96,respectively,which indicating a high level of expert authority.The experts presented high degrees of recognition for each item in the questionnaires in the two rounds of surveys.In the first round of expert questionnaire survey,3 items with inconsistent expert opinions on Chinese Daoyin therapy were deleted,and 2 items associated with manipulation were adjusted.In the second round of expert questionnaire survey,1 item with inconsistent expert opinions on Chinese Daoyin therapy was deleted.After the the end of surveys,14 items with high degrees of expert recognition and consistent opinions were retained.Conclusion:For the clinical application of Liu's orthopedic manipulation combined with Chinese Daoyin therapy in treatment of LDH,experts recommended that tendons should be emphasized in the orthopedic manipulation for treatment of LDH.According to the principle of strong tendons leading to firm bones and smooth tendons leading to bone alignment,the treatment should focus on regulating sinews and bones.The manipulation should follow the sequence of relaxation and restitution,with the former focusing on“pressing,kneading and acupoint pressing”and the latter varying according to different diseased segments.For the LDH patients with severe osteoporosis or giant LDH,caution should be exercised when using restitution manipulation.Furthermore,in treatment of LDH,relaxation manipulation is mainly adopted in the acute phase,and combination of manipulation with Chinese Daoyin therapy in the remission and recovery phases.The co-applied Chinese Daoyin therapy includes the steps of“turn your head back to treat five consumptions and seven damages”(五劳七伤往后瞧)in Baduanjin(八段锦),Yunshou(云手)in Tai Chi,and“raising the tiger's paws”(虎举)and“running like a deer”(鹿奔)in Wuqinxi(五禽戏).

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备注/Memo

备注/Memo:
基金项目:无锡市科技发展资金项目(Y20222009)
通讯作者:张贤 E-mail:zhangxian0772@sina.com
更新日期/Last Update: 1900-01-01