1.山东省立第三医院,山东省济南市无影山中路11号,250031
2.中国中医科学院针灸研究所
baitianyu19820217@163.com
收稿:2021-12-02,
修回:2022-02-27,
纸质出版:2022-05-17
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白田雨,李伟正,沈春子等.基于CT三维重建的深刺女性次髎、中髎穴针刺参数研究[J].中医杂志,2022,63(10):951-955.
BAI Tianyu,LI Weizheng,SHEN Chunzi,et al.Deep Needling Parameters of Ciliao(BL32) and Zhongliao(BL33) in Female based on Computerized Tomography-based Three-dimensinal Reconstruction[J].Journal of Traditional Chinese Medicine,2022,63(10):951-955.
白田雨,李伟正,沈春子等.基于CT三维重建的深刺女性次髎、中髎穴针刺参数研究[J].中医杂志,2022,63(10):951-955. DOI: 10.13288/j.11-2166/r.2022.10.011.
BAI Tianyu,LI Weizheng,SHEN Chunzi,et al.Deep Needling Parameters of Ciliao(BL32) and Zhongliao(BL33) in Female based on Computerized Tomography-based Three-dimensinal Reconstruction[J].Journal of Traditional Chinese Medicine,2022,63(10):951-955. DOI: 10.13288/j.11-2166/r.2022.10.011.
目的
2
基于CT三维重建方法探索深刺女性次髎、中髎穴的进针参数,为两穴的临床准确应用提供参考。
方法
2
招募20例女性志愿者,在针刺双侧次髎、中髎并确认针体均进入骶后孔后,进行盆腔CT扫描,建立3D图像,对针灸针的针体与骶骨平面皮肤的角度、进入皮肤的深度、与后正中线的距离、至L5棘突下的距离、与矢状面的角度进行测量,并与体表测量所得的相应数据进行比较。
结果
2
CT下测量的左右侧次髎针体与骶骨平面皮肤的角度分别为(71.42±9.06)°、(72.62±9.26)°,左右侧中髎角度分别为(71.31±8.21)°、(71.19±9.02)°,左右侧次髎针体进入皮肤的深度分别为(72.02±8.44)mm、(72.26±7.45)mm,左右侧中髎深度分别为(73.10±6.74)mm、(74.69±0.43)mm,左右侧次髎针尖均朝向后正中线方向与矢状面所成角度分别为(6.25±3.02)°、(6.51±3.75)°,左右侧中髎角度分别为(4.67±3.40)°、(5.21±5.34)°,与体表测量数据比较差异均无统计学意义(
P
>0.05)。CT测量双侧次髎、中髎针体至后正中线的距离分别为(19.89±1.03)mm、(18.30±1.34)mm,显著小于体表测量结果(
P
<0.05)。CT测量左右次髎至L5棘突下的距离分别为(56.35±3.34)mm、(56.11±3.23)mm,左右中髎距离分别为(75.63±5.45)mm、(75.13±5.71)mm,均显著大于体表测量结果(
P
<0.05)。深刺除出现3例后遗针感外,未出现其他不适。
结论
2
CT下测量与体表测量的女性次髎、中髎穴针刺参数部分数据存在差别,在取穴确定进针点时,次髎、中髎应在触摸到骶后孔的基础上略向上、向外确定进针点,针尖向下与骶骨平面皮肤成角约70°,针尖朝向后正中线方向与矢状面所成角度约5°,此种取穴、进针法比较容易深刺进入骶后孔,且一般不会出现明显不适。
Objective
2
To explore the deep needling parameters of Ciliao (BL32) and Zhongliao (BL33) in female through computerized tomography-based three-dimensional reconstruction, thereby providing references for further clinical practice.
Methods
2
Twenty female volunteers were given acupuncture at bilateral Ciliao and Zhongliao
,
and pelvic CT scanning was performed to obtain 3D images after the body of needles reached the posterior sacral foramen. The angle between the needle body and the sacrum plane, the needling depth, the distance from the posterior midline, the distance to the infraspecific L5, and the angle to the sagittal plane were measured, and were compared with the corresponding data obtained from the body surface measurement.
Results
2
The CT results showed that the needling angles of left and right Ciliao to the sacrum plane was 71.42°±9.06°, 72.62°±9.26°,and the needling angles of left and right Zhongliao was 71.31°±8.21°, and 71.19°±9.02°, respectively. The corresponding needling depth of the left Ciliao
right Ciliao
left Zhongliao
right Zhongliao was (72.02±8.44) mm, (72.26±7.45) mm, (73.10±6.74) mm, and (74.69±0.43) mm, respectively. The needle tips all point to the posterior midline, and the angle formed with the sagittal plane of the left Ciliao
right Ciliao
left Zhongliao
right Zhongliao was 6.25°±3.02°, 6.51°±3.75°, 4.67°±3.40°, and 5.21°±5.34°, respectively. All CT results mentioned above were not significantly different with body surface measurement data (
P
>0.05). The distances from the posterior midline to the needle body of bilateral Ciliao and Zhongliao were (19.89±1.03) mm and (18.30±1.34) mm, respectively, which were significantly shorter than the results of body surface measurement (
P
<0.05). The distances from the of the left Ciliao
right Ciliao
left Zhongliao
right Zhongliao to the infraspecific L5 were (56.35±3.34) mm, (56.11±3.23) mm, (75.63±5.45) mm, and (75.13±5.71) mm, respectively, which were significantly longer than the body surface measurement results (
P
<0.05). Except for three cases of residual needle sensation after deep needling, there was no other reported discomfort.
Conclusion
2
There are differences in certain needing parameters at Ciliao and Zhongliao in female between CT and body surface measurement. On the basis of touching the posterior sacral foramina, the needles at Ciliao and Zhongliao
should be inserted till the posterior sacral foramen and then slightly upward and outward. The needle tip should be downward with an angle of 70°with the sacrum plane, and points toward the posterior midline with an angle of 5°with sagittal plane. In this method of acupoint selection and needling, it is easier to deeply pierce the posterior sacral foramina, generally with no obvious discomfort.
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