應用低能量雷射於中西醫學的臨床治療研究

Abstract

近年來，低能量雷射治療已被普遍使用於中西醫學。在西醫方面，常使用低強度和長時間的雷射照射，產生生物刺激作用來治療損傷的組織，而中醫常將低能量雷射運用於雷射針灸。但是合適的治療方法和雷射參數仍不清楚，因此，本研究將探討低能量雷射對於治療肌肉骨骼系統疾病的效果，包括骨折、腕隧道症候群的西醫診斷的臨床雷射治療，分析中西醫對於外上髁肌腱炎的療效比較，及雷射針灸對於晝夜節律紊亂症的影響研究。 本論文研究中，招募9位閉鎖性骨折患者進行低能量雷射治療，經2週治療後，疼痛緩解及減少手部失能狀況皆有統計上顯著的差異(p < 0.05)。對於治療腕隧道症候群的研究，共招募36名患者進行2週治療研究，治療後雷射組較位雷射組有統計上的顯著減緩(p < 0.05)，追蹤後也發現在手部握力、功能及症狀皆有顯著差異(p < 0.05)。針對低能量雷射對於外上髁肌腱炎的療效則進行文獻回顧，發現文獻有7篇照射於壓痛點或激痛點，2篇照於針灸點及1篇兩種皆照射。進一步統合分析發現低能量雷射照射於壓痛點或激痛點，在治療及追蹤後具有中等和最大緩解疼痛的效益值。在雷射針灸的研究上，選擇45位年輕男性的夜間工作者，藉由雷射針灸內關穴，發現診灸前後及與對照組比較，在心律變異度的高頻、低頻及低高頻比值皆有統計上的顯著差異(p < 0.05)。 西醫的診斷及治療方面，對於低能量雷射治療閉鎖性骨折及腕隧道症候群是具有療效的，並且統合分析也發現，對於治療外上髁肌腱炎，照射於西醫診斷的壓痛點或激痛點，也具有較佳的治療效果。在中醫的雷射診灸治療方面，照射刺激內關穴，能增加迷走神經活性，抑制交感神經的活性，而達到調整自律神經功能平衡的效果。

In recent years, low-level laser therapy (LLLT) has been popular to be used in the rehabilitation medicine and Traditional Chinese Medicine. In the LLLT of western medicine, the biostimulation effect is used to treat injury tissues by its low irradiance and long term laser irradiance. In Traditional Chinese Medicine, laser acupuncture that combines LLLT with acupuncture is used. Nevertheless, suitable therapeutic methods and ideal parameters of LLLT are still unclear. In this dissertation, the therapeutic effects of LLLT for diseases of musculoskeletal system have been reviewed and investigated in western medicine or Traditional Chinese Medicine. In the first study of this dissertation, 9 subjects who had closed bone fracture without surgery were recruited. Pain scale, functional disability, and X-ray image were evaluated before and after treatment, as well as two-week follow-up. After two-week laser treatment, swelling and pain of the recruited the patients were reduced significantly. After treatment, LLLT could significantly reduce pain (p < 0.05) and decrease disability of involved hand (p < 0.05). In the second study, a low-level laser was placed directly above the transverse carpal ligament of the tested patients to examine the therapeutic effect of LLLT. Thirty-six patients with mild to moderate degree of CTS were randomly divided into two groups. The laser group received LLLT, on the other hand the placebo group received sham laser. Pain scale was significantly lower in the laser group than the placebo group after treatment and follow-up (p < 0.05). After two-week treatment, no significant differences were found in grip strengths, and symptoms and functional assessment (p > 0.05). However, there were statistically significant differences in these variables after follow-up (p < 0.05). The third study was to systematically review and meta-analyze the therapeutic effects of LLLT on lateral epicondylitis. Ten articles were searched to select, and in 7 of them the irradiation was conducted on tender points or myofascial trigger points (MTrPs). In other 2 articles, the irradiation was conducted on acupuncture points, and in the last one was conducted on both kinds. The results of meta-analysis revealed that applying LLLT on tender points or MTrPs would be able to improve the effect size of pain release after treatment and follow-up. The last experimental trial of the dissertation was according to Traditional Chinese Medicine to investigate the physiological influence of laser acupuncture. A low-level laser was placed on Neiguan point (PC6) to examine the impact of laser acupuncture on the autonomic nervous system. Forty-five healthy young males who were the night shift workers were recruited and evaluated their heart rate variability. After treatment and after 30-min rest, it showed that both groups exhibited statistically significant difference in high frequency (HF), low frequency (LF), and LF/HF ratio (p < 0.05). As compared with placebo group, it also showed that the laser group after laser treatment had statistically significant improvement (p < 0.05). The efficacy of LLLT had pain relief and beneficial result to treat the close bone fracture and carpal tunnel syndrome patients. Laser acupuncture stimulation applied to the Neiguan point (PC6) increased vagal activity and suppression of the cardiac sympathetic nerve. This dissertation was discovered that using LLLT on lateral epicondylitis in western medicine could effectively improve the therapeutic effects.