手法治疗腰椎间盘突出症疗效以及解除神经根受压的MRM分析

The curative effect to the lumbar disc herniation by manipulation treatment and the analyse of relieving nerve root compression by MRM

目的:观察腰椎间盘突出症患者治疗前后疗效及MRI、MRM变化,为手法治疗解除腰椎间盘突出症神经根受压提供客观的影像学依据,并进一步探讨手法治疗机制.方法:选取腰椎间盘突出症患者80例,其中男53例,女27例;年龄25～58岁,平均41岁.随机分为2组,手法治疗组40例,男27例,女13例,平均年龄40.5岁;药物治疗组40例,男26例,女14例,平均年龄41.5岁.两组间性别、年龄及所患病情均无统计学差异.分别进行手法及药物治疗,比较治疗前后疗效、MRI及MRM资料进行分析.结果:①手法治疗组疗效明显优于药物治疗组(P＜0.01).②两组患者治疗前后MRI突出髓核无明显变化.③MRM显示手法治疗组与药物治疗组患者神经根鞘袖的改变差异有显著性意义(P＜0.01),手法治愈患者神经根鞘袖外观由明显受压恢复到基本正常.结论:MRM为手法治疗彻底解除神经根受压提供了客观的影像学依据.手法治疗前后MRI未见突出髓核还纳,应从手法治疗改变脊柱、椎间盘、突出髓核生物力学特性出发,进一步研究其获效机制.

Objective： To provide objective medical radiology proof that manipulation treatment can remove the nerve root compression by comparing the change of image on MRM and MRI before and after therapy,and explore on the mechanism of manipulation treatment for the lumbar disc herniation. Methods：Eighty cases of lumbar disc herniation, including 53 male and 27 female, ranging in age 25-58 years with an average of 41 years, were divided into a manipulation treatment group and a medication group. There were not statistical difference in sex, age and state of illness between two groups. The outcome and the images of MRI and MRM before and after treatment were compared and analysed. Results： ①The therapeutic effect of the manipulation treatment group was signifcently better than that of medication group（P 〈 0.01 ）. ②There was no significant changes in the size of herniated nucleus pulposus before and after treatment in MRI scanning. There was significant difference in the change of the nerve root vagina between two groups in MRM（ P 〈 0.01）. The appearance of the nerve root vagina in patients successfllky cured by manipulation treatment return to normal status from obvious compressed status. Conclusion： MRM can provide the objective basis in using manipulation treatment to eliminate the nerve root compression. No reposition was found in the herniated nucleus pulposus. The mechanism for the curative effect of manipulation treatment needs to be further studied according to the biomechanics character of spine, intervertebral disc and herniated nucleus pulposus.