中药热敷配合推拿牵引对腰椎间盘突出症患者血液流变学的影响

Effect of the treatment of Chinese medicine heated adhesion together with manipulation and traction on the hemorheology in patients with prolapse of lumbar intervertebral disc

目的:观察中药热敷配合推拿牵引对腰椎间盘突出症患者血液流变学的影响。方法:①选择2003-11/2005-05广西医科大学第四附属医院骨科收治的腰椎间盘突出症患者120例,男76例,女44例。均对实验目的知情同意。120例患者被随机分为2组:观察组和对照组,各60例。正常人血液流变学参考值,由华西医科大学应用自动清洗旋转式黏度计检测1万余正常人统计得出。②对照组:采用自动牵引床进行单纯牵引治疗,重量为体质量的25%～100%,每次牵引时间30min,1次/d,6次为1个疗程。观察组:在给予与对照组相同的牵引治疗法基础上增加中药热敷(处方为生川乌、生草乌、花椒、洋金花各20g,伸筋草、透骨草、当归、红花各30g,延胡索、川芎、土鳖王、乳香、没药、威灵仙、刘寄奴、麻黄、细辛各15g,补骨脂、骨碎补各10g。将蒸热的布袋放置于其腰骶部热敷,冷却后交替更换布袋,30min/次,1次/d,6次为1个疗程)配合推拿治疗(每次治疗40min左右,6d为1个疗程)。治疗2个疗程,每疗程间隔3d。③治疗前后采用自动清洗旋转式黏度计测定全血高切黏度、全血低切黏度、血浆黏度、红细胞聚集指数、红细胞刚性指数;采用Wintrobe管测定红细胞压积;采用Clauss法测定纤维蛋白原。④样本均数采用t检验,计数资料采用χ2检验。结果:腰椎间盘突出症患者120例均进入结果分析。①治疗前观察组和对照组的全血高切黏度、全血低切黏度、血浆黏度、红细胞聚集指数、红细胞刚性指数、纤维蛋白原明显高于正常参考值(P<0.05),红细胞压积与正常人参考值比较,差异不明显(P>0.05)。观察组与对照组血液流变学指标差异不明显(P>0.05)。②治疗后对照组仅有全血黏度低切变率、纤维蛋白原明显低于治疗前(P<0.05),而全血黏度高切变率、血浆黏度、红细胞聚集指数、红细胞刚性指数、红细胞压积与治疗前相比无显著性差异(P>0.05)。观察组全血黏度高切变率、全血黏度低切变率、血浆黏度、纤维蛋白原、红细胞聚集指数明显低于治疗前(P<0.05),红细胞压积和红细胞刚性指数与治疗前比较,差异不明显(P>0.05)。结论:中药热敷配合推拿牵引对腰椎间盘突出症患者的血液流变学、血液动力学以及微循环均有一定的调整作用,且效果好于单纯牵引治疗。

AIM： To observe the effects of the treatment of Chinese medicine heated adhesion together with manipulation and traction on the hemorheology in patients with prolapse of lumbar intervertebral disc （PLID）. METHODS： （1） Totally 120 patients （76 males and 44 females） with PILD who were cured in the Department of Orthopedics of the Fourth Hospital of Guangxi Medical College from November 2003 to May 2005 were randomly divided into experimental group and control group with 60 patients in each group. They were told the purpose of experiment and consent. Normal value in hemorheolegy could be got from Huaxi Medical College who used the automatic cleaning rotation viscosity meter to determine more than 10 000 persons. （2） Controls group： Lumbar intervertebral disc hernias was treated only by the automatic traction bed, and weight accounted for 25%- 100% of body＇s mass, 30 minutes one time, one time per day, six times for a period. Experimental group： Patients received the same therapy as control group, while combining that with Chinese medicine heated adhesion and manipulation （prescription as follows： shengchuanwu, shengcaowu, huajioo and yangjinhua with 20 g of each; shenjincao, tougucoo, dangkui and honghua with 30 g of each; yanhusuo, chuanxiong, tubiewang, ruxiang, moyao, weilingxian, liujinu, mahuang, and xixin with 15 g of each; buguzhi and gusuibu with 10 g of each. the hot cloth hag with the above mentioned medicine was placed on patient＇s lumbar spine bottom, and the cool cloth bag with another one hot was replaced, 30 minutes one time, one time per day, six times for a period. The time of treatment was about 40 minutes, six days for a period. （3） The tallcut viscosity and the lowcut viscosity of whole blood, plasma viscosity, aggregation exponent, rigidity exponent of patients in this group were measured by the viscosity meter before and after treatment. Wintrobe tube was used to determined blood corpuscle and Clauss method was used to determine fihrinogen. （4） Sample average and count data were handle by t test and X^2 test, respectively. RESULTS： Totally 120 PILD patients entered the final analysis. （1） Before treatment, the talleut viscosity and the loweut viscosity of whole blood, plasma viscosity, aggregation exponent, rigidity exponent and fihrinogen of patients in the two groups were obvious higher than those of normal value （P〈0.05）. As compared with normal value, the differences of pressure of erythrocyte were not significant （P〉0.05）. The differences in the hemorheology items were not very significant between the experimental and the control before treatment （P〉0.05）. （2） After receiving treatment, only lowcut rate of blood viscosity and fihrinogen in the control group were obvious lower than those before treatment （P〈0.05）; however, other values were not significantly different （P〉0.05）： Values of tallcut viscosity and the lowcut viscosity of whole blood, plasma viscosity, fibrinogen and aggregation exponent in the experimental group were significantly lower than those before treatment （P 〈 0.05）, but values of pressure of erythrocyte and rigidity exponent were not significantly different as compared those before treatment （P 〉 0.05）. CONCLUSION： Traditional Chinese medicine heated adhesion in combination with manipulation and traction has some adjusted action to hemorheology, blood motion and mierocirculation in patients with PILD, and the effective is much better than only by traction.