三维正脊疗法联合银质针导热疗法对腰椎间盘突出症的干预效果

Interventional effects of three dimensional rectification apparatus and silver needle heat conductive treatment for lumbar disc herniation

目的:探讨三维正脊疗法与银质针导热疗法治疗腰间盘突出症的互补作用及机制。方法:于2002-02/2005-08选择解放军总医院康复医学科诊治的均由CT扫描或MRI检查确诊的腰椎间盘突出症患者240例。随机数字表法分成3组:三维正脊组,银质针导热组,三维正脊及银质针导热联合组,每组80例。三维正脊组采用三维正脊疗法,对间盘突出节段施行该疗法,1次/周,共做2次;银质针导热组采用银质针导热疗法对腰部和臀部软组织病变部位施行银质针导热疗法,1次/周,共2次;三维正脊及银质针导热联合组先后采用三维正脊疗法和银质针导热疗法,各2次。比较各组患者治疗前、治疗后3个月和6个月疼痛数字评分及治疗后1个月的临床体征改善情况及疗效结果。疗效评定标准:①痊愈。腰腿疼痛消失,临床体征均转为阴性,可恢复工作。②有效。腰腿疼痛基本消失,临床体征两三项转为阴性,可作轻微工作。③好转。腰腿疼痛减轻,临床体征有1项转为阴性,尚需继续治疗。④无效。治疗前后疼痛与体征无变化。结果:所有患者均完成治疗和指标评定,全部进入结果分析。①治疗后3个月三维正脊组、银质针导热组、三维正脊及银质针导热联合组疼痛数字评分值与治疗前相比均有降低,而三维正脊及银质针导热联合组更为明显(χ2=2.51,P<0.01)。治疗后6个月,各组病例的疼痛症状大多数获得控制,以三维正脊及银质针导热联合组更为明显(χ2=4.03,P<0.01)。其中银质针导热组和三维正脊组、三维正脊及银质针导热联合组与银质针导热组相比差异均有显著性意义(χ2=8.288.03,P<0.05)。②治疗后1个月各组临床体征均较治疗前明显改善,尤其是直腿抬高试验阳性率,治疗1个月后三维正脊及银质针导热联合组与银质针导热组,三维正脊及银质针导热联合组与三维正脊组相比差异均有非常显著性意义(χ2=9.26,9.03,P<0.01),而银质针导热组与三维正脊组相比差异无显著性意义(χ2=11.50,P>0.05)。③银质针导热组、三维正脊组和三维正脊及银质针导热联合组的有效率(痊愈及有效)分别为71%、72%和85%,三维正脊及银质针导热联合组与银质针导热组、三维正脊及银质针导热联合组与三维正脊组相比差异有非常显著性意义(χ2=6.30,6.12,P<0.01)。结论:三维正脊疗法具有解除肌肉痉挛,松解神经根粘连;银质针导热疗法则有消除椎管内外软组织无菌性炎症、改善血液供应和松解肌肉的作用。两种疗法治疗腰间盘突出症具有互补性。

AIM： To explore the complementary action and mechanism of three dimensional rectification and silver needle heat conductive treatment for lumbar disc herniation （LDH）. METHODS： Totally 240 LDH patients diagnosed with CT scanning or MRI examination were selected from the Department of Rehabilitation Medicine, Chinese PLA General Hospital between February 2002 and August 2005, They were randomly divided into three groups with 80 patients in each group. Group A： Three dimension.al rectification apparatus treatment was performed to the segment of the intervertebral disc herniation, once per week totally for 2 times. Group B： Silver needle heat conductivetreatment was conducted to patient＇s waist and buttocks, once per week totally for 2 times. Group C： Three dimensional rectification apparatus treatment and silver needle heat conductive treatment were successively done, each for 2 times, The numeric rating scale （NRS） score and improvements of clinical signs as well as curative effects were compared in three groups before treatment and 1-6 months after treatment. Evaluation standards of curative effect： ①Recovery： The pain in waist and legs were extinctive, and the clinical signs all turned to be negative, The patients could recover to their works, ②Effective： The pain in waist and legs fundamentally disappeared, and 2-3 items of clinical signs turned to be negative, The patients could make some mild works, ③Improved： The pain in waist and legs relieved, and only one clinical sign turned to be negative. The patients still needed further treatment.④Ineffective： There was no change in the pain and sign before and after treatment. RESULTS： All the patients accomplished the treatment and index assessment, thus entered the result analysis, ①The NRS scores decreased in three groups after 3-month treatment, especially in group C （x^2=2.51, P 〈 0.01）, And most of the painful symptoms were controlled after 6-month treatment, obviously in group C （X^2=4.03, P 〈 0.01）. There were significant differences between group A and group B, and between group B and group C （X^2=8.28, 8.03, P 〈 0.05）. ②After one-month treatment, the clinical signs of three groups were all improved notably, especially the positive rate of straight-leg raising test. The difference was quite significant between group C and group B, and between group C and group A （X^2=9.26, 9.03, P 〈 0.01）, whereas insignificant between group A and group B （X^2=11.50, P 〉 0.05）. ③The percentage of validity （fully recovery or effective） was 72% in group A, 71% in group B and 85% in group C. Moreover, there were also quite significant differences between group A and group C, and between group C and group B （X^2=6.30, 6.12, P 〈 0.01）. CONCLUSION： Three dimensional rectification apparatus treatment is effective for relieving the muscle spasm and relaxing the nerve root adhesion, while silver needle heat conductive treatment has effects on eliminating the aseptic inflammation of the soft tissues in or out of vertebral canal, improving the blood supply and relaxing the muscles. So the two therapies are complementary for treating LDH patients.