整骨理筋疗法治疗腰椎间盘突出症致放射痛的疗效评估

Evaluation of the curative effect of "Zhenggu Lijin" treatment for radiating pain induced by lumbar intervertebral disc protrusion

目的:观察整骨理筋疗法对腰椎间盘突出症致放射痛的改善情况。方法:①选择2003-05/2005-05解放军总医院康复医学科门诊及病房诊治的腰椎间盘突出症患者80例作为整骨理筋治疗组,另以25例同类患者作为空白对照组。两组男女比例、年龄差异无显著性意义。②整骨理筋治疗组接受整骨理筋治疗。医者先按顺序在患者患侧T7的上下关节突处、T12的上下关节突处、患侧腰椎间盘突出阶段的上下关节突处、下肢臀部相当于环跳穴的位置、窝部位、小腿腓肠肌中点处做静止按压动作,每点按压时间30s,反复3遍(在每做完1遍后,医者一手拇指按压住窝,另一手握住患侧踝部,作小腿屈曲的动作)。然后医者用两手大鱼际部位,按压在患者腰椎间盘突出部位准备好,嘱患者做先深呼吸后咳嗽的动作,在患者咳嗽的同时,医者双手大鱼际同时向前下方用力推压反复2遍,最后压住患者患侧的腰椎间盘突出部位做牵搬手法1次,手法完毕,2次/周,6次为1个疗程。空白对照组不行整骨理筋治疗。③整骨理筋治疗后3,12个月对两组患者进行随访。治疗前及治疗后3,12个月采用目测类比评分法对两组患者进行腰椎间盘突出症放射痛评分及患者自觉症状改善率评分。结果:按实际处理分析,整骨理筋治疗组80例患者于治疗后3,12个月随访时各有69例和56例进入结果分析。空白对照组25例全部进入结果分析。①治疗前后两组放射痛评分及患者自觉症状改善率情况:治疗前两组放射痛评分基本相似(P>0.05)。治疗后3个月,整骨理筋治疗组放射痛评分明显降低[(6.5±0.8),(3.4±0.2)分,t=56.3,P<0.001],而空白对照组无明显变化[(6.9±0.7),(6.7±0.6)分,P>0.05]。此外,治疗后3个月整骨理筋治疗组症状改善率明显高于空白对照组[(47.1±0.88),(0.26±0.05)%,P<0.001]。②整骨理筋治疗组治疗前后放射痛评分及患者自觉症状改善率情况:治疗后12个月放射痛评分明显低于治疗前[(3.6±0.6),(6.5±0.8)分,t=49.1,P<0.001],与治疗后3个月基本相似(P>0.05)。此外,治疗后12个月症状改善率达(39.1±0.48)%,明显高于治疗前水平(t=50.9,P<0.001)。结论:整骨理筋疗法能解除肌挛缩、消除放射痛,从而改善患者疼痛和不适症状,效果明显。

AIM： To observe the effect of relief using ＂Zhenggu Lijin＂ treatment for radiating pain due to lumbar intervertebrat disc protrusion. METHODS： ①Totally 80 patients with lumbar intervertebral disc protrusion who were treated in the outpatient and ward of Department of Rehabilitation Medicine, General Hospital of Chinese PLA between May 2003 and May 2005, were enrolled as ＂Zhenggu Lijin＂ treatment group. Another 25 patients with the same diseases as above were selected as the blank control group. There was no significant difference in proportion of males and females as well as age. ②The subjects in the ＂Zhenggu Lijin＂ treatment group received ＂Zhenggu Lijin＂ treatment. The physician pressed statically at T7 superior and inferior articular process, T,2 superior and inferior articular process of injured side, superior and inferior articular process of injured lumbar intervertebral disc protrusion, croup of lower limb （equal to the position of Huantiao point）, popliteal fossa as well as center of gastrocnemius muscle of leg in order, 30 s at each position, for 3 times （At the end of every time, one thumb of the physician pressed the popliteal fossa, another hand held ankle of injured side to do leg flexed action）. Then the physician pressed the position of lumbar intervertebral disc protrusion with henar eminence of hands and instructed the subjects having deep breath and eough. When the subjects coughed, the physician deeply pressed forwards twice with henar eminenee of hands. At last the physician pulled and moved when pressed the position of lumbar intervertebral disc protrusion of injured side once, and twice a week, 6 times as a course. The blank control group did not receive ＂＇Zhenggu Lijin＂ treatment. ③3 and 12 months after ＂Zhenggu Lijin＂ treatment, the subjects were followed up. The radiating pain and subjective improving rate were scored with visual analogue scale （VAS） in subjects with lumbar intervertebral disc protrusion of the two groups before treatment, 3 and 12 months ＇after treatment. RESULTS： According to intention-to-treat analysis, 69 and 56 subjects in the ＂Zhenggu Lijin＂ treatment group （n=80） when followed up at 3 and 12 months after treatment were involved in the result analysis, respectively, and 25 in the blank control group all entered the result analysis. ①The radiating pain score and subjective improving rate of the two groups before and ＂after treatment： Before treatment the radiating pain score were similar in the two groups （P 〉 0.05）. 3 months after treatment, radiating pain score markedly decreased in the ＂Zhenggu Lijin＂treatment group [（6.5 ±0.8）, （3.4±0.2）points,t=56.3,P 〈 0.001], while there was no significant change in the blank control group [（6.9±0.7）, （6.7±0.6） points,P 〉 0.05]. Besides, subjective improving rate was remarkably higher in the ＂Zhenggu Lijin＂ treatment group than that in the blank control group 3 months after treatment [（47.1±0.88 ）, （0.26±.05）%, P 〈 0.001 ]. ②The radiating pain score and subjective improving rate of the ＂Zhenggu Lijin＂ treatment group before and ＇after treatment： The radiating pain score at month 12 after treatment was obviously lower than that before treatment [（3.6±0.6）, （6.5 ±0.8）points,t=49.1 ,P 〈 0.001]. It was similar to that at month 3 after treatment （P 〉 0.05）. In addition, the subjective improving rate increased by （39.1±0.48）% at month 12 after treatment, which was dramatically higher than that before treatment （t=50.9,P 〈 0.001 ）. CONCLUSION： The ＂Zhenggu Lijin＂ treatment method can relief muscle contraction and eliminate radiating pain so as to improve patients＇ pain and discomfort symptom effectively.