手法治疗相反型腰椎间盘突出症患者20例

Manipulation for contrary lumbar intervertebral disc protrusion in 20 cases

目的:观察相反型腰椎间盘突出症患者经冯氏手法复位后的治疗结果。方法:选择1993-11/2005-04在解放军空军总医院正骨科就诊,经临床及影像学确诊的腰椎间盘突出症患者75例,按腰椎间盘突出方向与下肢症状的关系分为2组,即相反型组20例,普通型组55例,两组患者均知情同意。相反型组患者下肢症状与腰椎间盘突出方向相反,普通型组患者下肢症状与腰椎间盘突出方向相同。①用手法触诊检查确定腰椎棘突偏歪方向。②X射线腰椎正侧位片及CT或MRI检查。③应用冯氏手法对两组患者进行复位治疗,手法复位每3～5d进行1次,10次为1个疗程,1个疗程后即可进行疗效评定,这期间可配合腰部理疗。手法复位后3d内禁止患者作腰部的旋转动作,以保证复位椎体周围软组织的修复。疗效评定标准:①显效:症状大部分消失,直腿抬高试验超过70°,可恢复原工作。②好转:症状部分消失,直腿抬高较治疗前显著改善,可担任较轻工作。有效率=(显效例数+好转例数)/总例数。结果:75例患者全部进入结果分析,无脱落。①相反型组患者的腰椎影像学变化:棘突偏歪和腰椎间盘突出方向相反。②两组患者治疗1个疗程后的疗效比较:相反型组有效率为95%,普通型组有效率为98.2%,两组相比差异无显著性意义(P>0.05)。结论:冯氏手法是治疗相反型腰椎间盘突出症的有效方法之一,与同侧腰椎间盘突出导致下肢症状患者经冯氏手法治疗的结果无明显差异。

AIM： To studv the curative effect on the patients with the contrary, lumbar intervertebral disc protrusion （LIDP） treated by Feng＇s spinal manipulation （FSM）, METHODS： Totally 75 cases, who were diagnosed as LIDP in clinic and by imaging examination, were enrolled from Department of Manipulative Orthopaedics, Airforce General Hospital of Chinese PLA between November 1993 and April 2005, According to the direction of LIDP with symptoms in legs, all the participants were divided into contrary group （n=20） and common group （n=55）, with informed consents,①The deviation direction of spinous process of lumbar vertebra was confirmed by manipulative palpation, ②The examination of X-ray in the right and lateral view of lumbar spine and CT or MRl were performed, ③FSM treatment were applied for all the patients, once every 3-5 days and 10 times for a course, then the effects of the two groups were evaluated respectively, Physiotherapy was feasible during the course of disease, but the patients were forbidden to rotate within 3-day after FSM, in order to repair the soft tissue around the vertebral body, Standard of curative effect：①Excellent： Most of symptoms disappeared at over 70° angle of straightleg raising test, and the patients could regain the work.②Improved： Part of symptoms disappeared and straightleg raising test result showed the significant improvement, Patients after treatment could do slight work, Effective rate=（case number of excellent effect＋case number of improved effect）/total number of cases, RESULTS： All 75 cases were involved in the result analysis without drop. ①The imaging change of patients in contrary group： The direction of deviated lumbar spinous process was opposite to that of LIDP. ②After one course of disease, the effective rate was 95% for contrary type patients and 98.2% for common type patients. There was no significant difference of curative rate between the patients of two groups （P 〉 0.05）. CONCLUSION： FSM is effective for treating the symptoms of patients with contrary LIDP, and the effect is identical with that of manipulation for homonymy LIDP.