下腰痛的中西医结合治疗

Combined therapy of traditional Chinese medicine and western medicine for low back pain

目的:下腰痛因其病因复杂,治疗方法虽多,但并无特效方法,且有治疗显效慢、易复发的特点。归纳有关下腰痛临床治疗方法,进行综合分析。资料来源:应用计算机检索万方数据库2001-06/2006-07有关下腰痛临床治疗方面的文献,检索词“下腰痛,临床治疗”,并限定文章语言种类为中文。同时应用计算机检索Ovid2001-06/2006-07有关下腰痛临床治疗方面的文献,检索词“lowbackpain,clinicaltherapy”,并限定文章语言种类为English。资料选择:对检索到的有关下腰痛临床治疗方面的有关信息进行整理,选择针对性强的文章。临床试验研究选择采用随机、对照的文章,观察对比研究选择前瞻性的,综述则选择系统综述。同一领域的文献则选择近期发表或权威杂志的文章。排除重复研究、经验总结和个案报告。资料提炼:共检索到82篇相关文章,其中20篇文章符合要求,排除62篇,其中15篇临床试验研究未采用随机对照的原则,2篇观察对比性研究为回顾性的,10篇综述非系统综述,25篇系重复相同研究,7篇系经验总结,3篇系个案报告。资料综合:目前下腰痛的临床治疗方法主要包括以下几种:①康复治疗:包括卧床休息、腰椎牵引、物理治疗,是治疗下腰痛安全有效的方法。②药物治疗:非甾体类抗炎药、阿片类药物、肌松剂、抗抑郁药、补钙药物或雌激素、肿瘤坏死因子抑制剂可减轻疼痛、改善临床症状。③神经阻滞疗法:冷冻治疗和无水酒精化学性毁损腰脊神经后支源性下腰痛可达长期止痛的效果。④手术治疗:目前在下腰痛的众多术式中,椎间融合治疗是治疗椎间盘源性下腰痛的首选术式。⑤微创治疗:椎间盘内电热疗法和髓核成形术疗效可靠。⑥中医治疗:包括针灸、推拿治疗。针刺治疗下腰痛效果良好。推拿为治疗非特异性下腰痛的首选方法。⑦其他疗法:腰背痛学校是治疗下腰痛最有效方法之一。小针刀治疗慢性下腰痛远期疗效稳定。针压疗法也有效。结论:目前康复治疗和手术治疗是治疗下腰痛的主要方法。同时,一些微创治疗如椎间盘内电热疗法、髓核成形术等已运用于治疗,但应用仍有限。现在依然缺乏特效方法,有待进一步研究。

OBJECTIVE： Because of complicated etiological factors, low back pain （LBP） has no effective therapeutic method, although there are many therapeutic methods. It is characteristics of slow effect and easy to recurring. To summarize the clinical therapeutic methods of LBP and analyzed comprehensively. DATA SOURCES：A computer-based search was performed in Wanfang database to search the relevant literatures published between June 2001 and July 2006 in Chinese about the clinical therapy of LBP with the key words of＂low back pain, clinical therapy＂. Meanwhile, the English literatares of same aspect published in Ovid published from June 2001 to July 21306 were also retrieved with the same key words, STUDY SELECTION： After arrangement, the literatures aimed directly at the clinical therapy of LBP were selected. The randomized, controlled clinical trials were selected, prospective studies selected and system review selected. Of the same field, we chose the articles published recently or on the authority journals. Same study, experience summarization and case repert were excluded, DATA EXTRACTION： A total of 82 pertinent literatures were collected and 20 ones were accorded with inclusive criteria. Sixty-two articles were excluded, including 15 of clinical trial without randomized and controlled principle, 2 of retrospective study, 10 of review, 25 of same study, 7 of experience summarization and 3 of case report. DATA SYNTHESIS： At present, the clinical therapy of LBP included：①rehabilitative therapy included bed rest, traction, physical therapy. It was a safe and effective method of treating LBP. ②medications ：nonsteroidal anti-inflammatory drugs, opioids, muscle relaxants, antidepressant, calcium extender or estrogen, tumor necrosis factor （TNF） inhibition could reduce pain and improve clinical assessment.③nerve blocking： crotherapy and the treatment of dehydrated alcohol could achieve the effect of analgesia for long time by blocking dorsal ramus of spinal never for low back pain. ④surgery： Interbody fusion was the first choice for lumber discogenic pain in all kinds of surgery.⑤microinvasive therapy： The effect of intradiscal electrothermal treatment and neucleoplasty was reliable. ⑥tradition Chinese medical treatment included acupuncture and spinal manipulation. Acupuncture was effective for LBP. Spinal manipulation was the first choice for nonspecific LBP. ⑦others： Back school was one of the most effective methods of treating LBP. Long-term effect of small needle scaple therapy for chronic LBP was stable. Acupressure was also effective. CONCLUSION： Currently, rehabilitation and surgery are the main methods for LBP. At the same time, some microinvasive therapy such as intradiscal electrothermal treatment, neucleoplasty are in use, but still limited. Moreover, the specific therapies are in need of further study.