不同牵引节奏对快速牵引治疗腰椎间盘突出症的影响

Effect of traction rhythms on prominence of lumbar intervertebral disc

目的:不同牵引节奏对腰椎间盘突出症的治疗效果是否可以产生影响?分组比较其效果,以探索疗效更好、不良反应更少的牵引方法。方法:①对象:选择2005-10/2006-04山东省立医院门诊和病房以及济南华飞骨伤医院病房收治的腰椎间盘突出症患者220例,男116例,女104例;年龄(17～68)岁;病程1d～3年。②分组:按随机数字表法将患者分为一维牵引慢牵快放组60例,一维牵引快牵慢放组60例,三维牵引慢牵快放组50例,三维牵引快牵慢放组50例。各组性别、年龄、病程均衡。③干预:各组患者在普通治疗的基础上施以不同牵引节奏的牵引治疗。一维牵引慢牵快放组和快牵慢放组:应用山东省医疗器械研究所生产的WQL-307型牵引床,牵放时间分别为3～5s/0.5s,0.2s/1s;三维牵引慢牵快放组和快牵慢放组:应用济南市华飞产业有限公司生产的C型电脑三维牵引床,牵放时间分别为3～5s/0.5s,0.2s/1s;各组牵引距离为40～60mm,均牵引一两次,间隔不少于5d。④评估:观察各组患者临床疗效及治疗前后日本骨科学会(JOA)总评分变化。结果:220例患者全部进入结果分析。①临床疗效:一维慢牵快放牵引组的总有效率优于一维快牵慢放牵引组(91.67%,78.33%,P<0.05);三维慢牵快放牵引组的总有效率优于三维快牵慢放牵引组(96.00%,80.00%,P<0.05)。②治疗前后JOA总评分比较:一维慢牵快放牵引组前后差值与一维快牵慢放牵引组前后差值比较,差异有显著性(8.50±3.89,6.02±2.61,P<0.05),三维慢牵快放牵引组前后差值与三维快牵慢放牵引组前后差值比较,差异有显著性(9.14±4.09,6.78±2.45,P<0.05)。结论:无论是一维牵引慢牵快放还是三维牵引慢牵快放的疗效都优于传统的快牵慢放牵引法。慢牵快放牵引法能使手法的颤压力更有效地传递到突出物上,在安全前提下可牵引距离更大,相应椎间隙加大,后纵韧带牵张力增加,更有利于突出物变位还纳。

AIM：To explore the traction which has the better therapeutic effect and fewer side effects on the prominence of lumbar intervertebral disc （PLID） by different traction rhythms. METHODS： ①A total of 220 PLID cases aged 17-68 years were recruited from Shandong Provincial Hospital and Jinan Huafei Hospital of Trauma and Orthopaedics between October 2005 and April 2006, including 116 males and 104 females. Their history of disease arranged from 1 day to 3 years.②The patients were divided into four groups randomly： one-dimension ＂slow pull and rapid release＂ group （n =60）, one-dimension ＂rapid pull and slow release＂ group （n =60）, three-dimension ＂slow pull and rapid release＂ group （n =50）, three-dimension ＂rapid pull and slow release＂ group （n =50）. Four groups were matched well in gender, age and history of disease. ③All the patients accepted traction treatment by different traction rhythms based on common treatment. One dimension groups used WQL-307 traction table produced by Shangdong Institute of Medical Equipment; Three-dimension groups used C type computerized three-dimension traction table produced by Jinan Huafei Industrial Co., Ltd. The treatment time was 3-5 s/0.5 s and 0.2 s/1 s respectively, with the interval of no more than 5 days. Traction distance was 40-60 mm. ④The clinical effect of the patients and Japanese Orthopaedic Association （JOA） score changes were observed. RESULTS： All of 220 patients were involved in the result analysis. ①Clinical effect： The total effective rate of one-dimension ＂slow pull and rapid release＂ group was higher than that of one-dimension ＂rapid pull and slow release＂ group （91.67%, 78.33%, P 〈 0.05）. Three-dimension ＂slow pull and rapid release＂ was also better than three-dimension ＂rapid pull and slow release＂ （96.00%, 80.00%, P 〈 0.05）.②JOA score： There were significant differences in ＂slow pull and rapid release＂ group （one-dimension was 8.50~3.89, three-dimension was 9.14±4.09） and ＂rapid pull and slow release＂ group （one-dimension was 6.02±2.61, three-dimension was 6.78±2.45） in the JOA scores before and after treatment （P 〈 0.05）. CONCLUSION： ＂Slow pull and rapid release＂ traction rhythm （including one-dimension and three-dimension） is better than traditional ＂rapid pull and slow release＂ traction rhythm. ＂Slow pull and rapid release＂ traction can transmit hand pressure to the prominence effectively, tract longer safely, increase the intervertebral space, strengthen the tension on posterior longitudinal ligament and make the prominence restore more easily.