脊柱定点旋转复位法治疗游离型腰椎间盘突出症

Treatment of the lumbar disc herniation of sequestered type with FENG's spinal manipulation

目的:观察脊柱(定点)旋转复位法治疗游离型腰椎间盘突出症临床疗效并探讨其机制。方法:脊柱(定点)旋转复位法治疗游离型腰椎间盘突出症41例,男27例,女14例;年龄24～57岁,平均38.3岁。按患者主观症状、患侧直腿抬高试验(SLR)、脊柱运动、腰型进行临床评分,比较手法治疗前后评分结果并进行统计学分析。测量观察反映突出髓核大小的MRI椎间盘突出最大层面矢状径指数(SI),比较手法治疗前后SI值并进行统计学分析。结果:手法治疗后患者主观症状、SLR、脊柱运动、腰型积分明显增加(P<0.05),治疗前后临床综合评分分别为8.4500±2.4385、18.9000±1.8229,治疗后积分显著提高(P<0.05)。手法治疗前后SI值分别为0.5651±0.1387、0.5292±0.1499,统计学检验无显著性改变(P>0.05)。41例均获随访,时间3～36个月,平均11个月,无一例复发。结论:游离型腰椎间盘突出症的主要病理改变是单(多)个椎体位移。实施脊柱(定点)旋转复位法恢复患椎的解剖或代偿位置,临床表现可以随之锐减或消失。其机制并非髓核组织的缩小,可能是纠正椎体位移后减轻鞘膜囊(神经根)的形变和张力,恢复了脊柱的稳定性。

Objective ：To evaluate the clinical effect of the treatment for sequestered type lumbar disk herniation （SLDH） with FENG＇s spinal manipulation. Methods：Forty-one patients （27 male, 14 female ） were treated by FENG＇s spinal manipulation. The clinical results were measured by the Japanese and FENG＇s lumbar treatment standard and evaluated by scoring system for assessment of treatment for low back pain between pre- and post-treatment. To measure MRI sagittal index （SI） of lumbar disc herniation between pre- and post-treatment. Results：The score of subjective symptoms and clinical signs increased obviously after treatment. There was no statistical difference of SI between preand post-treatment （P〈0.05）. The outcome of treatment was satisfying. Conclusion：The major pathologic change of SLDH is the single/multiple vertebral subluxation. FENG＇s spinal manipulation can correct the vertebral subluxation which leading to the series of clinical manifestations. The good clinical outcome may due to the alleviation of distortion and tension of dura and nerve root with the recovery of the spinal column＇s stability.