脊柱手法治疗腰椎间盘突出症原则的演变

The History and Principle of Spinal Manipulation in the Reatment of Lumbar Disc Herniation

脊柱手法以纠正脊柱畸形或力学失衡为原则治疗腰椎间盘突出症的临床症状已经有数千年的历史了。但是，自从70多年前腰椎间盘突出症的病理机制被现代科学揭示以来，人们就开始逐渐忽略或摒弃脊柱力学失衡的手法治疗，转而关注突出髓核组织。但是，随着现代医学可发展，临床一线的医生们又逐渐发现了许多临床证据，证明大部分患者都可以通过保守治疗使症状得到缓解甚至临床治愈，而突出髓核在保守治疗成功之后并未产生显著改变，这不得不让现代医学重新审视突出髓核的临床意义。同时，根据脊柱手法在保守治疗临床工作的实际效应，临床医生在新的背景下，又开始重新展开对腰椎间盘突出症患者脊柱力学失衡问题的认识。本文从文献回顾的角度，总结了本病的这一认知历程，希望为腰椎间盘突出症病理认识的深入和治疗原则的完善带来一些启示。

It is generally agreed that spinal manipulation has been applied into the treatment of lumbar disc herniation （LDH） for thousands of years according to historical reviews of the paper. The balance restore of spinal column had been always the main aim of spinal manipulation during the time. The situation has been changed after LDH discovered pathomechanically about 70 years ago and the protruded nucleus pulposus has attracted the attention of whole world ever since and surgery become the major choice in LDH patients. Nevertheless, some latest reports of clinical observation in past decades exploring more and more solid evidences to prove that most of the patients will need no surgery at all and could be cured by conservative therapy without any changes of protruded nucleus pulposus at involved segment. The modem management of LDH suggests that we should not only pay attention to the protruded disk but also to the biomechanical balance of spinal column again as we had for thousands of years, which is concluded from the reviews of previous reports and history of LDH recognition in the paper. The only thing we should care more about is how to make full use of our modem knowledge to adjust our view of observation and management in clinical practice of spinal manipulation and to make a further understanding of the pathomechanics of LDH.