脊柱定点旋转复位法治疗腰椎间盘突出症的临床和影像学疗效观察

Clinical and imaging study on the treatment of lumbar intervertebral disc herniation(LIDH) by fixed-point and cyclorotation of spinal manipulation (Feng's spinal manipulation)

目的:通过观察手法治疗前后患者临床指标与影像学测试指标改变之间的关系,深入研究脊柱定点旋转复位法取得满意疗效的关键及可能机制,进一步验证脊柱内外平衡失调学说及椎体位移理论。方法:选取2006年8月至2008年5月于空军总医院就诊并采用脊柱定点旋转复位法进行治疗的腰椎间盘突出症患者34例,其中男20例,女14例;年龄18～53岁,平均(40.39±9.87)岁。比较治疗前后的直腿抬高角度(ASLR)、视觉疼痛量表(VAS)、腰背痛评分(JOA)、MRI轴位像突出髓核矢状径指数(SI)、神经根鞘袖和硬膜囊的夹角(α)、神经根鞘袖直径,并进行数据分析。结果:治疗后ASLR、VAS及JOA评分值明显高于治疗前(P<0.01);治疗前后突出髓核(SI)无明显改变(P>0.05);患者治疗后受压神经根袖直径明显增大(P<0.01);治疗前后神经根鞘袖和硬膜囊的夹角无明显改变(P>0.05)。结论:脊柱定点旋转复位法治疗腰椎间盘突出症可以取得满意的疗效。磁共振脊髓成像术(magnetic resonance myelography,MRM)为脊柱定点旋转复位法疗效提供了量化的影像学依据,提示脊柱定点旋转复位法取得疗效的关键可能在于解除神经根受压,而不是突出髓核与神经根形态、位置改变是否明显。

Objective：To observe the relationship between clinical index and image index before and after treatment with Feng＇s spinal manipulation（FSM）and study the key points and possible mechanism getting a satisfactory therapeutic effects,and further verify the theory of imbalance of spine and vertebral displacement. Methods：From August 2006 to May 2008,34 patients with LIDH were treated by FSM for 3 weeks in Air Force General Hospital of PLA. There were 20 males and 14 females with the mean age of （40.39±9.87） years （18 to 53 years）. The clinical data of the patients were retrospectively analyzed,including angle of straight leg raising（ASLR）,visual analogue score（VAS）,Japanese orthopaedics lumbodorsal pain score （JOA）,the sagittal diameter index （SI） of protruded nucleus pulposus of MRI axial view,angle of nerve sleeve and scleromeninx vesic（α）,the diameter of nerve root sheath sleeves. Results：After treatment,ASLR,VAS and JOA of patients were significantly higher than those before treatmeat（P0.01）. SI andαhad not obviously change before and after treatment. The diameter of nerve root sheath sleeves obviously increased after treatment（P0.01）. Conclusion：FSM can achieve satisfactory effect in treating LIDH. The magnetic resonance myelography（MRM） providses quantified imaging for the application of MSF,which suggest that the key point of obtainning effect for FSM may relief the root compression,rather than the obvious changes of shape and location of protruded nucleus pulposus and the nerve root.