推拿配合躯干肌功能锻炼治疗慢性盘源性腰痛的临床分析

Analysis of the effects of Chinese traditional manipulation combined with active trunk muscle exercises on chronic discogenic low back pain

目的:观察推拿配合躯干肌功能锻炼治疗慢性盘源性腰痛的疗效,为该疗法的临床应用提供依据。方法:将123例慢性盘源性腰痛患者随机分为3组:Ⅰ组46例,采用推拿配合躯干肌功能锻炼法治疗;Ⅱ组41例,仅行推拿手法治疗;Ⅲ组36例,仅采用躯干肌功能锻炼治疗。分别于治疗前、疗程结束后及治疗后12个月,采用视觉模拟评分法和Oswestry腰椎功能障碍指数问卷表评价患者最大腰痛程度及腰痛对患者日常社会生活和劳动能力的影响。结果:①视觉模拟评分:3组VAS评分存在分组效应(F=131.727,P=0.000)、时间效应(F=570.366,P=0.000)、分组与时间交互效应(F=121.005,P=0.000)。不同时点3组间两两比较:治疗后Ⅰ组与Ⅱ组间差异有统计学意义(P=0.000),Ⅰ组与Ⅲ组间差异有统计学意义(P=0.000),Ⅱ组与Ⅲ组间差异无统计学意义(P=0.146);治疗后12个月,Ⅰ组与Ⅱ组间差异有统计学意义(P=0.000),Ⅰ组与Ⅲ组间差异有统计学意义(P=0.000),Ⅱ组与Ⅲ组间差异无统计学意义(P=0.543)。②Oswestry腰椎功能障碍指数:3组患者Oswestry腰椎功能障碍指数存在分组效应(F=126.032,P=0.000)、时间效应(F=136.665,P=0.000)、分组与时间交互效应(F=121.010,P=0.000)。不同时点3组间两两比较:治疗后Ⅰ组与Ⅱ组间差异有统计学意义(P=0.000),Ⅰ组与Ⅲ组间差异有统计学意义(P=0.000),Ⅱ组与Ⅲ组间差异无统计学意义(P=0.182);治疗后12个月,Ⅰ组与Ⅱ组间差异有统计学意义(P=0.000),Ⅰ组与Ⅲ组间差异有统计学意义(P=0.000),Ⅱ组与Ⅲ组间差异无统计学意义(P=0.245)。结论:推拿疗法和躯干肌功能锻炼疗法的有机结合,避免了单独使用其中一种方法的弊端,对慢性盘源性腰痛有良好的治疗效果。

Objective：To observe the effects of Chinese traditional manipulation combined with active trunk muscle exercises on chronic discogenic low back pain.Methods：123 patients with chronic discogenic low back pain were randomly allocated to 3 groups.46 cases in GroupⅠreceived Chinese traditional manipulation treatment plus active trunk muscle exercises once daily for total 30 times.41 cases in GroupⅡreceived only Chinese traditional manipulation treatment once daily for total 30 times.36 cases in GroupⅢ received only active trunk muscle exercises once daily for total 30 times.The intensity of low back pain and its influence on quality of life and work ability of patients were evaluated and compared among groups according to visual analogue scale（VAS） and Oswestry disability index（ODI）before treatment,after treatment and 12 months after treatment.Results：①VAS：There were group effect（F=131.727,P=0.000）,time effect（F=570.366,P=0.000）,interaction of group and time（F=121.005,P=0.000）among groups.Compare between groups at different time node：statistical significance presented between GroupⅠand GroupⅡ（P=0.000）and between GroupⅠand GroupⅢ（P=0.000）after treatment,no statistical significance presented between GroupⅢand GroupⅡ（P=0.146）after treatment.12 months after treatment,there was statistical significance between GroupⅠand GroupⅡ（P=0.000）and between GroupⅠand GroupⅢ（P=0.000）,while there was no statistical significance between GroupⅢand GroupⅡ（P=0.543）.②ODI：Group effect（F=126.032,P=0.000）,time effect（F=136.665,P=0.000）,interaction of group and time（F=121.010,P=0.000） presented among groups.Compare between groups at different time node：statistical significance presented between GroupⅠand GroupⅡ（P=0.000）and between GroupⅠand GroupⅢ（P=0.000）after treatment,no statistical significance presented between GroupⅢand GroupⅡ（P=0.182）after treatment.12 months after treatment,there was statistical significance between GroupⅠand GroupⅡ（P=0.000）and between GroupⅠand GroupⅢ（P=0.000）,while there was no statistical significance between GroupⅢand GroupⅡ（P=0.245）.Conclusion：Chinese traditional manipulation therapy combined with active trunk muscle exercises has good effect on chronic discogenic low back pain,while the shortages of single application of each method are obviated.