仰卧旋转法治疗腰椎间盘突出症的病例对照研究

Case-control study on suspine rotation manipulation for the treatment of lumbar disc herniation

目的:比较仰卧位左右旋转作用力和平面作用力手法治疗腰椎间盘突出症的疗效。方法:2008年12月至2011年1月,收治腰椎间盘突出症患者134例,男74例,女60例;年龄17～67岁,50岁以上33例;膨出型9例,突出型74例,游离型51例。134例按随机数字表法分为治疗组(69例)和对照组(65例)。治疗组采用牵引治疗仪持续牵引20min后,用仰卧旋转手法治疗;对照组采用牵引治疗仪20min后,用平面用力推拿手法治疗。隔1d治疗1次,3次为1个疗程。治疗1个疗程后观察患者的症状和体征的积分(包括腰部疼痛与不适、下肢疼痛与麻木、大小便的情况、直腿抬高的水平、下肢行走能力、工作生活情况),并按疗效标准比较2种治疗方法的治疗效果。结果:2组患者均获得随访,时间0.5～2个月,平均1.1个月。治疗组与对照组的症状和体征均较治疗前有明显改善(P<0.01);对照组大小便无力与会阴麻木的症状较治疗前无明显改善(P>0.05)。治疗组69例中,良42例,可20例,差7例;对照组65例中,良20例,可25例,差20例。结论:仰卧位旋转手法治疗腰椎间盘突出症的整体疗效满意,但进行旋转手法操作时力量不宜过重,旋转次数也不宜过多。

Objective：To compare therapeutic effects between suspine rotation and flexion manipulation for treating lum- bar disc herniation. Methods： From December 2008 to January 2011,134 patients with lumbar disc herniation were treated, including 74 males and 60 females, ranging in age from 17 to 67 years, 33 patients with age over 50 years old. According to di- agnosis the ladder of the 9 cases bulging type ,74 hernia type, 51 cases free type. The patients were randomly divided into treatment group （ 69 cases） and control group （65 cases）. All the patients were treated with the three-dimensional computer- controlled traction therapeutic apparatus, with continued traction for 20 minutes. After traction, flexion manipulation and rotat- ing manipulation were respectively adopted in treatment group and control group （on alternate days one time,3 times as a course of treatment）. The symptoms and signs （including back pain and discomfort,lower limb pain and numbness,powerless urination and defecation, numbness in perineum, straight-leg raising degree, ability of lower extremity walking, work and live ） of patients were observed after treatment. Results：All patients were followed up for 0.5 to 6 months with an average of 1.1 months. After treatment, the symptoms and signs of patients have significantly improved （P〈0.01）, but the symptomes of power- less urination and defecation,numbness in perineum was not improved obviously （P〉0.05）. Forty-two of 69 patients in treat- ment group got excellent result, moderate in 20, poor in 7 ;Twenty of 65 patients in control group got excellent resuh, moderate in 25, poor in 20. Conclusion：The whole effect of lumbar backwards rotation manipulation is more satisfactory than flexsion manipulation for treating lumbar intervertebral disc herniation. But spinning force and times should be noticed.