整复手法治疗腰椎间盘突出症最佳应用时机的多中心随机对照研究

Multi-Center Randomize-Controlled Trial of Best Application Time of Manipulations for Lumbar Disc Herniation

目的探讨整复手法治疗腰椎间盘突出症的最佳应用时机,并评价其临床疗效。方法将来自3家医院的300例腰椎间盘突出症患者随机分为恢复期应用组、缓解期应用组、传统推拿组和西药组各75例。恢复期应用组急性期采用中药熏蒸、湿敷、中药敷贴治疗,缓解期采用软组织放松类手法配合牵引治疗,恢复期采用整复类手法配合牵引和功能锻炼操;缓解期应用组在缓解期应用整复手法治疗,传统推拿组在急性、缓解、恢复期中均用整复类手法治疗,其余治疗同恢复期应用组;西药组各期均口服萘丁美酮片每日1次,每次1g,并在急性期静脉滴注神经妥乐平,缓解期配合牵引治疗,恢复期配合牵引和功能锻炼操,各组均30天为1个疗程。分别于治疗前后观察各组患者静脉血一氧化氮(NO)、白细胞介素6(IL-6)水平、症状评分、肌骨彩超评分、表面肌电频率值,并于1个疗程后评价疗效,疗程结束后6个月随访并观察复发率。结果各组治疗后静脉血NO、IL-6水平、症状评分、肌骨彩超评分较治疗前均明显下降,表面肌电频率均明显上升(P<0.05)。治疗后恢复期应用组、缓解期应用组NO、IL-6水平均低于传统推拿组和西药组(P<0.05);恢复期应用组症状评分、肌骨彩超评分均低于缓解期应用组、传统推拿组和西药组,表面肌电频率值均高于其他3组(P<0.05)。恢复期应用组、缓解期应用组、传统推拿组、西药组治疗后有效率分别为98.6%、89.2%、77.5%、75.4%;随访时复发率分别为1.47%、11.59%、12.31%、14.29%。恢复期应用组有效率高于其他3组,复发率低于其他3组,差异均有统计学意义(P<0.05);缓解期应用组、传统推拿组、西药组有效率、复发率比较差异均无统计学意义(P>0.05)。结论整复手法恢复期应用可以作为治疗腰椎间盘突出症的优选方案且具有较好的临床疗效。

Objective To research the best application time of manipulations for lumbar disc herniation （LDH） and evaluate its therapeutic effect. Methods Totally 300 cases of LDH from three hospitals were randomized into recovery application group, remission application group, traditional massage group and western medicine group, with 75 in each. The recovery application group was given herbal fumigation, wet packing and applicator during the acute period, soft tissue relaxation and traction during the remission period and manipulations, traction and functional training exercise during the recovery period. The remission application group was given manipulations in remission. The traditional massage group was given manipulations during the acute, remission and recovery period. The western medicine group was given lg nabumetone tablets orally once daily, intravenous infusion of Neurotropin in the acute phase, traction in remission and traction and functional training exercise during the recovery period. One treatment course lasted for 30 days. The levels of nitric oxide （NO） and interleukin-6 （IL 6）, symptom score, musculoskeletal ultrasound score and surface electromyography frequency were observed before and after treatment. The therapeutic effect was evaluated after one treatment course. The recurrence rate was observed in the follow-up （6 months after the end of treatment）. Results The levels of NO and IL-6, symptom score and musculoskeletal ultrasound score were significantly decreased, but the surface electromyography frequency was significantly increased in all groups after treatment （P〈0.05）. The levels of NO and IL-6 in the recovery application group and remission application group were significantly lower than those in the traditional massage group and western medicine group （P〈0.05）. The scores of symptom and musculoskeletal ultrasound in the recovery application group were significantly lower than those in the other three groups, but the surface electromyography frequency was significantly higher than that in other three groups （P〈0.05）. The effective rate of the recovery application group, remission application group, traditional massage group and western medicine group was 98.6%, 89.2%, 77.5% and 75.4% respectively. The recurrence rate of the recovery application group, remission application group, traditional massage group and western medicine group was 1.4%, 11.59%, 12.31% and 14. 29% respectively. The efficacy of the recovery application group was significantly higher than that of other groups, hut the recurrence rate was significantly lower than that of other groups （P〈0.05）. There was no significant difference in the efficacy and recurrence rate among remission application group, traditional massage group and western medicine group （P 〉 0.05）. Conclusion The application of manipulations during the recovery period is a preferred and effective solution for LDH.