通痹止痛方结合针刺治疗60例根性坐骨神经痛

Tongbi Zhitong Decotion Combined with Acupuncture Treatment on 60 Patients with Sciatica of Nerve Roots

目的:观察通痹止痛方结合针刺辨证治疗根性坐骨神经痛的近期临床疗效及作用机制。方法:120例患者采用随机按数字表法分为针刺组和观察组各60例。针刺组采用单纯针刺治疗,观察组采用通痹止痛方结合针刺辨证治疗,10 d为1个疗程,间隔2 d继续下1个疗程,共2个疗程。采用视觉模拟量表(VAS)评分法评价疼痛程度,进行治疗前后Oswestry功能障碍指数和日本骨科协会下腰痛评价表(JOA)评价;检测治疗前后β-内啡肽(β-EP)、白细胞介素-1(IL-1)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平。结果:观察组临床总有效率为95%,优于针刺组的81.6%(P<0.05);治疗后第3,10,22天两组VAS评分均呈下降趋势(P<0.01),观察组在第10,22天VAS评分均低于针刺组(P<0.01);治疗后观察组Oswestry功能障碍指数低于针刺组,JOA评分高于针刺组(P<0.01);治疗后观察组β-EP高于针刺组,IL-1,IL-6和TNF-α水平低于针刺组(P<0.01)。结论:与单纯针刺治疗比较,针药结合疗法治疗根性坐骨神经痛在缓解疼痛,改善患者功能,提高临床疗效方面的作用机制可能与提高β-EP水平,减轻炎性反应有关。

Objective：To observe the clinical short-term curative effect and the mechanism of Tongbi Zhitong decotion combined with acupuncture in patients with sciatica of nerve root.Method：One hundred and twenty patients were randomly divided into control group and observation group of 60 patients each.Patients in control group received acupuncture treatment alone.Patients in observation group received differentiated treatment of Tongbi Zhitong decotion combined with acupuncture.All patients received two 10 days periods of treatment separated by 2 days without treatment.Pain degree on visual analog scale （VAS）,Oswestry disability index and Japanese orthopaedic association （JOA） score were evaluated before and after treatment.Levels of β-endorphin （β-EP）,interleukin-1 （IL-1）,interleukin-1 （IL-6） and tumor necrosis factor-α （TNF-α） were detected.Result：The total clinical effective rate in observation group was 95％,superior to 81.6％ in control group （P ＜0.05）.The VAS scores in both groups exhibited a declining tendency at 3,10 and 22 day after the treatment （P ＜0.01）.The VAS scores in observation group were lower than that in control group at 10,22 day after the treatment （P ＜ 0.01）.The oswestry dysfunction index in observation group was worse than that data in control group,while JOA scores in observation group were superior to that in control group （P ＜ 0.01）.The level of β-EP in observation group was higher （P ＜0.01）,while the levels of IL-1,IL-6 and TNF-α were lower in observation group than that in control group （P ＜ 0.01）.Conclusion：Compared with the treatment using acupuncture alone,acupuncture combined with medicine therapy has significant improvements in pain relieving,functional statue and clinical effective rate for patients with sciatica of nerve root.Its mechanisms may be achieved by raising β-EP level and reducing inflammatory reaction.