脊柱手法纠正“骨错缝”治疗腰椎间盘突出症的随机对照临床研究

Treatment of “vertebral dislocation” with spinal manipulation for lumbar disc herniation: a randomized controlled clinical study

目的探讨脊柱手法治疗腰椎间盘突出症(LDH)的临床意义。方法 176例LDH住院患者随机分为观察组89例和对照组87例。2组同时给予相同的脱水、消炎等常规治疗外,观察组给予冯氏脊柱手法治疗,对照组给予脊柱安慰手法治疗,疗程20天。治疗前后对2组分别进行症状学评价(ODI指数)、神经根刺激体征(RS)观察、结构力学紊乱体征(PS)量化评分和突出间盘组织椎管内占位情况的MRI测量分析。结果治疗后2组ODI指数、RS值和PS值均较治疗前有一定程度的改善;治疗后观察组ODI指数改善程度显著优于对照组,RS值明显低于对照组,差异均有统计学意义(P<0.01);PS值治疗后2组间差异无统计学意义(P>0.05)。MRI测量结果治疗前后及治疗后组间比较,差异均无统计学意义(P>0.05)。结论脊柱手法纠正"骨错缝"可促进LDH症状缓解,但症状改善与突出髓核的形态及结构学变化无显著相关性,因此手法治疗的重点在于恢复脊柱功能和建立代偿平衡。

Objective To explore the clinical significance of spinal manipulation in treating lumbar disc herniation （LDH）. Methods 176 hospitalized LDH patients were randomly divided into an observation group （89 cases） and a control group （87 cases）. In addition to the same dehytration, anti-inflammatory and other conventional baseline treatment, the observation group was treated with Feng＇ s spinal manipulation, while the control group received placebo spinal manipulation. The course of treatment was 20 days. Some clinical data before and after the treatment were measured and analyzed in two groups respectively, including symptom assessment （ODI）, nerve root irritation signs （RS） score, structural mechanics disorder symptoms （P S） score, and MRI of the protruded vertebral disc into the spinal canal. Results ODI, RS scores and PS scores after the treatment were more improved to a certain extent than that before the treatment in two groups. ODI of the observation group were significantly better than that of the control group, and RS value lower than that of the control group, the difference were statistically significant（ P 〈 0. 01 ） ; the difference of PS value after the treatment between the groups were not statistically significant （ P 〉 0. 05 ）. MRI results had no statistical significance before and after the treatment and also between the groups （ P 〉 0.05 ）. Conclusion Correcting ＂vertebral dislocation＂ with spinal manipulation can promote the alleviation of LDH, but the symptom changes and morphology and structural changes of ＂protruded nucleus＂ have no significant correlation. So the key of spinal manipulation is to recover the function of spinal column and establish the compensatory balance.