中西医结合治疗伴Modic改变盘源性下腰痛的临床观察

Clinical Observation on Chinese and Western Integrative Medicine in Treating DLBP Patients Accompanying Modic Change

目的观察伴终板Modic改变的慢性盘源性下腰痛患者在使用两种治疗方式的疗效差异，评判中西医结合在治疗上是否具有潜在的优势。方法将72例伴终板改变的慢性盘源性下腰痛患者随机分组，每组36例。治疗组采用围手术期中医辨证施治，并同时展开积极术前评估，排除手术禁忌症后采用经皮激光椎间盘减压术治疗；对照组单纯采用经皮激光椎间盘减压术治疗。分别于术前、术后2周、术后6个月评估慢性下腰痛改善程度。结果两组患者均住院治疗8—12d，平均（7．4±1．5）d，随访6～15个月，平均（8．3±1．6）个月。患者术后2周、术后6个月疼痛视觉模拟评分（VAS）及功能障碍指数评分（ODI）均低于于术前，且治疗组术后6个月相关数据均低于于对照组（P〈0．05）。结论通过中长期的随访，经皮激光椎间盘减压术配合自拟腰痛方治疗伴终板Modic改变的慢性盘源性下腰痛具有较好的效果，具有较大的临床应用价值。

Objective： To compare the different effects of two therapies on patients of chronic DLBP （discogenic low back pain） with endplate Modic changes to explore the potential advantages of Chinese and western integrative medicine in the treatment. Methods： The 72 chronic DLBP patients with endplate changes were randomly divided into two groups with the 36 eases in eaeh. The cases of treatment group were given TCM syndrome differentiation and treatment during perioperation period and PLDD （ pereutaneous laser dise decompression） after the active preoperative evaluation and exclusion of the surgical contraindieation; the only PLDD was administered to the cases of eontrol group. The symptom of chronic low back pain before treatment and its improvement in 2 weeks and 6 months after surgery were assessed. Results： Patients of both groups were hospitalized for 8 to 12 days, the average of （7.4±1.5） d and they were followed up for 6 to 15 months, the average of （8.3± 1.6） months. The VAS （ visual analog scale） pain scores and ODI （ functional disability index ） were lower than those before treatment after 2 weeks and 6 months surgery and the relevant data of treatment group after 6 months were all lower than those of control group （P〈0.05）. Conclusion： Through long-term follow-up, the effect of PLDD combined self-made lumbago formula on ehronic DLBP patients with endplate Modie changes is better and has great clinical application value.