针刺联用抗阻训练治疗中老年退行性腰椎不稳症的比较效果研究

Comparative Effectiveness Research on Combination of Acupuncture and Anti- resistance Training in the Treatment of Senile Degenerative Lumbar Instability

目的:采用3组随机单盲对照试验,比较单用针刺、单用抗阻训练或两种方法联用治疗中老年退行性腰椎不稳症总体效果。方法:将90例入组患者随机分成针刺组、康复组和联合组,分别给予单用针刺、单用抗阻训练以及两种方法联合的干预措施。比较3组治疗前、后的腰椎关节活动度评分、简化MCGILL评分、JOA评分、改良ODI评分、VAS评分等,并进行成本-效果分析的卫生经济学评价。结果:3组组内各评分比较,治疗后与治疗前腰椎关节活动度评分、简化MCGILL评分、JOA评分、改良ODI评分有明显变化趋势,且差异显著(P<0.01)。3组组间比较各项评分差异均不显著(P>0.05)。卫生经济学比较,针刺组成本效果优于康复组和联合组,且差异显著(P<0.01)。结论:针刺单用或联用抗阻训练治疗中老年退行性腰椎不稳症疗效确定,但针刺与抗阻训练两种疗法的联用并不优于其中一种疗法单用的效果。从卫生经济学角度单纯针刺方案既安全有效又经济。

Objective ： Randomized single blind controlled trial was used to compare the effects of single needle acupuncture, the single use of anti - resistance training, or two therapies in combination for the treatment of senile degenerative lumbar instability. Methods：90 cases of patients were randomly divided into an acupuncture group, a rehabilitation group （anti -resistance training） and a combined group. All the treatments were given once daily for 20 days. Outcome measurements included lumbar joint mobility score, simplified MCGILL score, Japanese orthopaedic association （JOA） score, modified oswestry disability index （ODI） score, visual analogue scale （VAS） pre and post -treatment. Cost effectiveness analysis was also conducted. Results：All the 90 patients received the treatment and were included in the final analysis. After treatment, the MCGILL score, JOA score, modified ODI score and VAS were significantly changed within each group, and the difference was signif- icant （P 〈0.01 ）. However, there was no statistical difference of these scores between different groups （P 〉 0. 05 ）. Compared with the rehabilitation group and the combined group, the cost effectiveness ratio of the acupuncture group was much better, and the difference was statistically significant （P 〈 0.01 ）. Conclusion：Acu- puncture, anti - resistance training or the combined therapy may all have effectiveness in the treatment of senile degenerative lumbar instability, but on the basis of the same treatment effect, the cost of acupuncture is lower.