神经根沉降征对中医综合疗法治疗腰椎管狭窄症疗效影响的临床研究

A clinical study of influence of nerve root sedimentation signs on clinical therapeutic effect of combined therapy of traditional Chinese medicine in the treatment of lumbar spinal stenosis

目的:探讨神经根沉降征对中医综合疗法治疗腰椎管狭窄症疗效的影响。方法:选取33例腰椎管狭窄症患者,按照是否存在神经根沉降征分为2组,阳性组19例、阴性组14例。2组患者均采用以十步推拿手法为核心的中医综合疗法治疗。采用视觉模拟量表(visual analogue scale,VAS)和日本骨科学会(Japanese orthopaedic association,JOA)腰痛疾患疗效评定量表(29分法)评定患者的疼痛程度和总体疗效。结果:治疗前2组患者的疼痛VAS评分比较,差异无统计学意义(t=-1.006,P=0.332);治疗结束后2组患者的疼痛VAS评分均降低[(7.32±0.89)分,(3.26±1.10)分,t=14.437,P=0.001;(6.92±1.32)分,(3.42±0.85)分,t=9.740,P=0.001];2组患者治疗结束后的疼痛VAS评分比较,差异无统计学意义(t=0.469,P=0.643)。治疗前2组患者的JOA评分比较,差异无统计学意义(t=1.623,P=0.115);治疗结束后2组患者的JOA评分均增大[(13.26±1.37)分,(17.42±2.24)分,t=-12.723,P=0.001;(14.14±1.75)分,(20.50±1.87)分,t=-17.079,P=0.001],阳性组治疗结束后的JOA评分低于阴性组(t=4.171,P=0.001)。结论:采用十步推拿手法为核心的中医综合疗法治疗腰椎管狭窄症,神经根沉降征阴性者疗效更优。

Objective：To explore the influence of nerve root sedimentation signs on clinical therapeutic effect of combined therapy of tra- ditional Chinese medicine（TCM） in the treatment of lumbar spinal stenosis （LSS）. Methods：Thirty -three patients with LSS were selected and randomly divided into positive group（ 19 cases）and negative group（ 14 cases）according to whether nerve root sedimentation signs were found. The patients in the 2 groups were treated with TCM complex therapy centered on ten - step manipulation maneuver. The pain degrees and the clinical curative effects were evaluated by using visual analogue scale （VAS）and therapeutic effect rating scale（ 29 points）for low back pain made by Japanese orthopaedic association（JOA） respectively. Results ：There was no statistical difference in pain VAS scores between the 2 groups before treatment（t = - 1. 006,P = 0. 332）. The pain VAS scores decreased in both of the 2 groups after the end of the treatment （7.32 ＋/-0.89 vs 3.26 ＋/- 1.10 points, t = 14. 437 ,P = 0.001 ;6.92 ＋/- 1.32 vs 3.42 ＋/- 0.85 points, t = 9. 740 ,P = 0.001 ）. There was no statistical difference in pain VAS scores between the 2 groups after the end of the treatment （t = 0. 469,P = 0. 643 ）. There was no statistical difference in JOA scores between the 2 groups before treatment（ t = 1. 623 ,P = 0.115 ）. The JOA scores increased in both of the 2 groups after the end of the treatment（ 13.26 ＋/- 1.37 vs 17.42 ＋/- 2.24 points, t = - 12. 723, P = 0. 001 ; 14.14 ＋/- 1.75 vs 20.50 ＋/- 1.87 points, t = - 17. 079, P = 0.001 ）. The JOA scores were lower in positive group compared to negative group after the end of the treatment （ t = 4. 171, P = 0. （901）. Conclusion： In treatment of LSS, the curative effect of TCM complex therapy centered on ten - step manipulation maneuver is bet- ter in patients without nerve root sedimentation signs compared to those with nerve root sedimentation signs.