国内腰椎间盘突出症非手术治疗的现状调查

Investigation of the application status of non-operative treatments of lumbar disc herniation in China

目的调查国内各种非手术方法在治疗腰椎间盘突出症(lumbar disc herniation,LDH)中的应用现状,为制定LDH保守治疗规范提供参考依据。方法应用计算机检索中国知网(CNKI)、万方数据库,时间为2011-2016年,来源为全部"期刊",分别检索并记录"关键词(腰椎间盘突出症)、主题(治疗)、主题词"组合的论文篇数,主题词包括"治疗、手术、非手术、保守治疗、卧床、牵引、推拿、按摩、穴位注射、手法、针灸、封闭、药物治疗、理疗、腰背肌、核心肌群、运动疗法、Mckenzie/麦肯基"等,对所得数据进行比较、分析,了解各种非手术方法在国内的应用现状。结果检索到近5年来CNKI/万方数据库已发表的关于腰椎间盘突出症治疗的论文共计8358/10372篇,涉及非手术治疗类为4740/5 377篇,其中涉及LDH中医类保守治疗的论文分别占全部治疗类的35.0%和36.5%,涉及各类物理因子治疗的论文占全部治疗类的5.0%和5.7%,而涉及运动疗法的仅占全部治疗类的2.6%和2.4%。提及LDH"牵引"方法的论文占全部治疗类的15.7%和17.0%,为非手术治疗中被提及最多的,其次为中医"推拿"类、"针灸"类,提及最少的是"心理治疗"。结论 LDH的治疗仍以非手术治疗为主,中医类保守治疗在其中占主导地位,牵引和物理因子治疗得到广泛的应用,而现代康复治疗技术,如运动疗法和康复手法等,尚未得到足够认识和开展。

Objective To investigate the application status of all kinds of non-operative treatments in treating lumbar disc hernia （LDH） in China as well as the existing problems, with an aim to formulate strict standards of conservative treatment for LDH. Methods To search the CNKI and WANFANG DATA （2011 to 2016）, with the source set as all periodicals. The published theses regarding the treatment of LDH in the recent 5 years, with LDH being the key word and all kinds of treatments （treatment, operative, non-operative, conservative, bed ridden, traction, manipulation, massage, acu- point injection, technique, acupuncture, closure, drug therapy, intervention, physiotherapy, lumbodorsal muscle, core muscles, exercise therapy, Mckenzie and rehabilitation） being the subject words were counted; the number of the thesis that had the key word combined with one or more subject words was recorded, respectively; and the obtained data were com- pared to analyze the application status of all kinds of non-operative treatments in China. Results About 8 358/10 372 pub- lished theses regarding the treatment of LDH in the recent 5 years were searched in the CNKI/WANFANG DATA, among which 4 740/5 377 involved non-operative treatments. The theses regarding the traditional chinese medicine （TCM） con- servative treatment occupied 35.0% or 36.5% of the total theses on treatment, those regarding various kinds of physical factor treatment occupied 5.0% or 5.7%, and exercise therapy made up 2.6% or 2.4% of the total theses on treatment, re- spectively in the CNKI or WANFANG DATA. The traction method was the most frequently mentioned method among the non-operative treatments, which accounted for 15.7% or 17.0% of the theses on treatment, respectively in the CNKI and WANFANG DATA, followed by the theses on TCM massage and theses on acupuncture, while psychotherapy was the most rarely mentioned. Conclusion In China, the treatment of LDH mainly relies on non-operative treatments, among which, traction and physical factor treatment have been extensively applied. The TCM non-operative treatments play a dominant role in the conservative treatment of LDH, while the modem rehabilitation techniques, such as exercise therapy has not yet been sufficiently understood and carried out.