腰椎定位斜扳法治疗腰椎失稳

Lumbar fixed-position oblique-pulling manipulation for treatment of lumbar vertebrae destabilization

目的:探讨腰椎定位斜扳法治疗腰椎失稳的临床疗效。方法:腰椎失稳患者100例,随机分为定位斜扳组和功能锻炼组,每组50例。在禁止腰部过度负重、每日卧床休息时间≥18 h、行走时腰围保护等基础上,功能锻炼组采用五点支撑法和飞燕点水法进行腰背肌功能锻炼,每日2次,每次5 min,共锻炼14 d;定位斜扳组行腰椎定位斜扳手法治疗,隔日1次,3次为1个疗程,共治疗2个疗程。分别于治疗前、治疗结束后即刻、治疗结束后6个月及治疗结束后1年,采用疼痛视觉模拟量表(visual analogue scale,VAS)评价患者腰痛情况,采用日本骨科学会(Japanese orthopedics association,JOA)腰背痛疾病治疗成绩评分标准评价患者腰椎功能恢复情况。观察2组患者腰痛VAS评分和腰椎功能JOA评分的变化趋势,并进行比较。结果:(1)腰部疼痛VAS评分。2组患者腰部疼痛VAS评分总体比较,组间差异有统计学意义,即存在分组效应(F=2.967,P=0.003)。治疗前后不同时间点之间腰部疼痛VAS评分比较,差异有统计学意义,即存在时间效应(F=381.062,P=0.000)。时间因素和分组因素存在交互效应(F=37.312,P=0.000)。2组患者腰部疼痛VAS评分随时间均呈降低趋势,但2组的降低趋势不完全一致;治疗前2组患者腰部疼痛VAS评分比较,组间差异无统计学意义[(6.08±1.08)分,(5.96±1.14)分;t=0.383,P=0.703];治疗后各时间点定位斜扳组腰部疼痛VAS评分均低于功能锻炼组[(2.16±0.85)分,(3.32±1.41)分,t=-3.530,P=0.000;(0.88±0.67)分,(1.96±0.61)分,t=-5.975,P=0.000;(0.40±0.30)分,(0.96±0.74)分,t=-3.150,P=0.003],定位斜扳组腰部疼痛VAS评分比功能锻炼组降低更快、更明显。(2)腰椎功能JOA评分。2组患者腰椎功能JOA评分总体比较,组间差异有统计学意义,即存在分组效应(F=38.473,P=0.000)。治疗前后不同时间点之间腰椎功能JOA评分比较,差异有统计学意义,即存在时间效应(F=417.467,P=0.000)。时间因素和分组因素存在交互效应(F=20.987,P=0.000)。2组患者腰椎功能JOA评分随时间均呈增高趋势,但2组的增高趋势不完全一致;治疗前2组患者腰椎功能JOA评分比较,组间差异无统计学意义[(13.76±1.72)分,(13.60±1.83)分,t=1.217,P=0.226];治疗后各时间点定位斜扳组腰椎功能JOA评分均高于功能锻炼组[(21.22±1.78)分,(17.22±2.00)分,t=10.879,P=0.000;(22.28±1.87)分,(18.58±1.65)分,t=10.448,P=0.000;(23.74±2.18)分,(19.64±1.61)分,t=10.662,P=0.000],定位斜扳组腰椎功能JOA评分比功能锻炼组增高更快、更明显。结论:腰椎定位斜扳法治疗腰椎失稳,与腰背肌功能锻炼相比,在缓解腰部疼痛和改善腰椎功能方面,起效更快、疗效更好。

Objective ： To explore the clinical curative effect of lumbar fixed - position oblique - pulling manipulation in treatment of lumbar vertebrae destabilization. Methods ： One hundred patients with lumbar vertebrae destabilization were randomly divided into fixed - position oblique - pulling manipulation group and functional exercise group,50 cases in each group. All patients were forbidden from lumbar overloading and were asked to rest in bed for ^18 hours every day and wear lumbar balteum while walking. The patients in functional exer-cise group were asked to do lumbodorsal muscle functional exercise by using five - point weight - support method and Feiyan Dianshui method,twice a day,5 minutes at a time for consecutive 14 days. The patients in fixed - position oblique - pulling manipulation group were treated with lumbar fixed - position oblique - pulling manipulation, one time every other day for consecutive 2 courses of treatment, three times for each course. The low back pain was evaluated by using visual analogue scale （ VAS） and the lumbar function recovery was evalua-ted by using Japanese orthopaedic association（ JOA）low back pain scoring system before treatment and at once,6 months and 1 year after the end of the treatment respectively. The variation tendencies of low back pain VAS scores and lumbar function JOA scores were observed and compared between the 2 groups. Results： There was statistical difference in low back pain VAS scores between the 2 groups in general, in other words, there was group effect（ F - 2. 967 ,P = 0. 003 ） . There was statistical difference in low back pain VAS scores between differ-ent timepoints before and after the treatment, in other words, there was time effect （ F = 3 81. 062 ,P = 0. 000 ） . There was interaction between time factor and group factor（ F = 37. 312 ,P =0. 000 ） . The low back pain VAS scores presented a time - dependent decreasing trend in both of the 2 groups,while the 2 groups were inconsistent with each other in the decreasing trend of low back pain VAS scores. There was no sta-tistical difference in low back pain VAS scores between the 2 groups before treatment（6. 08 ＋/-1.08 vs 5. 96 ＋/- 1. 14 points,t=0. 383, P =0. 703 ） . The low back pain VAS scores were lower in fixed - position oblique - pulling manipulation group compared to functional exer-cise group at each posttreatment time point（2. 16 ＋/-0. 85 vs 3. 32 ＋/- 1.41 points,^ = - 3. 530 = 0. 000; 0. 88 ＋ / - 0. 67 vs 1.96 ＋ / -0. 61 points,t = - 5. 975 = 0. 000 ; 0. 40 ＋/ -0. 30 vs 0. 96 ＋/ -0. 74 point s= - 3. 150= 0. 003） ,and the low back pain VAS scoresdecreased more rapidly and more obviously in fixed - position oblique - pulling manipulation group compared to functional exercise group. There was statistical difference in lumbar function JOA scores between the 2 groups in general,in other words,there was group effect（ F = 38. 473 ,P =0. 000） . There was statistical difference in lumbar function JOA scores between different timepoints before and after the treat-ment, in other words, there was time effect（F =417. 467,P =0. 000）. There was interaction between time factor and group factor（F = 20. 987 ,P = 0.000）. The lumbar function JOA scores presented a time - dependent increasing trend in both of the 2 groups, while the 2 groups were inconsistent with each other in the increasing trend of lumbar function JOA scores. There was no statistical difference in lumbar function JOA scores between the 2 groups before the treatment（ 13. 76 ＋/- 1.72 vs 13. 60 ＋/- 1.83 points,t = 1.217 ,P =0. 226） . The lum-bar function JOA scores were higher in fixed - position oblique - pulling manipulation group compared to functional exercise group at each posttreatment time point（21.22 ＋/- 1.78 vs 17. 22 ＋/-2. 00 points^ = 10. 879,P =0. 000; 22. 28 ＋ / - 1.87 vs 18. 58 ＋ / - 1.65 points^ = 10. 448 ,P = 0. 000; 23. 74 ＋/ -2. 18 vs 19. 64 ＋/ - 1.61 points^ = 10. 662,P =0. 000） ,and the lumbar function JOA scores increased morerapidly and more obviously in fixed - position oblique - pulling manipulation group compared to functional exercise group. Conclusion： Compared with lumbodorsal muscle functional exercises, lumbar fixed - position oblique - pulling manipulation provides superior curative effect and faster onset of action in alleviating low back pain and improving lumbar function in treatment of lumbar vertebrae destabilization.