针刀松解术治疗腰椎间盘突出症的临床研究

Clinical Observation of Acupotomy on Lumbar Disc Herniation

目的:观察针刀松解术治疗腰椎间盘突出症(LDH)的临床疗效。方法:将纳入的96例LDH患者按1:1随机分为针刀组和电针组,各48例。针刀组取夹脊穴、督脉点及坐骨神经通路压痛点等行针刀治疗,每疗程治疗1次休息4天,电针组电针夹脊穴,每疗程连续治疗4天休息1天,均治疗3个疗程,随访2周。治疗前、第1和3个疗程后及随访时对患者简式Mcgill疼痛量表(SF-MPQ)评分及Oswestry功能障碍指数(ODI)进行评价。计算两组的有效率、治愈率、复发率,并记录不良反应事件。结果:治疗前两组SF-MPQ评分及ODI评分无差异(P> 0. 05),第1和3个疗程后针刀组评分更低(P <0. 05),随访期两组SF-MPQ评分无差异(P> 0. 05),而针刀组ODI评分更低(P <0. 05);两组总有效率无差异(P> 0. 05),但针刀组治愈率更高、复发率更低(P <0. 05);均未发生严重不良反应。结论:两种治疗方法均安全有效,但针刀疗效更加稳定,镇痛效果更加迅速,且近期及远期腰椎功能的改善效果优于电针。

Objective: To observe the clinical effect of acupotomy on lumbar disc herniation(LDH). Methods: 96 cases of LDH were randomly divided into the acupotomy group( n =48) and the electro-acupuncture group( n =48). Jiaji points, tenderness of Du meridian and sciatic nerve pathway were chosen for the acupotomy(once per course, four days interval of each course). Electro-acupunture group was treated with electro-needling Jiaji points(four times per course, one day interval of each course). The two groups were treated for three courses followed by two weeks of follow-up. The scores of SF-MPQ and Oswestry Dysfunction Index(ODI) of the patients were evaluated before the treatment, after one course and three courses of the treatment, as well as during the follow-up period. The efficiency, cure rate and recurrence rate were calculated, and the adverse events were recorded in the two groups. Results: In terms of the scores of SF-MPQ and ODI, there were no differences between two groups before the treatment( P >0.05);they were much lower in the acupotomy group after one course and three courses of the treatment( P <0.05);during the follow-up period, no difference was seen in the SF-MPQ scores between the two groups( P >0.05);however, ODI score was lower in the acupotomy group( P <0.05). There was no difference in the total effective rate between the two groups( P >0.05). However, the curative rate was higher and the recurrence rate was lower in the acupotomy group( P <0.05). No serious adverse reactions occurred in either group. Conclusion: Both acupotomy and electro-acupuncture are safe and effective for LDH, but the effect of acupotomy is more stable and the analgesia effect is more rapid. Furthermore, the improvement of lumbar function is better than that of electro-acupuncture in the near and long term.