推拿联合针灸治疗血瘀型腰椎间盘突出症的临床疗效观察

Study on Lumbar Muscle Function and Curative Effects of Manipulation in Combination with Acupuncture on the Blood Stasis Type Lumbar Intervertebral Disc Protrusion

目的:观察推拿手法联合针灸对血瘀型腰椎间盘突出症的临床疗效。方法:选取2015年6月至2017年12月秦皇岛市中医医院收治的血瘀型腰椎间盘突出症患者100例作为研究对象,按照随机数字表法随机分为对照组和观察组,每组50例。对照组接受单纯针灸治疗,观察组在对照组基础上加用脊柱推拿手法,2组均以10次为1个疗程,连续治疗2个疗程。比较2组患者治疗前、治疗3 d、10 d后JOA评分系统(Japanese Orthopaedic Association Scores,JOA)、Oswestry功能障碍指数的变化、血小板计数、血浆凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、血栓弹力图及临床总有效率的变化、腰椎疼痛评分(VAS)、血清学指标、炎性因子的变化。结果:推拿手法联合针灸可明显改善血瘀型腰椎间盘突出症的JOA评分、Oswestry功能障碍指数及凝血状态,降低患者外周血SP、NPY、IL-1β、TNF-α水平,且具有时间依赖性。结论:推拿联合针灸可明显改善血瘀型腰椎间盘突出症症状,调节患者的高凝状态,该法具有一定的时间依赖性。

Objective:To observe the clinical effects of massage combined with acupuncture on blood stasis type lumbar disc herniation.Methods:A total of 100 patients with blood stasis type lumbar intervertebral disc protrusion were randomly divided into a control group(n=50)and an observation group(n=50).The control group received simple acupuncture treatment,the observation group on the basis of the control group recieved spinal massage manipulation,both groups take 10 times as a course of treatment,2 consecutive courses of treatment.The changes of JOA score system(Japanese Orthopaedic Association Scores JOA),Oswestry dysfunction index,platelet count,plasma prothrombin time(PT),activated partial prothrombin time(APTT),thromboelastogram and clinical total effectsive rate,lumbar pain score(VAS),serological index and inflammatory factors were compared between the 2 groups before treatment,3 days and 10 days after treatment.Results:Massage manipulation combined with acupuncture could significantly improve the JOA score,Oswestry dysfunction index and blood coagulation state of blood stasis lumbar disc herniation,and reduce the levels of SP,NPY,IL-1βand TNF-αin peripheral blood in a time-dependent manner.Conclusion:massage combined with acupuncture can obviously improve the symptoms of blood stasis lumbar disc herniation and regulate the hypercoagulable state of patients,which is time-dependent.