基于数据包络分析法的杵针综合疗法对腰椎间盘突出症临床效率分析

A data envelopment analysis-based study of the clinical efficiency of pestle needle combined therapy for lumbar disc herniation

目的:观察杵针对腰椎间盘突出症的疗效及对疼痛评分的影响。方法:将确诊为腰椎间盘突出症的及通过排除标准和剔除标准后的符合本次研究的患者,共计240例,依据就诊顺序及Doll’s临床病例随机表完全随机分为中医治疗组和西医对照组(现代康复治疗法);其中,中医治疗组内再分为中医治疗方案Ⅰ组(杵针)、中医治疗方案Ⅱ组(杵针+电针)、中医治疗方案Ⅲ组(杵针+推拿)、中医治疗方案Ⅳ组(杵针+电针+推拿)、中医治疗方案Ⅴ组(电针+推拿)。采用视觉模拟评分法(VAS)、改良日本骨科协会腰痛评分(M-JOA)和Oswestry功能障碍指数问卷表(ODI评分)记录各组患者疼痛和功能障碍的情况,同时采用Prolo功能经济结果评定量表评价各组患者功能状况和医疗费用。结果:与西医组比较,中医治疗组治疗后VAS评分降低,ODI评分、M-JOA评分和Prolo评分升高,差异具有统计学意义(P<0.05)。各中医治疗组产出指标中,中医治疗IV组的产出A、B、C值最高,差异具有统计学意义(P<0.05)。各中医治疗组综合效率值均小于1,即DEA不是有效单元;各组收益情况均为递减;中医治疗IV组为最优方案,C2R模型和BC2模型下,中医治疗IV组的效率值分别为0.32和0.39,均优于其他方案。在各中医治疗组松弛变量分析后,中医治疗IV组的各项产出指标最高。结论:中医治疗组优于西医对照组;中医治疗组在VAS评分与Prolo评分的改善值更优,西医对照组在改善ODI评分方面更具有优势;最优方案是杵针+电针+推拿,因此腰椎间盘突出症最优的中医适宜性方案是杵针+电针+推拿治疗,值得临床推广运用。

Objective:To observe the therapeutic efficacy of pestle needle on lumbar disc herniation and its effect on pain score.Methods:A total of 240 patients who were diagnosed with lumbar disc herniation and met the criteria of this study(based on the inclusion and exclusion criteria)were randomly divided into traditional Chinese medicine(TCM)-treated group and Western medicine control(WMC)group(treated with modern rehabilitation therapy)according to the order of visiting the hospital and Doll’s random table for clinical cases.The TCM-treated group was subdivided into TCM I-treated group(pestle needle),TCM II-treated group(pestle needle+electroacupuncture),TCM III-treated group(pestle needle+massage),TCM IV-treated group(pestle needle+electroacupuncture+massage),and TCM V-treated group(electroacupuncture+massage).The Visual Analogue Scale(VAS),Modified Japanese Orthopaedic Association(M-JOA)Score,and Oswestry Disability Index(ODI)were used to evaluate the pain and dysfunction in each group.The Prolo Functional Economic Rating Scale(Prolo Scale)was used to evaluate the functional status and medical expenses of the patients in each group.Results:Compared with the WMC group,the TCM-treated group had a significantly reduced VAS score but significantly increased ODI score,M-JOA score,and Prolo score(all P<0.05).As for the output indices of each TCM-treated group,the TCM IV-treated group had the highest output of A,B,and C values,with significant differences as compared with other groups(P<0.05).The overall efficiency value of each TCM-treated group was less than 1,indicating that the data envelopment analysis(DEA)was not an effective unit;the benefit of each group was decreasing;the regimen of the TCM IV-treated group proved to be the optimal.Under the C2 R model and the BC2 model,the efficiency values of the TCM IV-treated group were 0.32 and 0.39,respectively,which were superior to those of other regimens.In the slack variable analysis of each TCM-treated group,the output indices of the TCM IV-treated group were the highest.Conclusion:The TCM-treated group is superior to the WMC group,the former has greater improvements in VAS score and Prolo score,and the latter shows more advantages in improving ODI score.The optimal regimen is pestle needle+electroacupuncture+massage,which is also the optimal regimen suitable for TCM-based treatment of lumbar disc herniation,and shows promise for clinical application.