针刺联合运动疗法对腰椎间盘突出症患者镇痛作用、腰椎功能及炎性细胞因子的影响

Effect of Acupuncture plus Kinesiotherapy on Analgesia,Lumbar Function and Inflammatory Cytokines in Patients with Lumbar Intervertebral Disc Herniation

目的观察夹脊穴针刺联合运动疗法对腰椎间盘突出症患者腰腿疼痛、腰椎功能障碍及炎性反应的影响。方法将148例腰椎间盘突出症患者按随机数字表法分为西药组(74例,予以西药保守治疗+常规康复治疗)和针刺组(74例,予以针刺夹脊穴+运动康复疗法),对比分析西药组和针刺组的近期(随访3个月、6个月)和远期(随访12个月)临床疗效、腰腿疼痛(VAS评分)、炎性相关因子[白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)]、腰椎功能障碍指数(ODI)的差异。结果西药组和针刺组近期(随访3个月、6个月)治疗优良率比较差异无统计学意义(55.4%vs 58.1%;70.3%vs 73.0%;均P>0.05),但针刺组远期(随访12个月)治疗优良率高于西药组(77.0%vs 91.9%,P<0.05)。西药组和针刺组近期(随访3个月、6个月)和远期(随访12个月)的VAS评分、炎性因子(IL-6、TNF-α、hs-CRP)、ODI值均低于治疗前(P<0.05),且同一随访时刻点比较,针刺组均低于西药组(P<0.05)。结论针刺夹脊穴联合运动疗法可显著提升腰椎间盘突出症治疗的临床远期疗效,可降低机体炎性反应,改善患者腰腿疼痛症状和腰椎功能障碍症状。

Objective To investigate the effect of acupuncture at Huatuojiaji(Ex-B2)points plus kinesiotherapy on lumbar and leg pain,lumbar dysfunction and inflammatory reactions in patients with lumbar intervertebral disc herniation.Method One hundred and forty-eight patients with lumbar intervertebral disc herniation were allocated,using a random number table,to a Western medicine group(74 cases,conservative Western medication plus conventional rehabilitation treatment)and an acupuncture group(74 cases,acupuncture at Huatuojiaji points plus kinesiotherapy).The short-term(three-month and six-month follow-up)clinical therapeutic effects,the long-term(12-month follow-up)clinical therapeutic effects,lumbar and leg pain(VAS scores),inflammatory related factors(IL-6,TNF-α,hs-CRP)and the Oswestry Disability Index(ODI)scores were compared between the Western medicine and acupuncture groups.Result The excellent and good rate during short-term(three-month and six-month follow-up)had no significantly difference between the Western medicine and acupuncture groups(55.4%vs 58.1%and 70.3%vs 73.0%,both P>0.05),but the excellent and good rate during long-term(12-month follow-up)was higher in the acupuncture group than in the Western medicine group(77.0%vs 91.9%,P<0.05).During short-term(three-month and six-month follow-up)and long-term(12-month follow-up),the VAS score,inflammatory cytokines(IL-6,TNF-α,hs-CRP)levels and the ODI score decreased in the Western medicine and acupuncture groups compared with before treatment(P<0.05)and were lower in the acupuncture group than in the Western medicine group at the same follow-up time point(P<0.05).Conclusion Acupuncture at Huatuojiaji points plus kinesiotherapy can markedly improve the long-term clinical therapeutic effect on lumbar intervertebral disc herniation.It can reduce inflammatory reactions,relieve lumbar and leg pain and improve lumbar dysfunction in the patients.