推拿手法对腰椎间盘突出症的治疗效果及对腰椎椎管形态及椎间盘形态的影响

Curative effect of massage on lumbar disc herniation and its influence on lumbar canal and intervertebral disc morphology

目的观察推拿手法对腰椎间盘突出症的治疗效果及对腰椎椎管形态及椎间盘形态的影响。方法选取135例腰椎间盘突出症患者,随机分为两组,对照组(n=67)采用热敷治疗,实验组(n=68)在对照组基础上加用推拿手法进行治疗。比较两组患者治疗前后腰痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评分、日本骨科协会评估治疗(JOA)评分和腰椎椎管形态及椎间盘形态的磁共振成像(MRI)测量值,以及治疗有效率。结果治疗3周后,实验组VAS、ODI评分均低于对照组,JOA评分高于对照组,差异均有统计学意义(t分别=7.98、7.49、-7.94,P均<0.05)。治疗3周后,实验组MRI检查中腰椎间孔横径、前后径、侧隐窝宽度,和椎间盘厚度、膨出程度、突出程度、脱出程度与对照组比较,差异均无统计学意义(t分别=0.34、0.77、1.01、1.33、0.41、0.90、0.38,P均>0.05)。实验组患者临床治疗有效率为77.94%高于对照组的61.19%,差异有统计学意义(χ2=4.48,P<0.05)。结论对比单纯热敷治疗,中医推拿手法治疗腰椎间盘突出症可迅速缓解患者的腰痛症状,改善JOA、ODI评分,提高治疗有效率,但对患者MRI检查中腰椎椎管形态、椎间盘形态的测量值无明显改变。

Objective To observe the curative effect of massage on lumbar disc herniation(LHD)and its influence on lumbar canal and intervertebral disc morphology.Methods A total of 135 LHD patients were enrolled.The were divided into control group(n=67)and experiment group(n=68)by random number table method.The control group was received hot compress,the experiment group was received hot compress combined with massage.The score of visual analogue scale(VAS),Oswestry dysfunction index(ODI)and Japanese orthopaedic association(JOA)score,magnetic resonance imaging(MRI)measurements of lumbar canal and intervertebral disc morphology,and effective rate before and after treatment were compared between the two groups.Results After 3 weeks of treatment,scores of VAS and ODI in experiment group were lower than those in control group,while JOA score was higher than that in control group(t=7.98,7.49,-7.94,P<0.05).The differences in transverse diameter of lumbar intervertebral foramen,anteroposterior diameter,width of lateral recess,intervertebral disc thickness,bulge degree,protrusion degree and prolapse degree in experiment group and control group were not statistically significant at 3 weeks after treatment(t=0.34,0.77,1.01,1.33,0.41,0.90,0.38,P>0.05).The efficiency rate of experiment group was higher than that of control group(77.94%vs 61.19%)(χ2=4.48,P<0.05).Conclusion Compared with simple hot compress,massage can quickly alleviate low back pain in LHD patients,improve scores of JOA and ODI,and improve efficiency of treatment.But there is no significant change in MRI measurements of lumbar canal and intervertebral disc morphology.