热敏灸联合推拿对腰椎间盘突出症患者TXB2、PGE2水平及腰椎功能的影响

Effect of Thermal Moxibustion Combined with Tuina on Levels of TXB and PGE and Its Influence to Lumbar Function in Patients with LDH

目的:观察热敏灸联合推拿治疗腰椎间盘突出症(LDH)对患者血浆血栓烷素B2(TXB2)、血清前列腺素E2(PGE2)水平及腰椎功能的影响。方法:将我院2018年1月—2019年6月收治的104例LDH患者,随机分为观察组、对照组,各52例。对照组给予推拿手法治疗,观察组在此基础上给予热敏灸治疗。两组均连续治疗4周。比较两组治疗后临床疗效,治疗前后视觉模拟疼痛(VAS)评分、日本骨科协会下腰痛量表(JOA)评分、Oswestry功能障碍指数(ODI)、直腿抬脚高度、炎性因子及血流流变学指标水平。结果:观察组总有效率为94.23%(49/52),显著高于对照组的78.85%(41/52),差异有统计学意义(P <0.05)。治疗后两组血浆TXB2、血清PGE2和血清肿瘤坏死因子-α(TNF-α)水平较治疗前降低,且观察组低于对照组(P <0.05);治疗后两组血浆粘度、高切全血粘度、低切全血粘度和红细胞压积均较治疗前降低,且观察组低于对照组,差异有统计学意义(P <0.05)。治疗后两组VAS评分均较治疗前降低,且观察组低于对照组,差异有统计学意义(P <0.05);两组JOA、ODI评分均较治疗前升高,且观察组高于对照组,差异有统计学意义(P <0.05);两组直腿抬脚高度均较治疗前升高,且观察组高于对照组,差异有统计学意义(P <0.05)。结论:采用热敏灸联合推拿治疗LDH,可抑制炎性因子释放,显著缓解疼痛,改善腰椎功能,提高临床疗效,其效果优于单纯推拿手法治疗。

Objective: To observe the effects of thermal moxibustion combined with Tuina on the levels of plasma Thromboxane B2( TXB2) and serum Prostaglandin E2( PGE2) and its influence to lumbar spine function in patients with lumbar disc herniation( LDH). Methods: A total of 104 patients with LDH were randomly divided into the observation group and the control group,with 52 cases in each group. The control group was treated with Tuina manipulation;on which basis,the observation group was also treated with thermal moxibustion. Both groups were treated for 4 weeks. Clinical efficacy,the scores of VAS,Japanese Orthopedic Association Low Back Pain Scale( JOA) and Oswestry Dysfunction Index( ODI),as well as the levels of straight leg lift height,inflammatory factors and blood rheological indexes were compared between the two groups after the treatment. Results: The total effective rate was 94. 23%( 49/52) in the observation group,which was significantly higher than 78. 85%( 41/52) in the control group( P < 0. 05). The levels of plasma TXB2,serum PGE2,and serum tumor necrosis factor-α( TNF-α) were significantly decreased after the treatment than those before the treatment in the two groups;of which the decreases in the observation group were more significant( P < 0. 05). The levels of plasma viscosity,high-cut whole blood viscosity,low-cut whole blood viscosity,and hematocrit were reduced in the two groups after the treatment compared to those before the treatment;of which the reductions in the observation group were more significant( P < 0. 05). The scores of VAS decreased and the scores of JOA and ODI increased after the treatment in the two groups;of which the improvements in the observation group were more significant than those in the control group( P < 0. 05). The straight leg lift height in the two groups were increased in the two groups after the treatment;of which the observation group was higher than the control group( P < 0. 05). Conclusion: Thermal moxibustion combined with Tuina can inhibit the release of inflammatory factors,significantly relieve pain,improve lumbar spine function,and improve clinical efficacy,which is superior to single Tuina therapy.