定点两步疗法治疗巨大型腰椎间盘突出症的临床康复效果观察

Observation on the clinical rehabilitation effect of fixed-point two-step therapy on giant lumbar disc herniation

目的探索定点两步法治疗巨大型腰椎间盘突出症的方法和临床康复效果。方法选取2018年1月—2019年2月在北京市大兴区中西医结合医院骨伤科住院的符合巨大型腰椎间盘突出症诊断160例患者,采用随机数字表法分为治疗组和对照组,每组80例。治疗组采用责任定点侧扳手法联合悬浮式牵引治疗,对照组采用按揉手法联合悬浮式牵引治疗。比较两组患者临床疗效,两组治疗前后视觉模拟评分(VAS)、日本骨科协会评估治疗分数(JOA)、关节活动度(ROM)以及刺激神经根皮肤节段支配区所记录的皮节体感诱发电位(DSEP)差异。结果与对照组比较,治疗组总有效率升高,差异有统计学意义(P<0.05)。两组治疗后VAS低于治疗前,且治疗组低于对照组,差异有统计学意义(P<0.05);两组治疗后JOA评分高于治疗前,且治疗组高于对照组,差异有统计学意义(P<0.05)。两组治疗后ROM显著高于治疗前,且治疗组高于对照组,差异有统计学意义(P<0.05)。两组治疗后体感诱发电位DSEP-P40波潜伏期值低于治疗前,且治疗组低于对照组,差异有统计学意义(P<0.05)。结论应用定点两步法治疗巨大型腰椎间盘突出症,具有较好临床康复效果。

Objective To explore the method and clinical rehabilitation effect of the fixed-point two-step method to treat huge lumbar disc herniation.Methods From January 2018 to February 2019,a total of 160 patients who were hospitalized in the Department of Orthopedics and Traumatology of the Daxing District Hospital of Integrated Traditional Chinese and Western Medicine in Beijing were selected and they were divided into treatment group and control group by random number table method,with 80 cases in both groups.The treatment group was treated with the responsibility fixed-point side wrench method combined with suspension traction,while the control group was treated with massage manipulation combined with suspension traction.The clinical efficacy,the visual analogue scale(VAS),the Japanese orthopaedic association assessment treatment score(JOA),rang of motion(ROM),and skin segmental somatosensory evoked potential(DSEP)recorded in the skin segment innervation area of the stimulated nerve root before and after treatment were compared.Results Compared with the control group,the total effective rate of the treatment group was increased,and the difference was statistically significant(P<0.05).The VAS of the two groups after treatment were lower than those before treatment,while the treatment group was lower than the control group,and the differences were statistically significant(P<0.05);the JOA scores of the two groups after treatment were higher than before treatment,and the treatment group was higher than the control group,and the differences were statistically significant(P<0.05).The joint range of motion of the two groups after treatment were significantly higher than those before treatment,while the treatment group was higher than the control group,and the differences were statistically significant(P<0.05).The latency value of the somatosensory evoked potential DSEP-P40 wave after treatment between the two groups were lower than those before treatment,while the treatment group was lower than the control group,and the differences were statistically significant(P<0.05).Conclusion The application of fixed-point two-step method to treat giant lumbar disc herniation has a good clinical rehabilitation effect.