杠杆定位手法治疗腰椎间盘突出症的临床研究

A clinical study of lever positioning manipulation for treatment of lumbar disc herniation

目的:探讨杠杆定位手法治疗腰椎间盘突出症(lumbar dis cherniation,LDH)的临床疗效。方法:LDH患者93例,随机分为杠杆定位组和腰椎斜扳组。2组患者均先采用柔筋手法松解肌肉痉挛,然后杠杆定位组采用杠杆定位手法治疗、腰椎斜扳组采用腰椎斜扳手法治疗。隔天治疗1次,6次为1个疗程,共治疗2个疗程。分别于治疗前和治疗结束后,采用日本骨科协会(Japanese Orthopedic Association,JOA)腰痛评分评价患者腰痛程度,采用Oswestry功能障碍指数(Oswestry disability index,ODI)评分评价患者腰椎功能,采用Seze氏法测量腰椎曲度值,采用Ferguson’s法测量腰骶角;并在治疗结束后,参照《中医病证诊断疗效标准》中LDH疗效评价标准评价综合疗效。对2组患者的评价和测量结果进行比较。结果:治疗前,2组患者JOA腰痛评分比较,差异无统计学意义[(11.23±1.49)分,(11.13±1.34)分,t=-0.354,P=0.724];治疗结束后,2组患者JOA腰痛评分均较治疗前增加,且杠杆定位组高于腰椎斜扳组[(21.29±3.98)分,(18.74±4.20)分,t=3.590,P=0.001]。治疗前,2组患者腰部ODI评分比较,差异无统计学意义[(46.17±2.00)分,(46.22±1.89)分,t=-0.117,P=0.907];治疗结束后,2组患者腰部ODI评分均较治疗前降低,且杠杆定位组低于腰椎斜扳组[(20.55±8.34)分,(26.80±10.36)分,t=-3.209,P=0.002]。治疗前,2组患者腰椎曲度值和腰骶角比较,组间差异均无统计学意义[(0.62±0.11)cm,(0.65±0.10)cm,t=-1.298,P=0.198;24.72°±1.14°,25.00°±0.99°,t=-1.251,P=0.214];治疗结束后,2组患者腰椎曲度值和腰骶角均增加,且杠杆定位组均大于腰椎斜扳组[(1.62±0.39)cm,(1.31±0.44)cm,t=3.571,P=0.001;33.17°±3.14°,30.91°±3.59°,t=3.571,P=0.002]。治疗结束后评价综合疗效,杠杆定位组治愈27例、好转17例、无效3例,腰椎斜扳组治愈10例、好转26例、无效10例,杠杆定位组综合疗效优于腰椎斜扳组(Z=-3.632,P=0.000)。结论:采用杠杆定位手法治疗LDH,可缓解腰部疼痛,恢复腰椎功能,改善腰椎曲度和稳定性,疗效优于腰椎斜扳手法。

Objective:To explore the clinical curative effects of lever positioning manipulation for treatment of lumbar disc herniation(LDH).Methods:Ninety-three LDH patients were enrolled in the study and were randomly divided into 2 groups.All patients in the 2 groups were treated with sinew softening manipulation for releasing muscle spasms;moreover,the patients were treated with lever positioning manipulation(lever positioning group)and lumbar oblique-pulling manipulation(lumbar oblique-pulling group)respectively.The manipulations were performed in patients of the 2 groups on alternate days for consecutive 2 courses of treatment,6 times for each course.The low back pain and lumbar function were evaluated by using Japanese Orthopedic Associations(JOA)low back pain scores and Oswestry disability index(ODI)scores respectively,and the lumbar curvature value and lumbosacral angle(LSA)were measured by using Seze's method and Ferguson?s method respectively before the treatment and after the end of the treatment.The clinical curative effects were evaluated according to the therapeutic effect evaluation standard of LDH which was extracted from Standard for diagnosis and therapeutic effectiveness evaluation of traditional Chinese medicine syndromes after the end of the treatment.The evaluation results and measurement results were compared between the 2 groups.Results:There was no statistical difference in JOA low back pain scores between the 2 groups before the treatment(11.23±1.49 vs 11.13±1.34 points,t=-0.354,P=0.724).The JOA low back pain scores increased after the end of the treatment compared to pretreatment in the 2 groups,and were higher in lever positioning group compared to lumbar oblique-pulling group(21.29±3.98 vs 18.74±4.20 points,t-3.590,P=0.001).There was no statistical difference in lumbar ODI scores between the 2 groups before the treatment(46.17±2.00 vs 46.22±1.89 points,t=-0.117,P=0.907).The lumbar ODI scores decreased after the end of the treatment compared to pretreatment in the 2 groups,and were lower in lever positioning group compared to lumbar oblique-pul­ling group(20.55±8.34 vs 26.80±10.36 points,t=-3.209,P=0.002).There was no statistical difference in lumbar curvature value and LSA between the 2 groups before the treatment(0.62±0.11 vs 0.65±0.10 cm,t=-1.298,P=0.198;24.72±1.14 vs 25.00±0.99 degrees,t=-1.251,P=0.214).The lumbar curvature value and LSA increased after the end of the treatment compared to pretreat­ment in the 2 groups,and were greater in lever positioning group compared to lumbar oblique-pulling group(1.62±0.39 vs 1.31±0.44 cm,t=3.571,P=0.001;33.17±3.14 vs 30.91±3.59 degrees,t=3.571,P=0.002).After the end of the treatment,27 patients were cured,17 good and 3 poor in lever positioning group;while 10 patients were cured,26 good and 10 poor in lumbar oblique-pulling group.The lever positioning group surpassed the lumbar oblique-pulling group in the clinical curative effects(Z=-3.632,P=0.000).Conclusion:The lever positioning manipulation can relieve low back pain,restore lumbar function and improve lumbar curvature and stabil­ity in treatment of LDH,and its curative effect is better than that of lumbar oblique-pulling manipulation.