中药熏蒸联合体外冲击波治疗气滞血瘀型腰椎间盘突出症的临床疗效观察

Recent Clinical Observation on Treatment of Qi Stagnation and Blood Stasis Lumbar Disc Herniation by Traditional Chinese Medicine Smoked Washing Combined with Extracorporeal Shockwave Therapy

目的观察中药熏蒸联合体外冲击波治疗腰椎间盘突出症疗效。方法120例均为福建中医药大学附属漳州中医院骨伤科就诊的腰椎间盘突出症患者,按随机数字表法分为中药熏蒸组(A组)、体外冲击波组(B组)、联合组(C组),每组40例,记录3组患者治疗前、治疗20天后的椎间盘Pfirrmann分级情况、视觉模拟评分(VAS)及日本骨科协会(JOA)评分变化,结合改良MacNab疗效的优良率评定治疗效果。结果3组治疗前VAS、JOA评分及椎间盘Pfirrmann分级情况比较,差异均无统计学意义(P>0.05),治疗后3组的VAS、JOA评分均低于治疗前(P<0.05),且C组VAS、JOA评分的改善率优于A、B组(P<0.05)。治疗后3组改良MacNab疗效的优良率差异有统计学意义(P<0.05),C组的优良率(92.5%)最高。3组治疗前后椎间盘Pfirrmann分级比较,差异无统计学意义(P>0.05)。治疗后椎间盘Pfirrmann分级与VAS、改良MacNab疗效均无相关性。治疗过程中3组均未见严重不良反应。结论中药熏蒸联合体外冲击波治疗腰椎间盘突出症能有效缓解疼痛,改善腰椎功能活动,但对椎间盘退变的Pfirrmann分级无影响。

Objective To observe the clinical effect of Chinese medicine fumigation combined with extracorporeal shockwave therapy(ESWT)on lumbar disc herniation.Methods Totally 120 patients with lumbar disc herniation treated at the Department of Orthopedics and Traumatology,Zhangzhou Hospital of Traditional Chinese Medicine(TCM),Fujian University of TCM were assigned to three groups according to random number table:TCM fumigation group(A group),ESWT group(B group),and combined group(C group),40 patients in each group.Changes of the Pfirrmann grading,Visval Analogue Score(VAS)and Japanese Orthopaedic Association(JOA)scores before and after treatment were recorded.And the good rate of modified MacNab efficacy grading were comined to evaluate the treatment effects.Results There was no significant difference in pretreatment VAS,JOA,and disc Pfirrmann grading standard among the three groups(P>0.05).After treatment the VAS score and JOA score of the three groups were lower than those before treatment(P>0.05).The improvement of VAS score and JOA score in C group was better than that in A group and B group respectively(all P<0.05).After treatment there were statistical differences in the good rate of modified MacNab efficacy grading among the three groups(P<0.05),and the good efficacy rate of group C was the highest(92.5%).There was no significant difference in the Pfirrmann grading standard between before and after treatment in the three groups(P>0.05).There was no correlation among VAS grading or modified MacNab curative effect.No serious adverse reactions occurred in the 3 groups during the treatment.Conclusion Chinese medicine fumigation combined with ESWT for lumbar disc herniation effectively relieved pain and improved lumbar motion,but it had no effect on the Pfirrmann grading of disc degeneration.