整脊推拿手法联合针刺治疗腰椎间盘突出症的疗效观察

An observation on the efficacy of chiropractic and massage combined with acupuncture in treatment of lumbar disc herniation

目的观察整脊推拿手法联合针刺治疗腰椎间盘突出症(LDH)的疗效。方法选择中山市中医院2018年5月至2021年3月收治的LDH患者90例,采用随机数字表法将其分为观察组和对照组,每组45例。对照组采用整脊推拿手法治疗,观察组采用整脊推拿手法联合针刺治疗,两组疗程均为4周。比较两组临床疗效,治疗前后日本骨科协会(JOA)评分、视觉模拟量表(VAS)评分、生活质量评分,以及腰椎伸直过程、屈曲过程的平均表面肌电值(AEMG)。结果观察组临床总有效率高于对照组,差异有统计学意义(95.56%vs 80.00%;χ^(2)=5.075,P=0.024)。治疗后,两组JOA、SF-36评分均升高,VAS评分降低,与同组治疗前比较差异有统计学意义(P<0.05),且观察组变化较对照组更显著(P<0.05)。治疗后两组腰椎伸直过程的AEMG均升高,屈曲过程的AEMG均降低,与同组治疗前比较差异有统计学意义(P<0.05),且观察组变化较对照组更显著(P<0.05)。结论整脊推拿手法联合针刺治疗LDH可促进疼痛缓解,改善腰背肌力学效应和腰椎功能,提高生活质量,利于患者预后。

Objective To observe the efficacy of chiropractic and massage combined with acupuncture in treatment of lumbar disc herniation(LDH).Methods Ninety LDH patients admitted to Zhongshan Hospital of Traditional Chinese Medicine from May 2018 to March 2021 were selected and divided into observation group and control group by random number table method,with 45 cases in each group.The control group was treated with chiropractic and massage,and the observation group was treated with chiropractic and massage combined with acupuncture,with a treatment course of four weeks for both groups.The clinical efficacy was compared between the two groups.The Japanese Orthopaedic Association(JOA)score,the Visual Analogue Scale(VAS)score,the quality of life score,and the values of average surface electromyography(AEMG)during the process of lumbar extension and lumbar flexion were compared between the two groups before and after treatment.Results The total clinical effective rate of the observation group was higher than that of the control group,and the difference was statistically significant(95.56%vs 80.00%;χ^(2)=5.075,P=0.024).After treatment,the JOA and SF-36 scores increased and the VAS scores decreased in the two groups.Compared with those in the same group before treatment,the scores were significantly different after treatment(P<0.05),and the observation group had more significant changes than the control group(P<0.05).After treatment,the AEMG values increased during the lumbar extension process and decreased during the lumbar flexion process in the two groups.Compared with those in the same group before treatment,the AEMG values were significantly different after treatment(P<0.05),and the observation group had more significant changes than the control group(P<0.05).Conclusion Chiropractic and massage combined with acupuncture can promote pain relief,improve the mechanical effects of back muscles and lumbar spine function,improve the quality of life,and benefit the prognosis of the patients in the treatment of LDH.