基于弓弦理论运用针刀联合手法治疗L4~5椎间盘突出症临床研究

Clinical Study on the Treatment of L4~5 Intervertebral Disc Herniation with Acupotomy Combined with Manipulation Based on Bowstring Theory

目的观察基于弓弦理论运用针刀联合手法治疗腰L4~5椎间盘突出症的临床疗效。方法60例腰椎间盘突出症患者随机分为对照组与治疗组各30例。对照组采用5次手法治疗,治疗组在前者的手法基础上,第1、3、5次治疗后运用针刀松解椎间盘突出侧及相邻上、下3处腰椎小关节。比较患者治疗首次、末次的临床疗效、患者治疗后患侧直腿抬高度数改善程度、X线影像的针刀疗效及治疗组密歇根州立大学(MSU)突出区域、突出程度分型治疗前后的视觉模拟量表(VAS)评分、日本骨科协会评估量表(JOA)评分。结果治疗组总有效率为90.00%,高于对照组的70.00%(P<0.05);治疗组首次、末次患者直腿抬高度数改善程度均优于对照组(P<0.05);X线疗效比较,治疗后两组均较治疗前改善,治疗组改善程度优于对照组(P<0.05);治疗组MSU突出程度分型治疗前后的VAS评分、JOA评分比较,结果为1、2、3度的VAS评分、JOA评分均较治疗前改善,差异有统计学意义(P<0.05);治疗组MSU突出区域分型治疗前后的VAS评分、JOA评分比较,MSU-AB、MSU-B、MSU-C的VAS评分、JOA评分均较治疗前改善,差异有统计学意义(P<0.05)。结论基于弓弦理论运用针刀联合手法治疗腰L4~5椎间盘突出症可以有效缓解患者的症状、改善椎间隙,疗效与突出部位有一定的关联性。

Objective:To observe the clinical efficacy of acupotomy combined with manipulation based on bowstring theory in the treatment of lumbar L4~5 intervertebral disc herniation.Methods:60 patients with lumbar intervertebral disc herniation were randomly divided into the control group and the treatment group,30 cases in each group.The control group received 5 manipulations,and the treatment group,on the basis of the former manipulation,received acupotomy to release the herniated side of the intervertebral disc and three adjacent upper and lower lumbar facet joints after the 1st,3rd,and 5th treatments.The clinical efficacy of the first and last treatment,the improvement degree of the patient′s straight leg lift on the affected side after treatment,the acupotomy efficacy on the X-ray images,and the MSU prominence area,prominence degree classification,VAS score,and JOA score of the treatment group before and after treatment were compared.Results:The total effective rate in the treatment group was 90.00%,which was higher than 70.00% in the control group(P<0.05);the improvement in the first and last patient′s straight leg lifts in the treatment group was better than that in the control group(P<0.05),After treatment,both groups were improved in terms of X-ray image efficacy compared with before treatment,and the improvement in the treatment group was statistically significant(P<0.05).the VAS scores and JOA scores according to the MSU prominence classification before and after treatment in the treatment group were compared,and the results showed that the VAS scores and JOA scores of grades 1,2,and 3 were improved compared with those before treatment,and the difference was statistically significant(P<0.05);the VAS scores and JOA scores of MSU-AB,MSU-B and MSU-C were all improved compared with those before treatment,and the difference was statistically significant(P<0.05).Conclusion:Based on the bowstring theory,the use of acupotomy combined with manipulation in the treatment of lumbar L_(4~5) intervertebral disc herniation can effectively relieve the symptoms and improvethe intervertebral space of the patients,and the curative effect is related to the protrusion position.