颈腰椎整脊手法治疗腰椎间盘突出症临床研究

Clinical Study on the Treatment of Lumbar Disc Herniation by Cervical and Lumbar Spinal Manipulation

目的:观察颈腰椎整脊手法治疗腰椎间盘突出症(LDH)的临床疗效及对腰部功能、伸肌群生物力学特性的影响。方法:选取126例LDH患者,根据治疗方法不同分为治疗组(66例)与对照组(60例)。对照组给予针刺治疗,治疗组在对照组基础上给予颈腰椎整脊手法治疗。比较2组临床疗效及治疗前后中医证候积分、视觉模拟评分法(VAS)评分、日本骨科协会评估治疗分数(JOA)评分、伸肌群生物力学特性。结果:治疗组总有效率93.94%,高于对照组81.67%(P<0.05)。治疗后,2组中医证候积分、VAS评分均较治疗前降低(P<0.05),JOA评分升高(P<0.05),治疗组上述指标改善优于对照组(P<0.05)。治疗后,2组腰背屈伸比较治疗前减少(P<0.05),腰背伸状态下峰力矩、平均功率增加(P<0.05),治疗组治疗后上述指标改善优于对照组(P<0.05)。结论:颈腰椎整脊手法治疗LDH疗效确切,能减轻患者疼痛,改善腰部功能与腰椎平衡力,有利于患者腰背伸肌群生理功能及生物力学特性的恢复。

Objective:To observe the clinical effect of cervical and lumbar spinal manipulation in the treatment of lumbar disc herniation(LDH),and the influence on lumbar function,biomechanical characteristics of extensors.Methods:A total of 126 patients with LDH were selected,and divided into treatment group(66 cases)and control group(60 cases)according to different treatment methods.The control group was treated with acupuncture,and the treatment group was treated with cervical and lumbar spinal manipulation on this basis.Clinical effect,TCM syndrome scores,Visual Analogue Scale(VAS)scores,Japanese Orthopaedic Association(JOA)score,biomechanical characteristics of extensors were compared between the two groups.Results:The total effective rate in the treatment group(93.94%)was higher than that in the control group(81.67%)(P<0.05).After treatment,TCM syndrome scores and VAS scores of the two groups were decreased(P<0.05),and the JOA scores were increased(P<0.05).These indexes in the treatment group were better than those in the control group(P<0.05).After treatment,the ratios of lumbar flexion and extension in the two groups were decreased when compared with those before treatment(P<0.05),and the peak torque,average power in the lumbar extension state were increased(P<0.05),and the improvement of the above indexes in the treatment group was better than that in the control group(P<0.05).Conclusion:Cervical and lumbar spinal manipulation is effective in the treatment of LDH,which can reduce pain,improve lumbar function and lumbar balance,and is helpful for the recovery of physiological function and biomechanical characteristics of lumbar extensors.