施氏脊柱平衡手法结合筋骨导引术治疗中老年腰椎间盘突出症的多中心随机对照临床研究

A multicenter randomized controlled study for treatment of middle-aged and old-aged lumbar disc herniation by Shi-style spine balance manipulation combined with bone and muscle guidance

目的 观察施氏脊柱平衡手法结合筋骨导引术治疗中老年腰椎间盘突出症的临床疗效。方法 将4个分中心的144例中老年腰椎间盘突出症患者随机分为试验组和对照组,每组72例,试验组予施氏脊柱平衡手法结合筋骨导引术,对照组予骨盆牵引结合腰背肌康复训练;施氏脊柱平衡手法、骨盆牵引疗程为4周,筋骨导引术、腰背肌康复训练疗程为6个月。比较治疗前及治疗2周、4周、3个月、6个月时疼痛视觉模拟评分(VAS)、日本骨科学会(JOA)评分、Oswestry功能障碍指数(ODI),以及治疗前、治疗6个月时脊柱骨盆矢状位参数的变化情况。结果 (1)试验过程中,试验组剔除1例,对照组剔除2例,最终完成试验者试验组71例,对照组70例。(2)试验组、对照组总有效率分别为91.55%、88.57%,试验组临床疗效优于对照组(P<0.05)。(3)随着治疗时间的延长,两组VAS评分逐渐降低(F=307.785,P<0.001),治疗2周、4周、3个月、6个月时组间比较,试验组VAS评分低于对照组(P<0.05)。(4)随着治疗时间的延长,两组JOA评分逐渐升高(F=316.774,P<0.001);治疗3个月、6个月时组间比较,试验组JOA评分高于对照组(P<0.05)。(5)随着治疗时间的延长,两组ODI值逐渐降低(F=1328.008,P<0.001);治疗2周、4周时组间比较,试验组ODI值低于对照组(P<0.05)。(6)治疗后,两组脊柱骨盆矢状位参数均未见明显改变(P>0.05),组间比较,上述参数差异亦无统计学意义(P>0.05)。结论 施氏脊柱平衡手法结合筋骨导引术治疗中老年腰椎间盘突出症疗效满意,能显著缓解疼痛症状,提升躯体功能,改善患者的生活质量,其疗效不劣于骨盆牵引结合腰背肌康复训练。

Objective To observe the clinical efficacy of Shi-style spine balance manipulation(SBM)combined with muscle and bone guidance(MBG) in the treatment of lumbar disc herniation(LDH) of the middle-aged and elderly patients.Methods Totally 144 middle-aged and elderly patients with lumbar disc herniation from four sub-centers were randomly divided into a treatment group(n=72)and a control group(n=72). The treatment group was given Shi-style spine balance manipulation combined with muscle and bone guidance,and the control group was given pelvic mechanical traction combined with rehabilitation training of lumbar and back muscles. The treatment of Shi-style spine balance manipulation and pelvic traction lasted 4 weeks,while the muscle and bone guidance as well as the rehabilitation training of lumbar and back muscles lasted 6 months. The visual analogue scale(VAS)scores,Japanese Orthopaedic Association(JOA) scores,Oswestry Disability Index(ODI),and the changes of spinal-pelvic sagittal parameters were compared before treatment and at 2,4,12,24 weeks of treatment,respectively.Results (1)During the trial,one case was excluded from the test group and two cases were excluded from the control group. Finally,71 cases completed the trial in the treatment group and 70 cases in the control group.(2)The total effective rate was 91.55% in the treatment group and88.57% in the control group. The clinical efficacy of the treatment group was better than that of the control group(P<0.05).(3)With the progress of treatment,the VAS scores gradually decreased in both groups(F=307.785,P<0.001),and the VAS scores of patients in the treatment group were significantly lower than those in the control group at 2,4,12,24 weeks of treatment(P<0.05).(4)With the progress of treatment,the JOA scores gradually increased in both groups(F=316.774,P<0.001),and the JOA scores in the treatment group were higher than those in the control group at 3 and 6 months of treatment(P<0.05).(5) With the progress of treatment,the ODI values of the two groups gradually decreased(F=1328.008,P<0.001),and the ODI values in the treatment group were lower than those in the control group at 2 and 4 weeks of treatment(P<0.05).(6) After treatment,there was no significant difference in the spinal-pelvic sagittal parameters in both groups(P>0.05),and the difference in the spinal-pelvic sagittal parameters between the two groups was not statistically significant(P>0.05).Conclusion Shi-style spine balance manipulation combined with muscle and bone guidance has achieved a satisfactory result in the treatment of lumbar disc herniation in the middle-aged and elderly people,which can significantly relieve pain,enhance somatic function and improve patients’ quality of life. Its clinical efficacy is not inferior to that of pelvic mechanical traction combined with rehabilitation training of lumbar and back muscles.