针刺联合乌麻膏外敷治疗腰椎间盘突出症的临床观察

Clinical Observation of Acupuncture Combined with External Application of Wuma Paste in the Treatment of Lumbar Disc Herniation

【目的】观察针刺联合乌麻膏治疗腰椎间盘突出症的临床疗效。【方法】将70例腰椎间盘突出症患者随机分为观察组和对照组,每组各35例。观察组给予常规针刺联合乌麻膏外敷治疗,对照组给予常规针刺联合空白乌麻膏外敷治疗。6次为1个疗程,连续治疗4个疗程。治疗4周后,评价2组临床疗效,观察2组患者治疗前后视觉模拟评分量表(VAS)评分、日本骨科协会评估治疗分数(JOA)评分的变化情况,比较2组患者治疗前后血清中基质金属蛋白酶1(MMP-1)、肿瘤坏死因子α(TNF-α)和白细胞介素6(IL-6)、白细胞介素17(IL-17)水平的变化情况。并评价2组的安全性及复发情况。【结果】(1)观察组总有效率为97.14%(34/35),对照组为82.86%(29/35)。观察组疗效优于对照组,差异有统计学意义(P<0.05)。(2)治疗后,2组患者的JOA评分与VAS评分均明显改善(P<0.05),且观察组在改善JOA评分与VAS评分方面均明显优于对照组,差异有统计学意义(P<0.05)。2组患者JOA评分与VAS评分治疗前后差值比较,差异有统计学意义(P<0.05)。(3)治疗后,2组患者的血清MMP-1、IL-17、IL-6、TNF-α含量明显改善(P<0.05),且观察组在改善血清MMP-1、IL-17、IL-6、TNF-α含量方面明显优于对照组,差异有统计学意义(P<0.05)。(4)治疗结束2个月后,从治疗有效的患者中随访,观察组随访成功30例,对照组随访成功25例。在随访成功的患者中,观察组复发1例,复发率为3.33%(1/30),对照组复发7例,复发率为28.00%(7/25)。观察组复发率明显低于对照组,差异有统计学意义(P<0.05)。(5)观察组与对照组治疗期间均无明显不良反应情况发生。2组患者的不良反应发生率比较,差异无统计学意义(P>0.05)。【结论】针刺结合乌麻膏治疗腰椎间盘突出症,能明显改善患者的临床症状,有效降低患者血清中MMP-1、IL-17、IL-6、TNF-α的水平,疗效显著。

Objective To observe the clinical efficacy of acupuncture combined with Wuma Paste in the treatment of lumbar disc herniation(LDH).Methods Seventy patients with LDH were randomly divided into the observation group and the control group,with 35 patients in each group.The observation group was given conventional acupuncture combined with external application of Wuma Paste,while the control group was given conventional acupuncture combined with external application of blank Wuma Paste.Six times of treatments constituted one treatment course,and the treatment covered 4 consecutive courses.After 4 weeks of treatment,the clinical efficacy of the two groups was evaluated.The changes in Visual Analogue Scale(VAS)scores and Japanese Orthopaedic Association(JOA)scores were observed in the two groups before and after treatment.The serum levels of matrix metalloproteinase 1(MMP-1),tumor necrosis factorα(TNF-α)and interleukin 6(IL-6),interleukin17(IL-17)were compared between the two groups before and after treatment.The safety and recurrence of the two groups were also evaluated.Results(1)The total effective rate of the observation group was 97.14%(34/35)and that of the control group was 82.86%(29/35).The efficacy of the observation group was superior to that of the control group,the difference being statistically significant(P<0.05).(2)After treatment,the JOA score and VAS score of the two groups were significantly improved(P<0.05),and the observation group was significantly superior to the control group in improving the JOA score and VAS score,the difference being statistically significant(P<0.05).The difference in D-value of the JOA score and VAS score between the two groups was statistically significant before and after treatment(P<0.05).(3)After treatment,the serum MMP-1,IL-17,IL-6and TNF-αlevels in the two groups were significantly improved(P<0.05),and the observation group was significantly superior to the control group in improving the serum MMP-1,IL-17,IL-6 and TNF-αlevels,the difference being statistically significant(P<0.05).(4)Two months after the end of treatment,the follow-up from patients with effective treatment was conducted,with 30 successful follow-up cases in the observation group and25 successful follow-up cases in the control group.Among the patients with successful follow-up,there was one case of recurrence in the observation group with a recurrence rate of 3.33%(1/30),and seven cases in the control group with a recurrence rate of 28.00%(7/25).The recurrence rate of the observation group was significantly lower than that of the control group,the difference being statistically significant(P<0.05).(5)There were no significant adverse reactions occurred in the observation group and the control group during the treatment period,and the difference in the incidence of adverse reactions between the two groups was not statistically significant(P>0.05).Conclusion Acupuncture combined with Wuma Paste has significant effect in improving the clinical symptoms of patients with LDH,and effectively reducing the levels of MMP-1,IL-17,IL-6 and TNF-αin serum of patients.