三痹汤加减联合脊柱微调整脊手法治疗椎间盘源性腰痛急性期的临床观察

Clinical Study on the Treatment of Intervertebral Discogenic Low Back Pain in Acute Stage with Modified Sanbi Decoction Combined with Spinal Micro-adjustment Manipulation

目的 观察三痹汤加减联合脊柱微调整脊手法治疗椎间盘源性腰痛(DLBP)急性期的临床效果并探讨其作用机制。方法 66例患者随机分为观察组与对照组各33例。对照组予镇痛、营养神经等西医常规治疗措施,观察组在对照组基础上予以三痹汤加减联合脊柱微调整脊手法治疗。比较两组患者治疗前、治疗2个疗程后的疼痛程度(VAS)、Oswestry功能障碍指数(ODI)、腰部活动度以及炎症指标,观察两组综合疗效、不良反应发生情况的差异性。结果 两组治疗前VAS、ODI评分、前屈、后伸、侧屈、旋转角度、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平比较,差别均不大(均P>0.05)。两组治疗后VAS和ODI评分与治疗前比较均下降(均P<0.05),且观察组治疗后VAS和ODI评分均低于对照组(均P<0.05)。两组治疗后前屈、后伸、侧屈、旋转角度与治疗前比较均增加(均P<0.05),且观察组治疗后前屈、后伸、侧屈、旋转角度均高于对照组(均P<0.05)。两组治疗后TNF-α、IL-6水平与治疗前比较均下降(均P<0.05),且观察组治疗后TNF-α、IL-6水平均低于对照组(均P<0.05)。观察组总有效率为93.94%,高于对照组的72.73%(P<0.05)。两组治疗期间均未出现严重不良反应。结论 三痹汤加减联合脊柱微调整脊手法治疗DLBP急性期的临床疗效良好,有助于缓解患者的疼痛程度和腰椎功能障碍情况,改善腰椎活动度,降低血清TNF-α、IL-6水平。

Objective:To observe the clinical effect of modified Sanbi Decoction combined with spinal micro-adjustment manipulation in the treatment of acute stage of discogenic low back pain(DLBP). Methods:A total of66 patients with DLBP in the acute stage of cold-dampness obstruction type were randomly divided into the observation group and the control group,33 cases in each group. The control group was given conventional western medicine treatment measures such as analgesia and nutrition for nerves,and the observation group was given the modified Sanbi Decoction combined with spinal micro-adjustment manipulation on the basis of the control group. The visual analog scale(VAS)pain level,oswestry disability index(ODI),lumbar range of motion and inflammatory indexes were compared between the two groups before and after 2 courses of treatment,and the differences in comprehensive efficacy and adverse reactions between the two groups were observed. Results:There were no significant differences in VAS,ODI scores,flexion,extension,lateral flexion,rotation angles,TNF-α and IL-6 levels between the two groups before treatment(all P >0.05). The VAS and ODI scores of the two groups after treatment were decreased compared with those before treatment(both P< 0.05),and the VAS and ODI scores of the observation group after treatment were lower than those of the control group(both P< 0.05). The angles of flexion,extension,lateral flexion and rotation in the two groups after treatment were all increased compared with those before treatment(all P< 0.05),and the angles of flexion,extension,lateral flexion and rotation in the observation group were higher than those in the control group after treatment(all P< 0.05). The levels of TNF-α and IL-6 in the two groups after treatment were lower than those before treatment(all P< 0.05),and the levels of TNF-α and IL-6in the observation group after treatment were lower than those in the control group(both P< 0.05). The total effective rate in the observation group was 93.94%,which was higher than 72.73% in the control group(P< 0.05).There were no serious adverse reactions in the two groups during treatment. Conclusion:Modified Sanbi Decoction combined with spinal micro-adjustment manipulation has a good clinical effect in the treatment of acute DLBP,which is helpful to relieve pain and lumbar dysfunction,improve lumbar mobility,and reduce serum TNF-α and IL-6 levels.