针刺联合固肾逐瘀方治疗肝肾亏虚型腰椎间盘突出症疗效观察

Effect of administration of acupuncture stimulation combined with Gushen Zhuyu Decoction on lumbar function in patients with disc herniation

目的:观察针刺联合中药固肾逐瘀方治疗肝肾亏虚型腰椎间盘突出症(LDH)的临床疗效,并探讨部分作用机制。方法:147例LDH患者按照随机数字表法分为中药组、针刺组和联合组,每组49例。中药组予以固肾逐瘀方口服治疗,每日1剂;针刺组予以点、线、面、整体结合针法针刺治疗,每周治疗2次;联合组予以针刺联合中药治疗。各组均治疗4周。比较各组患者治疗前后疼痛视觉模拟量尺(VAS)评分、改良日本骨科协会问卷(M-JOA)评分、腰部活动范围(ROM)、腰部肌力,并比较各组患者血清肿瘤坏死因子α(TNF-α)、基质金属蛋白酶2(MMP-2)、Caspase-3、Caspase-9含量,对临床疗效进行评价。结果:治疗后各组患者VAS、M-JOA评分均较治疗前降低(P<0.01);联合组伸展、屈曲ROM较治疗前增大(P<0.01)。各组患者腰部屈肌、伸肌肌力较治疗前显著增加(P<0.01);血清TNF-α、MMP-2、Caspase-3、Caspase-9含量较治疗前显著降低(P<0.01)。联合组VAS、M-JOA评分均低于中药组和针刺组(P<0.01),伸展、屈曲ROM及腰部屈肌、伸肌肌力均大于中药组和针刺组(P<0.01),血清TNF-α、MMP-2、Caspase-3、Caspase-9含量低于中药组和针刺组(P<0.01)。联合组总有效率为93.88%(46/49),高于中药组的75.51%(37/49,P<0.05)和针刺组的71.43%(35/49,P<0.05)。结论:针刺联合固肾逐瘀方可缓解腰椎间盘突出症疼痛,改善腰背部肌肉力量和腰椎活动范围,降低血清TNF-α、MMP-2、Caspase-3、Caspase-9含量,更好地发挥治疗LDH的作用。

Objective To investigate the therapeutic effect of acupuncture stimulation combined with administration of“Gushen Zhuyu Tang”(decoction for consolidating kidney to eliminate blood stasis,DCKEBS)in the treatment of lumbar disc herniation(LDH)patients.Methods A total of 147 patients with LDH were randomly divided into DCKEBS,acupuncture and DCKEBS+acupuncture groups(n=49 cases in each group).The patients of the acupuncture group received a)acupuncture stimulation of Dazhui(GV14),Ganshu(BL18),Shenshu(BL23),Tianshu(ST25),Yanglingquan(GB34),etc.,b)fire needle pricking of the topical tendons,cord-like points,tender-points,c)row-needles stimulation of the attachment sites of muscles of the sacroiliac joint or crista iliaca,and d)acupotomy-debonding of the topical high-tension muscles,twice a week for 4 weeks.Those patients of the DCKEBS group were ordered to take DCKEBS[containing fried Yiyiren(Semen Coicis),Shanzhuyu(Fructus Corni),fried Baizhu(Rhizoma Astractylodis),Sangjisheng(Ramulus Loranthi),Duzhong(Cortex Eucommiae),Buguzhi(Fructus Psoraieae),etc.]150 mL,twice daily,continuously for 4 weeks,and those of the DCKEBS+acupuncture group received the combined treatment mentioned above in the acupuncture and DCKEBS groups.The pain severity was assessed by using visual ana-logue scale(VAS,0—10 points)and the modified Japan Orthopaedic Association questionnaire(M-JOA)score(0—30 points),separately,and the lumbar range of motion(ROM)and lumbar muscle strength were tested to evaluate the lumbar motor function.The levels of serum tumor necrosis factorα(TNF-α),matrix metalloproteinase-2(MMP-2),and apoptosis related factors Caspase-3 and Caspase-9 were assayed using ELISA.The total effective rates of the three groups were compared.Results After the treatment,the VAS and M-JOA scores,contents of serum TNF-α,MMP-2,Caspase-3 and Caspase-9 were significantly decreased(P<0.01),and the myodynamia of lumbar muscular flexor and extensor was considerably increased(P<0.01)in the three groups,and the ROM angles of lumbar extending and buckling were increased(P<0.01)in the DCKEBS+acupuncture group compared with pretreatment.Comparison among the 3 groups showed that the VAS and M-JOA scores,and serum TNF-α,MMP-2,Caspase-3 and Caspase-9 contents of the DCKEBS+acupuncture group were significantly lower than those of both DCKEBS and acupuncture groups(P<0.01),while the ROM angles of lumbar extending and buckling,and the myodynamia of lumbar muscular flexor and extensor were obviously higher in the DCKEBS+acupuncture group than those of the DCKEBS and acupuncture groups(P<0.01).The total effective rate was 93.88%(46/49)in the DCKEBS+acupuncture group,higher than 75.51%(37/49)in the DCKEBS group and 71.43%(35/49)in the acupuncture group(P<0.05).Conclusion Acupuncture combined with DCKEBS can relieve pain,improve lumbar muscle strength and lumbar movement function,and reduce serum TNF-α,MMP-2,Caspase-3 and Caspase-9 levels in LDH patients.