“筋骨并重”在“腰腹联合”手法治疗退行性腰椎滑脱症中的应用分析

The application of the theory of “equal emphasis on muscles and bones” in the treatment of degenerative lumbar spondylolisthesis by “combined lumbar and abdominal” manipulation

退行性腰椎滑脱症(Degenerative Lumbar Spondylolisthesis,DLS)是脊柱的一种退行性疾病,临床多采用保守治疗,其中手法是DLS临床治疗的重要手段之一,疗效显著。基于西医认为的DLS是因脊柱系统不稳定所致,而脊柱的稳定性是动态平衡和静态平衡的联合作用,以及中医骨伤学认为其病机为“骨错缝、筋出槽”的筋骨失衡观点,赵明宇主任医师将中医经络学理论、现代解剖学理论与DLS相结合,在此基础上创新性地提出了“腰腹联合”手法治疗DLS。赵明宇主任医师认为“脊柱稳定性”与“筋骨平衡”具体而论是以筋(肌肉)、骨(椎体)为主,即“筋骨并重”;筋(肌肉)不仅仅为腰背部的,腹部肌群亦尤为重要。“腰腹联合”手法治疗DLS患者的根本目的是恢复其筋骨平衡,有效提高脊柱稳定性。具体操作是以调节滑脱椎体,改善腰、腹肌群,恢复筋骨的平衡等为关键途径。文章从中西医对DLS的认识、“筋骨并重”理论的概述、“筋骨并重”在“腰腹联合”手法治疗DLS中的应用分析、“腰腹联合”手法治疗DLS的具体应用四个方面详细论述,以期为临床手法治疗DLS诊疗模式的构建提供思路。

Degenerative lumbar spondylolisthesis(DLS) is a degenerative disease of the spine, which is mostly treated clinically by conservative treatment, of which manipulation is one of the important tools in the clinical treatment of degenerative lumbar spondylolisthesis with remarkable efficacy. Based on the Western medical view that DLS is caused by the instability of the spinal system, and that the stability of the spine is a combination of dynamic and static equilibrium, as well as the TCM orthopedic view that the pathogenesis is a tendon-bone imbalance of “bone misalignment and tendon out of groove”, Dr. ZHAO Mingyu, a chief physician, has combined TCM meridian theory, modern anatomical theory and DLS, and on this basis, Dr. ZHAO has innovatively proposed the “combined lumbar and abdominal” manual therapy. Dr. ZHAO Mingyu believes that “spinal stability” and “tendon and bone balance” are mainly based on tendons(muscles) and bones(vertebrae), that is, “equal emphasis on muscles and bones”;tendons(muscles) are not only for the low back, the abdominal muscles are also particularly important. The fundamental purpose of “combined lumbar and abdominal” manual therapyt for patients with DLS is to restore the balance of the tendons and bones and effectively improve spinal stability;the specific operation is to adjust the slipped vertebrae, improve the lumbar and abdominal muscle groups, and restore the balance of the tendons and bones as the key way. This paper discusses in detail the understanding of DLS in TCM and Western medicine, the overview of the theory of “equal emphasis on muscles and bones”, the application of “equal emphasis on muscles and bones” in the treatment of DLS by the “combined lumbar and abdominal” manual therapy, and the specific application of the “combined lumbar and abdominal” technique in the treatment of DLS, in order to provide ideas for the construction of a clinical treatment model by manipulation for DLS.