基于Pfirrmann分级观察枳壳甘草汤治疗腰椎间盘突出症的临床疗效

Clinical Efficacy of Zhike Gancao Decoction in the Treatment of Lumbar Disc Herniation Based on Pfirrmann Classification

[目的]基于Pfirrmann分级观察枳壳甘草汤治疗腰椎间盘突出症的疗效,并分析其对预后的影响。[方法]将2016年1月1日至2018年12月31日收治的126例瘀水互结型腰椎间盘突出症患者按随机数字表法分为对照组(63例,脱落7例)和治疗组(63例,脱落6例),再结合影像学,对各组患者进行Pfirrmann分级。对照组予塞来昔布胶囊口服,每次0.2 g,1次/d;地奥司明片口服,每次0.9 g,2次/d,并嘱患者行腰背肌功能锻炼。治疗组在对照组的基础上配合枳壳甘草汤加减口服,1剂/d。两组疗程均为6周。分别于治疗前、治疗后1个月和治疗后24个月随访,运用疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、日本骨科协会(Japanese Orthopaedic Association,JOA)下腰痛量表评分、中医证候评分评估临床疗效;通过X线九分法对治疗后24个月的腰椎侧位片进行评分,并结合治疗前的Pfirrmann分级,观察椎间盘退变与疗效间的联系。[结果]治疗后24个月,所有患者的JOA、VAS评分,ODI,瘀水互结证评分,以及Ⅳ型患者的X线九分法评分与治疗前比较均有所改善,且差异有统计学意义(P<0.05)。组间比较中,治疗组患者瘀水互结证评分优于对照组,差异有统计学意义(P<0.01);具体分型而言,除JOA评分外,治疗组Ⅳ型患者的其余各项评分优于对照组Ⅳ型患者,差异均具有统计学意义(P<0.05);同一组内Ⅳ型患者的JOA、VAS评分与Ⅰ~Ⅲ型患者比较,差异有统计学意义(P<0.05,P<0.01)。[结论]在口服西药和运动疗法的基础上,采用枳壳甘草汤内服治疗腰椎间盘突出症,近期能改善腰腿疼痛等症状;对于严重椎间盘退行性改变的患者,远期能稳定病情,减缓疾病进展。

[Objective]To observe the efficacy of Zhike Gancao Decoction in the treatment of lumbar disc herniation(LDH)based on Pfirrmann classification and analyze its effect on prognosis.[Methods]One hundred and twenty-six patients with LDH of stasis and water interconnection type admitted from January 1,2016 to December 31,2018 were divided into control group(63 cases,7 cases of detachment)and treatment group(63 cases,6 cases of detachment)according to the random number table method,and then Pfirrmann grading was performed for each group in combination with imaging.The control group was given Celecoxib capsule orally,0.2 g each time,once a day,and Diosmin tablets orally,0.9 g each time,twice a day,and the patients were instructed to perform functional exercises for the low back muscles.In treatment group,on the basis of control group,Zhike Gancao Decoction was given orally with the addition and reduction of 1 dose/d.The duration of treatment for both groups was 6 weeks.The clinical efficacy was evaluated by using pain visual analogue(VAS)score,Oswestry dysfunction index(ODI),Japanese Orthopaedic Association(JOA)lower back pain scale,and Chinese medicine syndrome score at before,1 month and 24 months after treatment,respectively;the lumbar lateral radiographs at 24 months after treatment were scored by X-ray nine-point scale and combined with Pfirrmann grading before treatment to observe the association between disc degeneration and efficacy.[Results]Twenty-four months after treatment,all patients’JOA and VAS scores,ODI index,stasis and water intercourse index scores,and X-Ray nine-point scale of typeⅣpatients were improved compared with those before treatment,and the differences were statistically significant(P<0.05).In the comparison between the two groups,the differences in the scores of stasis and water intercourse were statistically significant(P<0.01),and the treatment group was better than the control group.In terms of specific subtypes,except for the JOA score,the differences in all the scores of typeⅣpatients in treatment group were statistically significant(P<0.05),and the treatment group was better than the control group.The differences were statistically significant(P<0.05,P<0.01),when comparing the JOA,VAS score of typeⅣpatients with those of typeⅠtoⅢpatients within the same group.[Conclusion]On the basis of oral western medicine and exercise therapy,the internal treatment of LDH with ZhiKe Gancao Decoction can relieve symptoms such as back and leg pain in the near term,and stabilize the disease and slow down its progression in the long term in patients with severe degenerative disc changes.