从脾论治腰椎间盘突出症的临床观察

Clinical Observation on the Treatment of Lumbar Disc Herniation from Spleen

目的:基于从脾论治腰椎间盘突出症的思路,评价健脾化痹方治疗腰椎间盘突出症(脾虚湿滞证)的有效性和安全性。方法:选取50例腰椎间盘突出症(脾虚湿滞证)患者,采取随机数字表法随机分为观察组和对照组,每组25例;观察组予健脾化痹方口服,对照组予洛索洛芬钠片口服,连续治疗4周。对比治疗前后及3个月后数字等级评定量表(NRS)疼痛评分、EuroQol 5维问卷5级量表(EQ-5D-5L)评分、Oswestry功能障碍指数(ODI)评分、健康调查简表(SF-36)评分及中医疗效变化情况,同时记录不良事件发生情况。结果:观察组腰痛、臀痛NRS评分、EQ-5D-5L效应指数值、ODI评分及SF-36总评分相比治疗前有明显改善,差异有统计学意义(P<0.05);对照组躯体健康(PCS)评分相比治疗前有明显改善,差异有统计学意义(P<0.05)。随访3个月观察组NRS评分、EQ-5D-5L评分、ODI评分及SF-36评分相比治疗前明显改善,差异有统计学意义(P<0.05)。对照组除臀痛NRS评分及精神健康(MCS)评分外其他评分相比治疗前明显改善,差异有统计学意义(P<0.05)。中医疗效方面,治疗后观察组和对照组总有效率分别为88%和64%,随访3个月观察组和对照组总有效率分别为92%和68%,两组之间差异有统计学意义(P<0.05)。结论:基于从脾论治腰椎间盘突出症的理念,健脾化痹方可有效改善腰椎间盘突出症(脾虚湿滞证)患者的疼痛、腰椎功能、生存质量及中医证候。

Objective:To evaluate the efficacy and safety of Jianpi Huabi decoction in treating lumbar disc herniation(spleen deficiency and dampness stagnation syndrome)based on the concept of treating lumbar disc herniation from the spleen.Methods:50 patients with lumbar intervertebral protrusion(syndrome of spleen deficiency and dampness stagnation)were randomly divided into an observation group and a control group,with 25 cases in each group.Jianpi Huabi decoction was taken in the observation group,and losuprofin sodium tablets were taken orally for 4 weeks in the control group.The changes of numerical rating scale(NRS)pain score,EQ-5D-5L score,Oswestry disability index(ODI)score,SF-36 score,and traditional Chinese medicine efficacy before,after treatment and 3 months later were compared.The occurrence of adverse events were documented.Results:The NRS pain score,EQ-5D-5L efficacy index,ODI score,and SF-36 total score of the observation group patients showed significant improvement compared to before treatment(P<0.05).The physical component summary(PCS)score of the control group patients showed significant improvement compared to before treatment(P<0.05).After 3 months,the NRS pain score,EQ-5D-5L score,ODI score,and SF-36 score of the observation group patients showed significant improvement compared to before treatment(P<0.05).The control group showed significant improvement in all scores except for the NRS score and mental component summary(MCS)score of buttock pain compared to before treatment(P<0.05).In terms of traditional Chinese medicine efficacy,the total effective rates of the observation group and the control group after treatment were 88%and 64%,respectively.After 3 months,the total effective rates of the observation group and the control group were 92%and 68%,respectively,with statistical significance between the two groups(P<0.05).Conclusion:Jianpi Huabi decoction can effectively improve the pain,lumbar dysfunction,quality of life and TCM syndrome of patients with LDH(spleen deficiency dampness stagnation syndrome)based on the concept of treating LDH from the spleen.