“柔筋调脊”针法联合平衡针法治疗腰椎间盘突出症的临床研究

Clinical Study on Treatment of Lumbar Intervertebral Disc Herniation by Softening Tendons and Adjusting Spine Acupuncture Combined with Balance Acupuncture

目的 探讨“柔筋调脊”针法联合平衡针法治疗腰椎间盘突出症(Lumbar disc herniation, LDH)的疗效及对血清白细胞介素1β(Interleukin-1β,IL-1β)、重组人碱性金属蛋白酶-3(Matrix metal proteinase 3,MMP-3)及肿瘤坏死因子α(Tumor necrosis factor, TNF-α)水平影响。方法 选取河南中医药大学第二附属医院风湿病科收治的腰椎间盘突出症患者86例,随机分为对照组(43例,平衡针法)和治疗组(43例,“柔筋调脊”针法联合平衡针法),对照组给予平衡针法,主穴:臀痛穴和腰痛穴,配穴:膝痛穴和踝痛穴,治疗组联合给予“柔筋调脊”针法,取穴:腰阳关、委中、阳陵泉、华佗夹脊穴、环跳,项背部可加风池、大杼、颈百劳等穴位,对比两组治疗后临床疗效,采用改良Barthel指数评定量表(Modified barthel index, MBI)评价两组日常生活能力,采用视觉模拟疼痛评分法(Visual analogue scale, VAS)评价两组治疗前后疼痛度,采用日本骨科协会评估治疗分数(Japanese Orthopaedic Association score, JOA)评价两组治疗前后腰椎功能,治疗前后根据证候严重程度对两组主症和次症进行评分,采用酶联免疫吸附法(Enzyme-linked immuno sorbent assay, ELISA)测定血清IL-1β、MMP-3及TNF-α水平,采用健康调查量表(The MOS item short from health survey, SF-36)评价患者生活质量,对比两组治疗前后硬膜囊前后径、矢状径、神经根受压比值。结果 治疗后治疗组疗效较高(P<0.05);治疗后两组VAS评分明显降低,MBI评分和JOA评分明显升高(P<0.05);并且治疗组改善较多(P<0.05);治疗后两组中医证候评分明显降低(P<0.05);并且治疗组降低较多(P<0.05);治疗前两组血清IL-1β、MMP-3、TNF-α水平差异无统计学意义(P>0.05);治疗后两组血清IL-1β、MMP-3、TNF-α水平显著降低(P<0.05);并且治疗组降低较多(P<0.05);治疗后两组SF-36各条目评分明显升高(P<0.05);且治疗组升高较多(P<0.05);治疗后两组硬膜囊前后径、神经根受压比明显降低,硬膜囊矢状径明显升高(P<0.05);并且治疗组改善较明显(P<0.05)。结论 采用“柔筋调脊”针法联合平衡针法治疗LDH具有较好的疗效,能够降低血清IL-1β、MMP-3及TNF-α水平,减轻疼痛。

Objective To investigate the curative effect of softening tendons and adjusting spine acupuncture combined with balance acupuncture in the treatment of lumbar disc herniation(LDH)and the effect of serum levels of interleukin-1β(IL-1β),recombinant human basic metal proteinase 3(MMP-3)and tumor necrosis factorα(TNF-α).s Methods A total of 86 pa-tients with lumbar disc herniation admitted to the rheumatology department of the Second Affiliated Hospital of Henan University of Chinese Medicine were randomly divided into control group(43 cases,balance acupuncture)and treatment group(43 cases sof-tening tendons and adjusting spine acupuncture combined with balance acupuncture.The main points included anal and lumbar pain points.The matching points included knee pain points and ankle pain points).The treatment group was given the softening tendons and adjusting spine acupuncture acupuncture method and Yaoyangguan(DU3),Weizhong(BL40),Yanglingquan(GB34),Huatuo Jiaji acupoints(EX-B2),Huantiao(GB30),Fengchi(GB20),Dazhu(BL11),Jingbailao(EX-HN14)and other acupoints on the back of the body were added.The clinical efficacy of the two groups was compared,and the daily living a-bility of the two groups was evaluated by Modified Barthel Index(MBI).The visual analogue scale(VAS)was used to evaluate the pain degree of the two groups before and after treatment,and the Japanese Orthopaedic Association Score(JOA)before and after treatment to evaluate the lumbar function of the two groups.The main and secondary symptoms were scored according to the severity of syndrome before and after treatment.Serum levels of IL-1β,MMP3 and TNF-αwere measured by enzyme-linked immuno sorbent assay(ELISA).The MOS item short from health survey(SF-36)was used to evaluate the quality of life of the patients,and the ratio of anterior and posterior dural diameter,sagittal diameter and nerve root compression before and after treat-ment was compared between the two groups.s Results The therapeutic effect was higher in the treatment group(P<0.05).After treatment,VAS score was significantly decreased,MBI score and JOA score were significantly increased(P<0.05)and the scores of the treatment group improved more significantly(P<0.05).After treatment,the TCM syndrome score of the two groups decreased significantly(P<0.05)and the score of the treatment group decreased more significantly(P<0.05).There were no differences in serum levels of IL-1β,MMP-3 or TNF-αbetween the two groups before treatment(P>0.05).After treat-ment,the levels of serum levels of IL-1β,MMP-3 and TNF-αin two groups were significantly decreased(P<0.05)and the levels of the treatment group decreased more significantly(P<0.05).After treatment,the score of SF-36 items in both groups increased significantly(P<0.05)and the score of the treatment group increased significantly(P<0.05);After treatment,the anterior and posterior diameter of the dural sac and the compression ratio of the nerve root were significantly decreased,while the sagittal diameter of the dural sac was significantly increased(P<0.05).The improvement in treatment group was obvious(P<0.05).n Conclusion Softening tendons and adjusting spine acupuncture combined with balance acupuncture has a good therapeutic effect on lumbar disc herniation,and can reduce the levels of serum IL-1β,MMP-3 and TNF-αand alleviate the pain.