温督通脉隔药火疗法对腰椎间盘突出症患者腰椎功能、运动功能的影响

Impact of Wendu Tongmai fire therapy with prepared Chinese medicine on lumbar function and motor function in patients with lumbar disc herniation

目的 探讨温督通脉隔药火疗法对腰椎间盘突出症(LDH)患者腰椎功能、运动功能的影响,以期为临床相关治疗提供参考。方法 选取2021年10月—2022年10月贵州省黔南州中医医院收治的LDH患者60例为研究对象。采用随机数字表法分为常规针刺组、隔药火疗组,每组30例。常规针刺组患者进行常规针刺治疗,隔药火疗组在常规针刺组基础上进行温督通脉隔药火疗法治疗。比较2组患者治疗前后(治疗后为治疗2周后)中医证候、视觉模拟量表(VAS)、腰椎功能评分表(JOA)、Oswestry功能障碍指数问卷(ODI)、Fugl-Meyer评定量表(FMA)评分及5-羟色胺(5-HT)、P物质(SP)、神经肽Y(NPY)水平;治疗结束后比较2组患者治疗效果。结果 治疗前,2组患者中医证候中腰部疼痛、运动受限、下肢麻木评分比较,差异无统计学意义(P>0.05);治疗后,2组患者中医证候中腰部疼痛、运动受限、下肢麻木评分均低于治疗前,且隔药火疗组低于常规针刺组,差异均有统计学意义(P<0.05)。治疗前,2组患者5-HT、SP、NPY水平比较,差异无统计学意义(P>0.05)。治疗后,2组患者5-HT、SP、NPY水平均低于治疗前,且隔药火疗组低于常规针刺组,差异均有统计学意义(P<0.05)。治疗前,2组患者JOA、ODI、VAS评分及腰部关节活动度比较,差异无统计学意义(P>0.05)。治疗后,2组患者JOA评分及腰部关节活动度大于治疗前,且隔药火疗组大于常规针刺组,差异均有统计学意义(P<0.05);治疗后,2组患者ODI、VAS评分小于治疗前,且隔药火疗组小于常规针刺组,差异均有统计学意义(P<0.05)。治疗前,2组患者FMA中旋转、屈伸、侧屈评分比较,差异无统计学意义(P>0.05);治疗后,2组患者FMA中旋转、屈伸、侧屈评分高于治疗前,且隔药火疗组高于常规针刺组,差异均有统计学意义(P<0.05)。隔药火疗组患者治疗总有效率高于常规针刺组,差异有统计学意义(P<0.05)。结论 使用常规针刺联合温督通脉隔药火疗法对LDH患者进行治疗,能够减轻患者中医证候,减轻患者疼痛,改善患者腰椎功能、腰部功能障碍、腰部关节活动度、下肢运动功能状况,为LDH的临床治疗提供一定的参考依据。

Objective To investigate the impact of Wendu Tongmai fire therapy with prepared Chinese medicine on the lumbar function and motor function of patients with lumbar disc herniation(LDH),in order to provide a reference for clinical treatment.Methods A total of 60 LDH patients admitted to Qiannan Traditional Chinese Medicine Hospital from October 2021 to October 2022 were selected as the study participants.They were randomly allocated to a conventional acupuncture group and a fire therapy group,with 30 cases in each group.Patients in the conventional acupuncture group received conventional acupuncture treatment,while those in the fire therapy group underwent Wendu Tongmai fire therapy with prepared Chinese medicine on top of the conventional acupuncture.The study compared the TCM syndrome,visual analog scale(VAS),Japanese Orthopaedic Association(JOA)score on lumbar function,Oswestry Disability Index(ODI),Fugl-Meyer Assessment Scale(FMA)scores,and levels of 5-hydroxytryptamine(5-HT),substance P(SP),and neuropeptide Y(NPY)before and after treatment(2 weeks post-treatment)for both groups.The therapeutic effects of the two groups were compared after treatment.Results Before treatment,no statistically significant difference was observed in the TCM syndrome scores for lumbar pain,limited movement,and lower limb numbness between the two groups(P>0.05);after treatment,these scores were lower than before in both groups,with the fire therapy group showing significantly lower scores than the conventional acupuncture group(P<0.05).Before treatment,no statistically significant difference was noted in the levels of 5-HT,SP,and NPY between the two groups(P>0.05).After treatment,the levels of these substances were lower than before in both groups,with the fire therapy group showing significantly lower levels than the conventional acupuncture group(P<0.05).Before treatment,no statistically significant difference was found in the JOA,ODI,VAS scores,and lumbar joint mobility between the two groups(P>0.05).After treatment,the JOA scores and lumbar joint mobility were higher than before in both groups,with the fire therapy group showing significantly higher values than the conventional acupuncture group(P<0.05).Moreover,the ODI and VAS scores were lower than before,with the fire therapy group showing significantly lower values than the conventional acupuncture group(P<0.05).Before treatment,no statistically significant difference was found in the FMA scores for rotation,flexion,and lateral flexion between the two groups(P>0.05);after treatment,these scores were higher than before in both groups,with the fire therapy group showing significantly higher scores than the conventional acupuncture group(P<0.05).The overall response rate of treatment in the fire therapy group was significantly higher than in the conventional acupuncture group(P<0.05).Conclusion The combination of conventional acupuncture with Wendu Tongmai fire therapy with prepared Chinese medicine can alleviate the TCM syndrome in LDH patients,reduce pain,improve lumbar function,lumbar disability,lumbar joint mobility,and lower limb motor function,providing a certain reference for the clinical treatment of LDH.