郑氏中医非手术疗法联合腹式呼吸训练治疗破裂型腰椎间盘突出症的临床疗效

Clinical Efficacy of Zheng′s Traditional Chinese Medicine Non-Surgical Therapy Combined with Abdominal Breathing Training in Treating Ruptured Lumbar Disc Herniation

目的探讨郑氏中医非手术疗法联合腹式呼吸训练对破裂性腰椎间盘突出(ruptured lumbar disc herniation,RLDH)患者矢状面平衡参数、疼痛、功能障碍和生活质量的影响。方法回顾性分析该院2017年10月—2020年3月389例破裂型腰椎间盘突出症患者资料,根据治疗方法不同分为对照组137例(西医常规治疗联合腹式呼吸训练)和观察组252例(郑氏中医非手术疗法联合腹式呼吸训练),比较治疗前、治疗2周疼痛情况、腰部功能障碍、生活质量,12个月后随访,比较矢状面平衡参数变化。结果治疗后,两组NRS评分均随时间延长而显著降低,各时间点差异有统计学意义,且观察组治疗1、2周及治疗后12个月NRS评分显著低于对照组(P<0.05);治疗后,两组JOA评分均随时间延长而显著升高,ODI指数均随时间延长而显著降低,各时间点差异有统计学意义(P<0.05),且观察组治疗2周及治疗后12个月JOA评分显著高于对照组,ODI指数低于对照组(P<0.05);治疗后,两组生理健康、心理健康、社会关系、环境方面生活质量评分均随时间延长而显著升高,各时间点差异有统计学意义(P<0.05),且观察组治疗2周及治疗后12个月各项生活质量评分显著高于对照组(P<0.05);治疗后12个月,观察组SS、LL较治疗前升高(P<0.05),PT较治疗前降低(P<0.05),观察组PI变化及对照组各项矢状面平衡参数变化均无统计学意义(P>0.05),且观察组SS、LL高于对照组(P<0.05),PT低于对照组(P<0.05);治疗2周期间以及治疗12个月后,两组无不良反应发生。结论郑式中医非手术疗法联合腹式呼吸训练在近期和远期均能减轻RLDH患者腰部疼痛,改善功能障碍、生活质量,并改善矢状面平衡。

Objective To investigate the effects of combination of Zheng′s traditional Chinese medicine non-surgical therapy and abdominal breathing training on sagittal balance parameters,dysfunction,pain and quality of life in patients with ruptured lumbar disc herniation(RLDH).Methods The data of 389 patients with RLDH who were treated in the hospital was retrospectively analyzed between October 2017 and March 2020.The selected patients were classified into control group(137 cases,conventional western medicine treatment combined with abdominal breathing training)and observation group(252 cases,Zheng′s traditional Chinese medicine non-surgical therapy combined with abdominal breathing training)in accordance with the differences in treatment methods.The pain status,lumbar dysfunction and quality of life before treatment and after 2 weeks of treatments and the changes in sagittal balance parameters after 12 months of follow-up were compared.Results After treatment,the numerical rating scale(NRS)score of the two groups was significantly decreased with the extension of time,and the difference at each time point was statistically significant,and the NRS score in observation group after 1 and 2 weeks of treatment and at 12 months after treatment was significantly lower than that in control group(P<0.05).The Japanese Orthopedic Association(JOA)score of both groups after treatment was significantly enhanced while the Oswestry Disability Index(ODI)was significantly reduced with the extension of time,with statistical significance at each time point(P<0.05),and the JOA score in observation group after 2 weeks of treatment and at 12 months after treatment was significantly higher while the ODI index was lower compared to that of the control group(P<0.05).After treatment,the scores of dimensions of quality of life such as physical health,mental health,social relations and environment in the two groups were significantly increased with the extension of time,and the differences were statistically significant at each time point(P<0.05),and the scores of dimensions of quality of life after 2 weeks of treatment and at 12 months after treatment were significantly higher in the observation group than those in the control group(P<0.05).At 12 months after treatment,the the values of SS and LL in observation group were elevated compared with those before treatment(P<0.05)while the PT was declined compared with that before treatment(P<0.05).There were no statistical differences in PI change in observation group and sagittal balance parameters in control group(P>0.05),and the values of sacral slope(SS)and lumbar lordosis(LL)in the observation group were higher than those in the control group(P<0.05)while the pelvic incidence(PT)was lower than that in the control group(P<0.05).No adverse reactions occurred in both groups during 2 weeks of treatment and after 12 months of treatment.Conclusion Zheng′s traditional Chinese medicine non-surgical therapy combined with abdominal breathing training can relieve the lumbar pain,and improve the dysfunction,quality of life in the short and long term and the sagittal balance of patients with RLDH.