热敏灸配合痛点揉拨推拿手法治疗腰椎间盘突出症伴慢性下腰痛的临床研究

Clinical study on heat-sensitive moxibustion combined with kneading and massage manipulation at pain points in treating patients with lumbar disc herniation and chronic low back pain

目的评价热敏灸配合痛点揉拨推拿手法治疗腰椎间盘突出症(LDH)伴慢性下腰痛(LBP)的临床疗效。方法随机对照试验研究。选择2020年1月-2022年12月六安市中医院91例患者作为观察对象,采用随机数字表法分为试验组46例和对照组45例。对照组予以常规推拿手法治疗,试验组予以热敏灸配合痛点揉拨推拿手法治疗。2组均连续治疗4周。采用VAS量表评估腰部疼痛程度,改良版Oswestry功能障碍指数(ODI)评估腰部功能障碍程度;采用血液流变仪检测血浆黏度、红细胞压积、全血低切黏度和全血高切黏度,评价临床疗效。结果试验组临床总有效率为93.48%(43/46)、对照组为77.78%(35/45),2组比较差异有统计学意义(χ^(2)=4.58,P=0.032)。治疗后,试验组VAS评分[(3.81±0.74)分比(4.29±0.85)分,t=2.88]、ODI评分[(8.79±2.65)分比(11.25±3.74)分,t=3.63]低于对照组(P<0.01);血浆黏度[(1.35±0.06)mPa•s比(1.41±0.08)mPa•s,t=4.05]、红细胞压积[(37.46±2.38)%比(40.15±2.94)%,t=4.80]、全血低切黏度[(7.41±1.53)mPa•s比(8.64±1.72)mPa•s,t=3.61]和全血高切黏度[(3.81±0.29)mPa•s比(4.07±0.31)mPa•s,t=4.13]低于对照组(P<0.01)。结论热敏灸配合痛点揉拨推拿手法可有效缓解LDH伴慢性LBP患者腰部疼痛症状,改善腰部功能障碍及血流动力学状态,提高临床疗效。

Objective To evaluate the clinical efficacy of heat-sensitive moxibustion combined with kneading and massage manipulation at pain points in treating patients with lumbar disc herniation(LDH)and chronic low back pain(LBP).Methods Randomized controlled trial.A total of 91 patients with LDH and LBP who were admitted to Lu'an Hospital of Traditional Chinese Medicine from January 2020 to December 2022 were selected as the observation subjects.They were divided into the experimental group(46 cases)and the control group(45 cases)by random number table method.The control group was treated with conventional massage manipulation,while the experimental group was treated with heat-sensitive moxibustion combined with kneading and massage manipulation at pain points.Both groups received 4 weeks of continuous treatment.The degree of lumbar pain was evaluated with the Visual Analogue Scale(VAS),and the degree of lumbar dysfunction was evaluated with modified Oswestry Disability Index(ODI).Plasma viscosity,hematocrit,whole blood low shear viscosity and whole blood high shear viscosity were measured using a blood rheometer.Clinical efficacy was evaluated.Results The total clinical effective rates in the experimental group and the control group were 93.48%(43/46)and 77.78%(35/45),with a statistical significance between groups(χ^(2)=4.58,P=0.032).After treatment,the VAS score[(3.81±0.74)vs.(4.29±0.85),t=2.88]and ODI score[(8.79±2.65)vs.(11.25±3.74),t=3.63]of the experimental group were lower than those of the control group(P<0.01).Plasma viscosity[(1.35±0.06)mPa•s vs.(1.41±0.08)mPa•s,t=4.05],hematocrit[(37.46±2.38)%vs.(40.15±2.94)%,t=4.80],whole blood low shear viscosity[(7.41±1.53)mPa•s vs.(8.64±1.72)mPa•s,t=3.61]and whole blood high shear viscosity[(3.81±0.29)mPa•s vs.(4.07±0.31)mPa•s,t=4.13]were lower than those in the control group(P<0.01).Conclusion Heat-sensitive moxibustion combined with kneading and massage manipulation at pain points can effectively relieve LBP in patients with LDH and chronic LBP,improve lumbar dysfunction and hemodynamic status,and enhance clinical efficacy.