通督活血汤对腰椎间盘突出症急性期患者腰椎功能及血清炎症因子水平的影响

Effect of Tongdu Huoxue Decoction on Lumbar Spine Function and Serum Inflammatory Factor Levels in Patients with Acute Lumbar Disc Herniation

目的:观察通督活血汤治疗腰椎间盘突出症(LDH)急性期的临床疗效。方法:将2020年1月至2023年6月湖北省中医院和洪湖市中医医院骨科门诊收治的316例LDH急性期患者随机分为2组。对照组156例(脱落2例)予美洛昔康片治疗,观察组153例(脱落5例)予以通督活血汤治疗,2组均治疗3个月。比较2组临床疗效、治疗前后及McGill疼痛积分量表(SF-MPQ)、Oswestry功能障碍指数(ODI)评分、日本骨科协会下腰痛评价量表评分(JOA)、采用酶联免疫吸附测定法(ELISA)检测患者治疗前后血清白细胞介素-1β(IL-1β)、IL-6、肿瘤坏死因子-α(TNF-α)水平,采用NDI-092型肌电图诱发电位仪检测2组患者治疗前后的胫神经、腓总神经运动传导速度及临床疗效疗效,并比较2组患者的临床安全性。结果:治疗后观察组总有效率95.4%(146/153),对照组总有效率76.3%(119/156),观察组总有效率高于对照组(χ^(2)=23.18,P<0.05)。与本组治疗前比较,2组患者的SF-MPQ、ODI评分,IL-1β、IL-6、TNF-α水平均明显降低(P<0.05),与对照组治疗后比较,观察组下降更为明显(P<0.05)。2组患者的JOA得分、胫神经、腓总神经运动性传导速度均明显升高(P<0.05),与对照组治疗后比较,观察组升高更明显(P<0.05)。结论:通督活血方能够缓解LDH急性期腰腿痛、改善腰椎功能、抑制炎性反应,具有较好的安全性,值得临床推广。

Objective:To observe the clinical efficacy of Tongdu Huoxue decoction in the treatment of acute lumbar disc herniation(LDH).Method:A total of 316 patients with acute LDH admitted to the orthopedic outpatient department of Hubei Provincial Hospital of Traditional Chinese Medicine and Honghu City Hospital of Traditional Chinese Medicine from January 2020 to June 2023 were randomly divided into two groups.156 cases in the control group(two cases with stopped follow-up)were treated with meloxicam tablets,while 153 cases in the observation group(five cases with stopped follow-up)were treated with Tongdu Huoxue decoction.Both groups were treated for three months.The clinical efficacy,McGill Pain Score Scale(SF-MPQ),Oswestry Dysfunction Index(ODI)score,and the Japanese Orthopaedic Association(JOA)scores of the two groups before and after treatment were compared.The serum levels of interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)of the patients before and after treatment were determined by using enzyme-linked immunosorbent assay(ELISA).The NDI-092 type electromyographyevoked potential instrument was adopted to measure the motor conduction velocity and clinical efficacy of the tibial and common peroneal nerves in patients of the two groups before and after treatment,and the clinical safety of the two groups of patients was compared.Result:After treatment,the total effective rate in the observation group was 95.4%(146/153),significantly higher than that in the control group of 76.3%(119/156)(χ^(2)=23.18,P<0.05).After treatment,both groups showed significant reductions in SF-MPQ and ODI scores,as well as the levels of IL-1β,IL-6,and TNF-α(P<0.05),with the observation group showing a more significant reduction(P<0.05).Both groups showed a significant increase in JOA scores and motor conduction velocities of the tibial and common peroneal nerves after treatment(P<0.05),with the observation group showing a more significant increase(P<0.05).Conclusion:Tongdu Huoxue decoction can alleviate lumbar and leg pain in acute LDH,improve lumbar spine function,and suppress inflammatory reactions.It is highly safe and is worthy of clinical promotion.