综合康复疗法联合药物治疗腰椎间盘突出症随机平行对照研究

Randomized Parallel Controlled Study of Comprehensive Rehabilitation Therapy Combined with Drug Therapy for Lumbar Disc Herniation

[目的]观察综合康复疗法联合药物治疗腰椎间盘突出症疗效。[方法]使用随机平行对照方法,将150例门诊患者按就诊顺序号方法随机分为两组。对照组75例七叶皂苷钠10g+生理盐水250m L,静滴,10d;腰痛宁胶囊,4～6粒/次,1次/d。治疗组75例综合康复疗法,牵引:使用牵引床,根据体重、性别、年龄、病程等设置牵引重量、角度、旋转方向和度数等,患者俯卧位,起始牵引重量一般为为体重的50%,逐渐加重,最多不超过体重90%,20min/次,1次/d,牵引后休息30min;腰部斜扳法:患者俯卧位,沿脊柱两侧自上而下进行按摩,由轻至重,充分放松肌肉,后患者侧位,患侧在上,医者在患者身后,一手放在患者肩部,另一只手在髋部,嘱患者放松,两手向反方向用力,用力旋转腰部,斜扳法后休息30min;运动训练:(1)疼痛减轻后可进行运动训练,患者仰卧位,上肢贴床,左右腿伸直交替向上抬起,2次/d,25min/次,(2)疼痛剧烈可采用空蹬法,曲腿,类似蹬自行车,空蹬法;(3)双手叉腰倒着走;(4)飞燕式,俯卧位,以腹部为支点,抬头、抬胳膊、抬腿,根据病情适当调节每次运动时间及每天次数;药物治疗同对照组。连续治疗1个月为1疗程。观测临床表现、VAS评分、直腿抬高试验角度、不良反应。治疗1疗程(1个月),判定疗效。[结果]治疗组临床痊愈42例,显效25例,有效6例,无效2例,总有效率97.33%;对照组临床痊愈38例,显效20例,有效7例,无效10例,总有效率86.67%;治疗组疗效优于对照组(P<0.05)。VAS评分、直腿抬高试验角度两组均有改善(P<0.01),治疗组改善优于对照组(P<0.01)。[结论]综合康复疗法联合药物治疗腰椎间盘突出症,疗效满意,无严重不良反应,值得推广。

[Objective] To observe the effect of comprehensive rehabilitation therapy combined with medication on lumbar disc herniation. [Method] 150 outpatients were randomly divided into two groups according to the order number of visits by randomized parallel control method. 75 cases of control group were treated with sodium aescinate 10 g + saline 250 mL, intravenous drip for 10 days, Yaotongning capsule for 4-6 capsules per time, once a day. In the treatment group, 75 cases were treated with comprehensive rehabilitation therapy, traction: traction bed was used to set traction weight, angle, rotation direction and degree according to weight, sex, age and course of disease. The initial traction weight was 50% of the body weight, and gradually increased, up to 90% of the body weight, 20 minutes per time, once a day, and 30 minutes of rest after traction.The two sides of the spine are massaged from top to bottom, from light to heavy, fully relaxing the muscles,then the patient’s side is on the upper side. The doctor puts one hand behind the patient’s shoulder and the other hand on the hip. He instructs the patient to relax, exert both hands in the opposite direction, rotate the waist vigorously, and rest for 30 minutes after oblique wrenching. Sports training: 1. After pain is alleviated,exercise training is carried out, and the patient is in supine position. The upper limbs are attached to the bed,the left and right legs are stretched up alternately, 2 times a day, 25 minutes a time. 2. The pain can be severe by empty pedal, curved legs, similar to pedaling bicycles, empty pedal, 3 hands crossed waist, 4. Swallowlike,prone position, with abdomen as the fulcrum, head-up, arm-up and leg-up, according to the condition,adjust the exercise time and the number of times per day appropriately;the drug treatment is the same as the control group. Continuous treatment for one month is a course of treatment. Clinical manifestations, VAS score, straight leg elevation test angle and adverse reactions were observed. One course of treatment(1 month)was used to determine the curative effect. [Result] In the treatment group, 42 cases were cured, 25 cases were markedly effective, 6 cases were effective and 2 cases were ineffective, the total effective rate was 97.33%. In the control group, 38 cases were cured, 20 cases were markedly effective, 7 cases were effective and 10 cases were ineffective, the total effective rate was 86.67%. The curative effect of the treatment group was better than that of the control group(P<0.05). VAS score and straight leg elevation test angle were improved in both groups(P<0.01), and the improvement in treatment group was better than that in control group(P<0.01).[Conclusion] Comprehensive rehabilitation therapy combined with drug treatment for lumbar intervertebral disc herniation has satisfactory curative effect and no serious adverse reactions, which is worthy of promotion.