针刀合谷刺法联合三维整脊手法治疗腰椎间盘突出症的临床观察

目的观察针刀合谷刺法联合三维整脊手法治疗腰椎间盘突出症(lumbar disc herniation,LDH)的临床疗效,为临床非手术治疗LDH提供新思路,并为“筋骨并重”理念提供临床科学依据。方法将60例LDH患者随机分为观察组与对照组,每组30例,观察组采用针刀联合三维整脊手法,对照组采用单纯针刀疗法。通过观察治疗前后两组患者的视觉疼痛模拟评分(visual analogue score,VAS)、日本骨科协会评估治疗(Japanese Orthopaedic Association,JOA)评分、后肌链角度肌张力指数、整体姿势对称性、腰部姿势对称性、椎旁关键肌表面肌电指标,比较两组的临床疗效、后肌链张力效应及椎旁肌耐疲劳性。结果(1)观察组总有效率86.67%,高于对照组的73.33%,但差异无统计学意义(P>0.05)。(2)治疗后,两组患者VAS评分、后肌链角度肌张力指数、整体姿势对称性及腰部姿势对称性指标均较治疗前降低(P<0.05,P<0.01),且观察组VAS评分、角度肌张力指数、腰段姿势对称性指标均低于对照组(P<0.05),但脊柱整体姿势对称性稍高于对照组,差异无统计学意义(P>0.05)。(3)治疗后,两组患者JOA评分、患侧腹直肌、腹横肌以及腰段竖脊肌均方根(root mean square,RMS)值均较治疗前明显提高(P<0.05,P<0.01),且观察组JOA评分、患侧腰段竖直肌RMS值高于对照组(P<0.05),而两组患侧腹直肌、腹横肌RMS值组间比较差异无统计学意义(P>0.05);两组健侧腹直肌、腹横肌、腰段竖脊肌RMS值与治疗前相比,差异无统计学意义(P>0.05)。结论针刀合谷刺法联合三维整脊手法能够缓解LDH患者临床症状,改善腰椎功能活动,提高患者生活质量,有效调整后肌链张力指数及腰部姿势对称性,提升椎旁肌肉肌力,促进局部生物力学平衡,其疗效优于单纯针刀组。

Clinical efficacy of Tuina manipulations for lumbar disc herniation and its influence on posture-associated indicators

Objective:To observe the clinical efficacy of sinew-bone balancing manipulation in treating lumbar disc herniation(LDH)and offer clinical evidence to support the concept of paying equal attention to sinew and bone.Methods:Sixty LDH patients were randomized into an observation group and a control group,with 30 cases in each group.The observation group was treated with the sinew-bone balancing manipulation,and the control group received conventional Tuina(Chinese therapeutic massage)manipulation.The clinical efficacy and posterior muscle chain tone effect were compared between the two groups by observing the visual analog scale(VAS)score,Japanese Orthopaedic Association(JOA)score,and posture-associated indicators.Results:The total effective rate was 86.7%in the observation group,higher than 76.7%in the control group,but the between-group difference in efficacy was statistically insignificant(P>0.05).After treatment,the VAS and JOA scores,angle-dependent muscle tone indicator of the posterior muscle chain,and lumbar posture symmetry showed significant changes in both groups(P<0.05).The VAS and JOA scores,angle-dependent muscle tone indicator of the posterior muscle chain,and lumbar posture symmetry in the observation group were significantly different from those in the control group after treatment(P<0.05),but the between-group difference in the general posture symmetry was statistically insignificant(P>0.05).Conclusion:Both the sinew-bone balancing and conventional Tuina manipulations can reduce pain in LDH patients,improve lumbar function,and adjust the angle-dependent muscle tone coefficient of the posterior muscle chain and lumbar posture symmetry;except for the general posture symmetry of the posterior muscle chain,the sinew-bone balancing manipulation wins out over the conventional Tuina manipulation.