[1]杨晗丹,范德辉,刘建,等.牵抖冲压法和常规牵引法治疗腰椎间盘突出症的对比研究[J].中医正骨,2016,28(12):26-30.
　YANG Handan,FAN Dehui,LIU Jian,et al.A comparative study of draw-shake-ram manipulation versus conventional lumbar traction for treatment of lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(12):26-30.
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牵抖冲压法和常规牵引法治疗腰椎间盘突出症的对比研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期数:
2016年12期
页码:
26-30
栏目:
临床研究
出版日期:
2016-12-30

文章信息/Info

Title:
A comparative study of draw-shake-ram manipulation versus conventional lumbar traction for treatment of lumbar disc herniation
作者:
杨晗丹1; 范德辉2; 刘建2; 林锦坤3; 苏美意2; 张振宇2; 吴晶晶2; 康健2; 邓玲琳2
1.广州中医药大学,广东 广州 510006;
2.广东省第二中医院,广东 广州 510095;
3.重庆市铜梁区中医院,重庆 402560
Author(s):
YANG Handan1; FAN Dehui2; LIU Jian2; LIN Jinkun3; SU Meiyi2; ZHANG Zhenyu2; WU Jingjing2; KANG Jian2; DENG Linglin2
1.Guangzhou University of Chinese Medicine,Guangzhou 510006,Guangdong,China 2.The Second Hospital of Traditional Chinese Medicine of Guangdong,Guangzhou 510095,Guangdong,China 3.Tongliang Hospital of Traditional Chinese Medicine,Chongqing 402560,China
关键词:
椎间盘移位;  腰椎;  牵引术;  牵抖冲压法;  临床试验
Keywords:
intervertebral disc displacement;  lumbar vertebrae;  traction;  draw-shake-ram manipulation;  clinical trial
摘要:
目的:比较牵抖冲压法和常规牵引法治疗腰椎间盘突出症的临床疗效。方法:将90例腰椎间盘突出症患者随机分为2组,每组45例,分别采用牵抖冲压法和常规牵引法治疗。每天均治疗1次,7次为1个疗程,疗程间休息2 d,共治疗2个疗程。分别于治疗前和治疗2个疗程后比较2组患者腰痛视觉模拟量表(visual analog scale,VAS)评分、改良日本骨科学会(Japanese orthopaedic association,JOA)腰痛疾患评分和腰部软组织张力,并于治疗2个疗程后参照《中药新药临床研究指导原则》中腰椎间盘突出症的疗效评价标准比较2组患者的总体疗效。结果:①腰痛VAS评分。治疗前2组患者腰痛VAS评分比较,差异无统计学意义[(7.74±0.72)分,(7.52±0.67)分,t=1.501,P=0.137]; 治疗2个疗程后,牵抖冲压组腰痛VAS评分低于常规牵引组[(2.17 ±1.42)分,(3.57±1.58)分,t=4.421,P=0.000],牵抖冲压组和常规牵引组腰痛VAS评分均低于治疗前(t=21.362,P=0.000; t=23.128,P=0.000)。②改良JOA腰痛疾患评分。治疗前2组患者改良JOA腰痛疾患评分比较,差异无统计学意义[(10.24 ±2.15)分,(10.62±1.73)分,t=0.924,P=0.358]; 治疗2个疗程后,牵抖冲压组改良JOA腰痛疾患评分高于常规牵引组[(23.56 ±3.21)分,(19.02 ±4.13)分,t=5.822,P=0.000],牵抖冲压组和常规牵引组改良JOA腰痛疾患评分均高于治疗前(t=15.440,P=0.000; t=12.584,P=0.000)。③腰部软组织张力。治疗前2组患者患侧、健侧腰部软组织位移比较,组间差异均无统计学意义[(5.72±0.17)mm,(5.67±0.15)mm,t=1.480,P=0.143;(6.10 ±0.16)mm,(6.07±0.18)mm,t=0.836,P=0.406]。治疗2个疗程后,牵抖冲压组患侧和健侧腰部软组织位移均大于常规牵引组[(6.71 ±0.18)mm,(5.91±0.19)mm,t=20.505,P=0.000;(7.28 ±0.21)mm,(6.11±0.16)mm,t=29.729,P=0.000]; 牵抖冲压组患侧和健侧腰部软组织位移均大于治疗前(t=26.823,P=0.000; t=29.983,P=0.000); 常规牵引组患侧腰部软组织位移大于治疗前(t=6.651,P=0.000),健侧腰部软组织位移与治疗前比较,差异无统计学意义(t=1.114,P=0.286)。④总体疗效。治疗2个疗程后,牵抖冲压组临床治愈21例、显效16例、有效4例、无效4例,常规牵引组临床治愈12例、显效11例、有效12例、无效10例; 牵抖冲压组的总体疗效优于常规牵引组(Z=-2.789,P=0.005)。结论:对于腰椎间盘突出症患者而言,采用牵抖冲压法和常规牵引法治疗,均能缓解腰部疼痛,降低腰部软组织张力,促进腰椎功能的恢复; 但牵抖冲压法的总体疗效优于常规牵引法,值得临床推广应用。
Abstract:
Objective:To compare the clinical curative effects of draw-shake-ram manipulation versus conventional lumbar traction for treatment of lumbar disc herniation(LDH).Methods:Ninty patients with LDH enrolled in the study were randomly divided into 2 groups,45 cases in each group.The patients were treated with draw-shake-ram manipulation(group A)and conventional lumbar traction(group B)respectively,once a day for 2 course of treatment,7 times for each course with a 2-day rest-insertion between courses.The visual analog scale(VAS)scores and modified Japanese orthopaedic association(JOA)scores for low back pain and lumbar soft tissue tension were compared between the 2 groups before the treatment and after 2-course treatment,and the total clinical curative effects were also compared between the 2 groups according to the therapeutic effect criterion of LDH which was extracted from Guiding principles of clinical research on new Chinese medicine after 2-course treatment.Results:There was no statistical difference in low back pain VAS scores between the 2 groups before treatment(7.74+/-0.72 vs 7.52+/-0.67 points,t=1.501,P=0.137).The low back pain VAS scores were lower in group A compared to group B after 2-course treatment(2.17+/-1.42 vs 3.57+/-1.58 points,t=4.421,P=0.000)and the low back pain VAS scores decreased in both of the 2 groups(t=21.362,P=0.000; t=23.128,P=0.000).There was no statistical difference in modified JOA low back pain scores between the 2 groups before treatment(10.24+/-2.15 vs 10.62+/-1.73 points,t=0.924,P=0.358).The modified JOA low back pain scores were higher in group A compared to group B after 2-course treatment(23.56+/-3.21 vs 19.02+/-4.13 points,t=5.822,P=0.000)and the modified JOA low back pain scores increased in both of the 2 groups(t=15.440,P=0.000; t=12.584,P=0.000).There was no statistical difference in the lumbar soft tissue displacement of affected and unaffected sides between the 2 groups before treatment(5.72+/-0.17 vs 5.67+/-0.15 mm,t=1.480,P=0.143; 6.10+/-0.16 vs 6.07+/-0.18 mm,t=0.836,P=0.406).The lumbar soft tissue displacement of affected and unaffected sides increased in group A after 2-course treatment(t=26.823,P=0.000; t=29.983,P=0.000),and they were greater in group A compared to group B(6.71 +/-0.18 vs 5.91+/-0.19 mm,t=20.505,P=0.000; 7.28+/-0.21 vs 6.11+/-0.16 mm,t=29.729,P=0.000).The post-treatment lumbar soft tissue displacement of affected sides were greater than those of pre-treatment(t=6.651,P=0.000)and there was no statistical difference in the lumbar soft tissue displacement of unaffected sides between pre-treatment and post-treatment(t=1.114,P=0.286).After 2-course treatment,21 patients were cured,16 good,4 fair and 4 poor in group A; while 12 patients were cured,11 good,12 fair and 10 poor in group B.The group A surpassed the group B in the clinical curative effect(Z=-2.789,P=0.005).Conclusion:Both draw-shake-ram manipulation and conventional lumbar traction can relieve low back pain and reduce lumbar soft tissue tension and improve lumbar function recovery in patients with LDH,while the former surpasses the latter in the total clinical curative effects,so it is worthy of popularizing in clinic.

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备注/Memo

备注/Memo:
基金项目:广州市科技和信息化局重大民生科研课题(2014Y2-00045)
通讯作者:范德辉 E-mail:1317073040@qq.com
更新日期/Last Update: 2016-12-30