[1]麦敏军,黄尚君,古波,等.腰椎定位斜扳法治疗腰椎失稳[J].中医正骨,2018,30(04):19-22,27.
　MAI Minjun,HUANG Shangjun,GU Bo,et al.Lumbar fixed-position oblique-pulling manipulation for treatment of lumbar vertebrae destabilization[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(04):19-22,27.
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腰椎定位斜扳法治疗腰椎失稳()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期数:
2018年04期
页码:
19-22,27
栏目:
腰椎疾患
出版日期:
2018-04-20

文章信息/Info

Title:
Lumbar fixed-position oblique-pulling manipulation for treatment of lumbar vertebrae destabilization
作者:
麦敏军1; 黄尚君1; 古波1; 黄有荣2
1.广西壮族自治区北海市中医医院,广西 北海 536000; 2.广西中医药大学附属瑞康医院,广西 南宁 530011
Author(s):
MAI Minjun1; HUANG Shangjun1; GU Bo1; HUANG Yourong2
1.Beihai Hospital of Traditional Chinese Medicine of Guangxi Zhuang Autonomous Region,Beihai 536000,Guangxi,China 2.Ruikang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine,Nanning 530011,Guangxi,China
关键词:
腰椎;  失稳;  推拿; 脊柱;  运动疗法
Keywords:
Keywords lumbar vertebrae;  destabilizing;  manipulation; spinal;  exercise therapy
摘要:
目的:探讨腰椎定位斜扳法治疗腰椎失稳的临床疗效。方法:腰椎失稳患者100例,随机分为定位斜扳组和功能锻炼组,每组50例。在禁止腰部过度负重、每日卧床休息时间≥18 h、行走时腰围保护等基础上,功能锻炼组采用五点支撑法和飞燕点水法进行腰背肌功能锻炼,每日2次,每次5 min,共锻炼14 d; 定位斜扳组行腰椎定位斜扳手法治疗,隔日1次,3次为1个疗程,共治疗2个疗程。分别于治疗前、治疗结束后即刻、治疗结束后6个月及治疗结束后1年,采用疼痛视觉模拟量表(visual analogue scale,VAS)评价患者腰痛情况,采用日本骨科学会(Japanese orthopedics association,JOA)腰背痛疾病治疗成绩评分标准评价患者腰椎功能恢复情况。观察2组患者腰痛VAS评分和腰椎功能JOA评分的变化趋势,并进行比较。结果:①腰部疼痛VAS评分。2组患者腰部疼痛VAS评分总体比较,组间差异有统计学意义,即存在分组效应(F=2.967,P=0.003)。治疗前后不同时间点之间腰部疼痛VAS评分比较,差异有统计学意义,即存在时间效应(F=381.062,P=0.000)。时间因素和分组因素存在交互效应(F=37.312,P=0.000)。2组患者腰部疼痛VAS评分随时间均呈降低趋势,但2组的降低趋势不完全一致; 治疗前2组患者腰部疼痛VAS评分比较,组间差异无统计学意义[(6.08±1.08)分,(5.96±1.14)分; t=0.383,P=0.703]; 治疗后各时间点定位斜扳组腰部疼痛VAS评分均低于功能锻炼组[(2.16±0.85)分,(3.32±1.41)分,t=-3.530,P=0.000;(0.88±0.67)分,(1.96±0.61)分,t=-5.975,P=0.000;(0.40±0.30)分,(0.96±0.74)分,t=-3.150,P=0.003],定位斜扳组腰部疼痛VAS评分比功能锻炼组降低更快、更明显。②腰椎功能JOA评分。2组患者腰椎功能JOA评分总体比较,组间差异有统计学意义,即存在分组效应(F=38.473,P=0.000)。治疗前后不同时间点之间腰椎功能JOA评分比较,差异有统计学意义,即存在时间效应(F=417.467,P=0.000)。时间因素和分组因素存在交互效应(F=20.987,P=0.000)。2组患者腰椎功能JOA评分随时间均呈增高趋势,但2组的增高趋势不完全一致; 治疗前2组患者腰椎功能JOA评分比较,组间差异无统计学意义[(13.76±1.72)分,(13.60±1.83)分,t=1.217,P=0.226]; 治疗后各时间点定位斜扳组腰椎功能JOA评分均高于功能锻炼组[(21.22±1.78)分,(17.22±2.00)分,t=10.879,P=0.000;(22.28±1.87)分,(18.58±1.65)分,t=10.448,P=0.000;(23.74±2.18)分,(19.64±1.61)分,t=10.662,P=0.000],定位斜扳组腰椎功能JOA评分比功能锻炼组增高更快、更明显。结论:腰椎定位斜扳法治疗腰椎失稳,与腰背肌功能锻炼相比,在缓解腰部疼痛和改善腰椎功能方面,起效更快、疗效更好。
Abstract:
ABSTRACT Objective:To explore the clinical curative effect of lumbar fixed-position oblique-pulling manipulation in treatment of lumbar vertebrae destabilization.Methods:One hundred patients with lumbar vertebrae destabilization were randomly divided into fixed-position oblique-pulling manipulation group and functional exercise group,50 cases in each group.All patients were forbidden from lumbar overloading and were asked to rest in bed for≥18 hours every day and wear lumbar balteum while walking.The patients in functional exercise group were asked to do lumbodorsal muscle functional exercise by using five-point weight-support method and Feiyan Dianshui method,twice a day,5 minutes at a time for consecutive 14 days.The patients in fixed-position oblique-pulling manipulation group were treated with lumbar fixed-position oblique-pulling manipulation,one time every other day for consecutive 2 courses of treatment,three times for each course.The low back pain was evaluated by using visual analogue scale(VAS)and the lumbar function recovery was evaluated by using Japanese orthopaedic association(JOA)low back pain scoring system before treatment and at once,6 months and 1 year after the end of the treatment respectively.The variation tendencies of low back pain VAS scores and lumbar function JOA scores were observed and compared between the 2 groups.Results:There was statistical difference in low back pain VAS scores between the 2 groups in general,in other words,there was group effect(F=2.967,P=0.003).There was statistical difference in low back pain VAS scores between different timepoints before and after the treatment,in other words,there was time effect(F=381.062,P=0.000).There was interaction between time factor and group factor(F=37.312,P=0.000).The low back pain VAS scores presented a time-dependent decreasing trend in both of the 2 groups,while the 2 groups were inconsistent with each other in the decreasing trend of low back pain VAS scores.There was no statistical difference in low back pain VAS scores between the 2 groups before treatment(6.08+/-1.08 vs 5.96+/-1.14 points,t=0.383,P=0.703).The low back pain VAS scores were lower in fixed-position oblique-pulling manipulation group compared to functional exercise group at each posttreatment time point(2.16+/-0.85 vs 3.32+/-1.41 points,t=-3.530,P=0.000; 0.88+/-0.67 vs 1.96+/-0.61 points,t=-5.975,P=0.000; 0.40+/-0.30 vs 0.96+/-0.74 points,t=-3.150,P=0.003),and the low back pain VAS scores decreased more rapidly and more obviously in fixed-position oblique-pulling manipulation group compared to functional exercise group.There was statistical difference in lumbar function JOA scores between the 2 groups in general,in other words,there was group effect(F=38.473,P=0.000).There was statistical difference in lumbar function JOA scores between different timepoints before and after the treatment,in other words,there was time effect(F=417.467,P=0.000).There was interaction between time factor and group factor(F=20.987,P=0.000).The lumbar function JOA scores presented a time-dependent increasing trend in both of the 2 groups,while the 2 groups were inconsistent with each other in the increasing trend of lumbar function JOA scores.There was no statistical difference in lumbar function JOA scores between the 2 groups before the treatment(13.76+/-1.72 vs 13.60+/-1.83 points,t=1.217,P=0.226).The lumbar function JOA scores were higher in fixed-position oblique-pulling manipulation group compared to functional exercise group at each posttreatment time point(21.22+/-1.78 vs 17.22+/-2.00 points,t=10.879,P=0.000; 22.28+/-1.87 vs 18.58+/-1.65 points,t=10.448,P=0.000; 23.74+/-2.18 vs 19.64+/-1.61 points,t=10.662,P=0.000),and the lumbar function JOA scores increased more rapidly and more obviously in fixed-position oblique-pulling manipulation group compared to functional exercise group.Conclusion:Compared with lumbodorsal muscle functional exercises,lumbar fixed-position oblique-pulling manipulation provides superior curative effect and faster onset of action in alleviating low back pain and improving lumbar function in treatment of lumbar vertebrae destabilization.

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备注/Memo

备注/Memo:
基金项目:广西壮族自治区北海市科学研究与技术开发计划项目(201005008) 通讯作者:黄有荣 E-mial:hyr088@163.com
更新日期/Last Update: 2018-08-24