[1]王志强,林顺,朱宇,等.口服益气活血方为主保炎治疗脱出和游离型腰椎间盘突出症[J].中医正骨,2024,36(08):69-72.
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口服益气活血方为主保炎治疗脱出和游离型腰椎间盘突出症()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期数:
2024年08期
页码:
69-72
栏目:
临床报道
出版日期:
2024-08-20

文章信息/Info

作者:
王志强林顺朱宇俞鹏飞杨柳姜宏刘锦涛李晓春
南京中医药大学附属苏州市中医医院,江苏 苏州 215009
关键词:
椎间盘移位 腰椎 重吸收 益气活血方 炎症保留
摘要:
目的:探讨以口服益气活血方为主保炎治疗脱出和游离型腰椎间盘突出症(lumbar disc herniation,LDH)的临床疗效。方法:2019年1月至2023年1月收治64例LDH患者。男34例,女30例; 年龄20~58岁,中位数37岁; 中医辨证均为血瘀证; 脱出型43例,游离型21例; 牛眼征Ⅰ型25例、Ⅱ型17例、Ⅲ型22例。均采用口服益气活血方治疗,每日1剂,水煎服,早晚饭后分2次服用,4周为1个疗程。急性期要求患者绝对卧床休息,同时口服盐酸乙哌立松片,每次50 mg,每天3次。疼痛无法缓解时,口服盐酸曲马多片,每次50 mg。治疗期间所有患者均不应用非甾体抗炎药和糖皮质激素。选择日本骨科学会(Japanese Orthopedic Association,JOA)腰痛评分、腰痛视觉模拟量表(visual analogue scale,VAS)评分、突出物体积、突出物吸收率(吸收率≥30%视为发生重吸收、吸收率≥50%视为发生明显重吸收)作为疗效指标进行疗效评价。结果:64例患者均按规定方案完成治疗,均未使用非甾体抗炎药和糖皮质激素,治疗时间4~16周,中位数10周。治疗开始后6个月,61例患者症状明显缓解,3例患者症状缓解不明显。治疗开始后6个月,本组患者JOA腰痛评分较治疗前提高[(10.73±2.76)分,(24.11±3.00)分,t=9.230,P=0.017],腰痛VAS评分较治疗前降低[(7.30±1.09)分,(2.38±0.92)分,t=15.880,P=0.024],椎间盘突出物体积较治疗前减小[(2 194.30±745.71)mm3、(1 083.94±721.58)mm3,t=8.564,P=0.000)]。49例患者(76.56%)发生重吸收,其中牛眼征Ⅰ型19例、Ⅱ型14例、Ⅲ型16例; 39例患者(60.94%)发生明显重吸收,其中牛眼征Ⅰ型18例、Ⅱ型11例、Ⅲ型10例。牛眼征Ⅰ型患者突出物吸收率(61.99±31.66)%,Ⅱ型患者突出物吸收率(62.11±32.85)%,Ⅲ型患者突出物吸收率(39.89±32.01)%。治疗后症状明显缓解的61例患者中48例发生了重吸收,13例未发生重吸收; 症状缓解不明显的3例患者中1例发生了明显重吸收,给予地塞米松、甘露醇对症治疗后症状缓解,另外2例最终采用手术治疗。结论:以口服益气活血方为主保炎治疗脱出和游离型LDH疗效确切,保留炎症有利于突出椎间盘组织的重吸收。

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备注/Memo

备注/Memo:
基金项目:国家自然科学基金项目(82374220,82074467); 江苏省中医药科技发展项目(MS2022080); 第三批江苏省中医药领军人才项目(苏中医科教〔2023〕17号); 江苏省科教能力提升工程:江苏省医学重点学科和医学重点实验室建设项目(苏卫科教〔2022〕9号); 苏州市2022年度第二十九批科技发展计划(市重点实验室新建)项目(SZS2022019); 苏州市科技发展计划项目(SKYD2023151,SKYD2023152); 苏州市“科教兴卫”青年科技项目(KJXW2021047)
更新日期/Last Update: 1900-01-01