核心稳定性训练联合针刺治疗慢性腰椎间盘突出症疗效观察
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摘要
目的探讨核心稳定性训练联合针刺治疗慢性腰椎间盘突出症(LDH)的临床疗效。方法将160例慢性LDH患者按照数字随机表法分为针刺组和联合组,联合组和针刺组分别76例、77例完成研究,针刺组接受针刺治疗,联合组接受核心稳定性训练联合针刺治疗,比较两组治疗前后腰椎功能日本骨科协会(JOA)腰痛疾患疗效评定系统评分、疼痛视觉模拟评分法(VAS)评分、Oswestry腰椎功能障碍指数(ODI)腰椎活动范围,并比较两组治疗总有效率。结果治疗4周、8周后,联合组VAS、ODI评分低于针刺组(P?<0.01),JOA评分高于针刺组(P?<0.01),治疗8周后,腰椎前屈、后伸、左屈及右屈活动度大于针刺组(P?<0.01),治疗总有效率高于针刺组(P?<0.05),差异均有统计学意义。结论核心稳定性训练联合针刺可有效减轻局部炎症反应,缓解疼痛,改善腰椎功能,治疗慢性LDH效果显著。
【Objective】To investigate the clinical effect of core stability training combined with acupuncture on chronic lumbar disc herniation(LDH).【Methods】Totally 160 patients with chronic LDH were divided into the acupuncture group and the combination group according to random table method. Seventy-six patients in the combination group were treated with core stability training combined with acupuncture, and 77 patients in the acupuncture group were treated with acupuncture. The JOA score, VAS score, Oswestry dability index(ODI), the range of motion of the lumbar spine of the two groups were compared before and after treatment. The total effective rate of the two groups was compared.【Results】The VAS and ODI score of the combined group were lower than those of the acupuncture group(P <0.01), the JOA score of the combined group was higher than that of the acupuncture group after 4-and 8-weeks treatment(P <0.01). After 8-weeks treatment, the activity of lumbar flexion, extension, left flexion and right flexion in the combination group were greater than those in the acupuncture group(P <0.01), and the total effective rate of treatment was higher in the combination group than in the acupuncture group(P <0.05). All the differences were statistically significant.【Conclusion】Core stability training combined with acupuncture can effectively alleviate local inflammation, relieve pain and improve lumbar vertebral function. It is effective in treatment of chronic LDH.
【Objective】To investigate the clinical effect of core stability training combined with acupuncture on chronic lumbar disc herniation(LDH).【Methods】Totally 160 patients with chronic LDH were divided into the acupuncture group and the combination group according to random table method. Seventy-six patients in the combination group were treated with core stability training combined with acupuncture, and 77 patients in the acupuncture group were treated with acupuncture. The JOA score, VAS score, Oswestry dability index(ODI), the range of motion of the lumbar spine of the two groups were compared before and after treatment. The total effective rate of the two groups was compared.【Results】The VAS and ODI score of the combined group were lower than those of the acupuncture group(P <0.01), the JOA score of the combined group was higher than that of the acupuncture group after 4-and 8-weeks treatment(P <0.01). After 8-weeks treatment, the activity of lumbar flexion, extension, left flexion and right flexion in the combination group were greater than those in the acupuncture group(P <0.01), and the total effective rate of treatment was higher in the combination group than in the acupuncture group(P <0.05). All the differences were statistically significant.【Conclusion】Core stability training combined with acupuncture can effectively alleviate local inflammation, relieve pain and improve lumbar vertebral function. It is effective in treatment of chronic LDH.
引文
[1]徐清平,宋登峰,朱晓峰,等.中药内服联合中医手法、针灸治疗腰椎间盘突出症的临床疗效[J].中华中医药学刊, 2018,36(3):765-768.
[2]徐峰,王林,靳婷婷,等.国内腰椎间盘突出症非手术治疗的现状调查[J].北京医学, 2018, 40(2):132-136, 193.
[3]van der Meer S, Trippolini MA, van der Palen J, et al. Which instruments can detect submaximal physical and functional capacity in patients with chronic nonspecific back pain? A systematic review[J]. Spine(Phila Pa 1976), 2013, 38(25):E1608-E1615.
[4]Aboagye E, Karlsson ML, Hagberg J, et al. Cost-effectiveness of early interventions for non-specific low back pain:a randomized controlled study investigating medical yoga, exercise therapy and selfcare advice[J]. J Rehabil Med, 2015, 47(2):167-173.
[5]李曌嫱,秦义,田元祥,等.针灸治疗腰椎间盘突出症的CiteSpace知识图谱可视化分析[J].中国针灸, 2017, 37(5):545-548.
[6]张长杰.肌肉骨骼康复学[M].第2版.北京:人民卫生出版社,2016:257-259.
[7]程继伟,王振林,刘伟,等. Oswestry功能障碍指数的改良及信度和效度检验[J].中国脊柱脊髓杂志, 2017, 27(3):235-241.
[8]燕铁斌.现代康复治疗学[M].广州:广东科技出版社, 2004:493.
[9]国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社, 1994:201-202.
[10]Lee CW, Hwangbo K, Lee IS. The effects of combination patterns of proprioceptive neuromuscular facilitation and ball exercise on pain and muscle activity of chronic low back pain patients[J]. J Phys Ther Sci, 2014, 26(1):93-96.
[11]黄卫,胡昊,耿协梅.常规康复治疗基础上联合水中核心稳定训练治疗腰椎间盘突出症的疗效观察[J].颈腰痛杂志, 2018,39(1):115-117.
[12]Hosseinifar M, Akbari M, Behtash H, et al. The effects of stabilization and mckenzie exercises on transverse abdominis andmultifidusmusclethickness,pain,anddisability:a randomized controlled trial in nonspecific chronic low back pain[J]. J Phys Ther Sci, 2013, 25(12):1541-1545.
[13]侯建强.针刺郄穴治疗腰椎间盘突出症的疗效及对腰椎功能和血液流变学的影响[J].针灸临床杂志, 2018, 34(7):39-41.
[14]刘焱,黄桂成,鲍自立,等.针刺联合耳针沿皮透刺治疗腰椎间盘突出症的临床对照研究[J].针灸临床杂志, 2017, 33(2):13-15.
[15]项璇儿,杜俊英,房军帆,等.不同病理痛早期电针镇痛频率优选及其脊髓背角TRPV1活化机制研究[J].中华中医药杂志,2018, 33(5):1707-1712.
[16]龚剑秋,司马振奋,张芳,等.核心稳定性训练对腰椎间盘突出症患者表面肌电时频参数的影响[J].中国骨与关节损伤杂志, 2018, 33(5):484-487.
[2]徐峰,王林,靳婷婷,等.国内腰椎间盘突出症非手术治疗的现状调查[J].北京医学, 2018, 40(2):132-136, 193.
[3]van der Meer S, Trippolini MA, van der Palen J, et al. Which instruments can detect submaximal physical and functional capacity in patients with chronic nonspecific back pain? A systematic review[J]. Spine(Phila Pa 1976), 2013, 38(25):E1608-E1615.
[4]Aboagye E, Karlsson ML, Hagberg J, et al. Cost-effectiveness of early interventions for non-specific low back pain:a randomized controlled study investigating medical yoga, exercise therapy and selfcare advice[J]. J Rehabil Med, 2015, 47(2):167-173.
[5]李曌嫱,秦义,田元祥,等.针灸治疗腰椎间盘突出症的CiteSpace知识图谱可视化分析[J].中国针灸, 2017, 37(5):545-548.
[6]张长杰.肌肉骨骼康复学[M].第2版.北京:人民卫生出版社,2016:257-259.
[7]程继伟,王振林,刘伟,等. Oswestry功能障碍指数的改良及信度和效度检验[J].中国脊柱脊髓杂志, 2017, 27(3):235-241.
[8]燕铁斌.现代康复治疗学[M].广州:广东科技出版社, 2004:493.
[9]国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社, 1994:201-202.
[10]Lee CW, Hwangbo K, Lee IS. The effects of combination patterns of proprioceptive neuromuscular facilitation and ball exercise on pain and muscle activity of chronic low back pain patients[J]. J Phys Ther Sci, 2014, 26(1):93-96.
[11]黄卫,胡昊,耿协梅.常规康复治疗基础上联合水中核心稳定训练治疗腰椎间盘突出症的疗效观察[J].颈腰痛杂志, 2018,39(1):115-117.
[12]Hosseinifar M, Akbari M, Behtash H, et al. The effects of stabilization and mckenzie exercises on transverse abdominis andmultifidusmusclethickness,pain,anddisability:a randomized controlled trial in nonspecific chronic low back pain[J]. J Phys Ther Sci, 2013, 25(12):1541-1545.
[13]侯建强.针刺郄穴治疗腰椎间盘突出症的疗效及对腰椎功能和血液流变学的影响[J].针灸临床杂志, 2018, 34(7):39-41.
[14]刘焱,黄桂成,鲍自立,等.针刺联合耳针沿皮透刺治疗腰椎间盘突出症的临床对照研究[J].针灸临床杂志, 2017, 33(2):13-15.
[15]项璇儿,杜俊英,房军帆,等.不同病理痛早期电针镇痛频率优选及其脊髓背角TRPV1活化机制研究[J].中华中医药杂志,2018, 33(5):1707-1712.
[16]龚剑秋,司马振奋,张芳,等.核心稳定性训练对腰椎间盘突出症患者表面肌电时频参数的影响[J].中国骨与关节损伤杂志, 2018, 33(5):484-487.