推拿联合神经触激术治疗腰椎管狭窄症临床观察
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摘要
目的观察推拿联合神经触激术治疗腰椎管狭窄症(LSS)的临床疗效。方法将60例LSS患者按照随机数字表法分为2组,均予推拿治疗。治疗组30例联合神经触激术治疗;对照组30例联合常规针刺治疗。2组均1周为1个疗程,连续治疗2个疗程,疗程结束后1个月随访。比较2组疗效;观察2组治疗前后及随访时疼痛视觉模拟评分法(VAS)评分、日本骨科协会(JOA)下腰痛评分系统评分变化;测量2组治疗前后硬膜囊横截面积变化。结果治疗组总有效率86. 67%,对照组总有效率66. 67%,治疗组疗效优于对照组(P <0. 05)。与本组治疗前比较,2组治疗后、随访时疼痛VAS评分均降低(P <0. 05),JOA下腰痛评分系统评分均升高(P <0. 05)。治疗组治疗后、随访时疼痛VAS评分均低于对照组同期(P <0. 05),JOA下腰痛评分系统评分高于对照组同期(P <0. 05)。2组治疗前后硬膜囊横截面积比较差异无统计学意义(P>0. 05),2组治疗后硬膜囊横截面积比较差异无统计学意义(P> 0. 05)。结论推拿联合神经触激术治疗LSS疗效明显,可快速缓解临床症状。
Objective To observe the clinical effects of massage combined with acupuncture nerve stimulation in the treatment of lumbar spinal stenosis( LSS). Methods 60 patients with LSS were divided into two groups according to the random number table method. All of them were treated by massage. 30 cases in treatment group were treated by acupuncture nerve stimulation. 30 cases in control group were treated by ordinary acupuncture. Both groups were treated for one week for 1 course,2 courses for continuous treatment,and follow-up after one month end of the course. The effects of two groups were compared. The changes of pain visual analogue score( VAS) and the Japanese Orthopaedic Association( JOA) score before and after treatment and during follow-up were observed.The changes of dural sac cross-sectional area before and after treatment were measured. Results The total effective rate was 86. 67% in treatment group and 66. 67% in control group. The clinical effect of the treatment group was better than that of the control group( P < 0. 05). Compared with the group before treatment,the VAS scores of the two groups were decreased after treatment and at the follow-up( P < 0. 05),and the JOA scores were increased( P< 0. 05). The VAS scores of the treatment group after treatment and at the follow-up were lower than those of the control group( P < 0. 05),and the JOA score was higher than that of the control group( P < 0. 05). Compared with the group before treatment,there was no significant change in the dural sac cross-sectional area after treatment in the two groups( P > 0. 05),and there was no significant difference in the dural sac cross-sectional area between the two groups after treatment( P > 0. 05). Conclusion Massage combined with acupuncture nerve stimulation is effective in the treatment of LSS,which can quickly relieve clinical symptoms.
Objective To observe the clinical effects of massage combined with acupuncture nerve stimulation in the treatment of lumbar spinal stenosis( LSS). Methods 60 patients with LSS were divided into two groups according to the random number table method. All of them were treated by massage. 30 cases in treatment group were treated by acupuncture nerve stimulation. 30 cases in control group were treated by ordinary acupuncture. Both groups were treated for one week for 1 course,2 courses for continuous treatment,and follow-up after one month end of the course. The effects of two groups were compared. The changes of pain visual analogue score( VAS) and the Japanese Orthopaedic Association( JOA) score before and after treatment and during follow-up were observed.The changes of dural sac cross-sectional area before and after treatment were measured. Results The total effective rate was 86. 67% in treatment group and 66. 67% in control group. The clinical effect of the treatment group was better than that of the control group( P < 0. 05). Compared with the group before treatment,the VAS scores of the two groups were decreased after treatment and at the follow-up( P < 0. 05),and the JOA scores were increased( P< 0. 05). The VAS scores of the treatment group after treatment and at the follow-up were lower than those of the control group( P < 0. 05),and the JOA score was higher than that of the control group( P < 0. 05). Compared with the group before treatment,there was no significant change in the dural sac cross-sectional area after treatment in the two groups( P > 0. 05),and there was no significant difference in the dural sac cross-sectional area between the two groups after treatment( P > 0. 05). Conclusion Massage combined with acupuncture nerve stimulation is effective in the treatment of LSS,which can quickly relieve clinical symptoms.
引文
[1]白永权.手法结合针药治疗腰椎间盘突出伴椎管狭窄30例的疗效观察[J].中国医学创新,2014,11(11):113-115.
[2]王诚宏.针灸治疗腰椎管狭窄症的疗效研究[J].中华物理医学与康复杂志,2009,31(1):42-43.
[3]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:217-218.
[4]严金林.推拿临证指南[M].北京:中医古籍出版社,2003:244-248.
[5] Van Roo JD,Lazio MP,Pesce C,et al. Visual analog scale(VAS)for assessment of acute mountain sickness(AMS)on Aconcagua[J]. Wilderness Environ Med,2011,22(1):7-14.
[6]蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:267.
[7]马伟丽,常晓丹,杨培.退变性中央型腰椎管狭窄硬膜囊横截面积与神经根沉降征相关性研究[J].生物医学工程与临床,2018,22(4):430-434.
[8]夏可周,郭卫春.退变性腰椎管狭窄症手术治疗中不同术式的应用进展[J].山东医药,2016,56(39):103-106.
[9]金大地.腰椎间盘突出症和椎管狭窄症手术并发症的回顾性分析[J].中华骨科杂志,2003,23(11):653-656.
[10]陈科,潘汉升,周先明,等.经皮椎间孔镜与开放手术治疗腰椎管狭窄症的Meta分析[J].微创医学,2018,13(1):34-38,44.
[11]寇福新,孙常太.退行性腰椎管狭窄症的治疗进展[J].中国脊柱脊髓杂志,2013,23(8):756-759.
[12] Lee DY,Lee SH. Learning curve for percutaneous endoscopic lumbar discectomy[J]. Neurol Med Chir(Tokyo),2008,48(9):383-388.
[13]马明辉,杨延全,丁宇.腰椎管狭窄症的诊断及治疗研究进展[J].海军总医院学报,2010,23(3):160-163.
[14]刘侃,吴闻文,李利,等.选择性神经根阻滞术在老年人多节段腰椎椎管狭窄症诊断中的应用[J].脊柱外科杂志,2014,12(2):73-77.
[15]李强.经皮椎间孔镜治疗老年性腰椎管狭窄症疗效观察[J].中国卫生标准管理,2016,7(14):52-53.
[16] Kanchiku,Tsukasa,Imajo,et al. Comparisons on Efficacy of Elcatonin and Limaprost Alfadex in Patients with Lumbar Spinal Stenosis and Concurrent Osteoporosis:A Preliminary Study Using a Crossover Design[J]. Asian Spine J,2014,8(4):469-475.
[17]刘京宇,周谋望,侯树勋,等.腰椎退行性疾病术后康复模式研究[J].中国骨与关节杂志,2016,5(3):183-187.
[18] Frymoyer JW. Degenerative Spondylolisthesis:Diagnosis and Treatment[J]. J Am Acad Orthop Surg,1994,2(1):9-15.
[19]龙如昌,吴毅文.腰椎管狭窄症的非手术治疗[J].颈腰痛杂志,2003,24(2):101-102.
[20]景绘涛,彭易雨,陈敏,等.夹脊穴深刺治疗腰椎管狭窄症疗效观察[J].中国针灸,2011,31(9):791-794.
[21]陆保全,卢爱玲.牵引、微波加干扰电联合治疗腰椎管狭窄症疗效分析[J].中国医学创新,2013,10(5):31-32.
[22]韦以宗.中医整脊学[M].北京:中国中医药出版社,2016:109.
[23]马锐,陈建常.腰椎椎管狭窄症的诊断与治疗现状[J].检验医学与临床,2013,10(1):72-75.
[24] Whitman JM,Flynn TW,Childs JD,et al. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis:a randomized clinical trial[J]. Spine(Phila Pa 1976),2006,31(22):2541-2549.
[25]田强,赵家友,郭汝松,等.脊柱推拿配合独活寄生汤治疗腰椎管狭窄症临床研究[J].新中医,2015,47(8):250-251.
[26]任月林,任旭飞.实用针刀医学治疗学[M].北京:人民卫生出版社,2006:215-220.
[27]宋宝,李华东,李梅梅.瞬时强电针结合腰椎侧扳法治疗腰椎间盘突出症下肢麻木31例[J].中国针灸,2018,38(2):193-194.
[2]王诚宏.针灸治疗腰椎管狭窄症的疗效研究[J].中华物理医学与康复杂志,2009,31(1):42-43.
[3]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:217-218.
[4]严金林.推拿临证指南[M].北京:中医古籍出版社,2003:244-248.
[5] Van Roo JD,Lazio MP,Pesce C,et al. Visual analog scale(VAS)for assessment of acute mountain sickness(AMS)on Aconcagua[J]. Wilderness Environ Med,2011,22(1):7-14.
[6]蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:267.
[7]马伟丽,常晓丹,杨培.退变性中央型腰椎管狭窄硬膜囊横截面积与神经根沉降征相关性研究[J].生物医学工程与临床,2018,22(4):430-434.
[8]夏可周,郭卫春.退变性腰椎管狭窄症手术治疗中不同术式的应用进展[J].山东医药,2016,56(39):103-106.
[9]金大地.腰椎间盘突出症和椎管狭窄症手术并发症的回顾性分析[J].中华骨科杂志,2003,23(11):653-656.
[10]陈科,潘汉升,周先明,等.经皮椎间孔镜与开放手术治疗腰椎管狭窄症的Meta分析[J].微创医学,2018,13(1):34-38,44.
[11]寇福新,孙常太.退行性腰椎管狭窄症的治疗进展[J].中国脊柱脊髓杂志,2013,23(8):756-759.
[12] Lee DY,Lee SH. Learning curve for percutaneous endoscopic lumbar discectomy[J]. Neurol Med Chir(Tokyo),2008,48(9):383-388.
[13]马明辉,杨延全,丁宇.腰椎管狭窄症的诊断及治疗研究进展[J].海军总医院学报,2010,23(3):160-163.
[14]刘侃,吴闻文,李利,等.选择性神经根阻滞术在老年人多节段腰椎椎管狭窄症诊断中的应用[J].脊柱外科杂志,2014,12(2):73-77.
[15]李强.经皮椎间孔镜治疗老年性腰椎管狭窄症疗效观察[J].中国卫生标准管理,2016,7(14):52-53.
[16] Kanchiku,Tsukasa,Imajo,et al. Comparisons on Efficacy of Elcatonin and Limaprost Alfadex in Patients with Lumbar Spinal Stenosis and Concurrent Osteoporosis:A Preliminary Study Using a Crossover Design[J]. Asian Spine J,2014,8(4):469-475.
[17]刘京宇,周谋望,侯树勋,等.腰椎退行性疾病术后康复模式研究[J].中国骨与关节杂志,2016,5(3):183-187.
[18] Frymoyer JW. Degenerative Spondylolisthesis:Diagnosis and Treatment[J]. J Am Acad Orthop Surg,1994,2(1):9-15.
[19]龙如昌,吴毅文.腰椎管狭窄症的非手术治疗[J].颈腰痛杂志,2003,24(2):101-102.
[20]景绘涛,彭易雨,陈敏,等.夹脊穴深刺治疗腰椎管狭窄症疗效观察[J].中国针灸,2011,31(9):791-794.
[21]陆保全,卢爱玲.牵引、微波加干扰电联合治疗腰椎管狭窄症疗效分析[J].中国医学创新,2013,10(5):31-32.
[22]韦以宗.中医整脊学[M].北京:中国中医药出版社,2016:109.
[23]马锐,陈建常.腰椎椎管狭窄症的诊断与治疗现状[J].检验医学与临床,2013,10(1):72-75.
[24] Whitman JM,Flynn TW,Childs JD,et al. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis:a randomized clinical trial[J]. Spine(Phila Pa 1976),2006,31(22):2541-2549.
[25]田强,赵家友,郭汝松,等.脊柱推拿配合独活寄生汤治疗腰椎管狭窄症临床研究[J].新中医,2015,47(8):250-251.
[26]任月林,任旭飞.实用针刀医学治疗学[M].北京:人民卫生出版社,2006:215-220.
[27]宋宝,李华东,李梅梅.瞬时强电针结合腰椎侧扳法治疗腰椎间盘突出症下肢麻木31例[J].中国针灸,2018,38(2):193-194.