温针灸联合三维牵引治疗腰椎间盘突出症急性期的疗效及对IL-1β、IL-6、hs-CRP的影响
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摘要
目的观察温针灸联合三维牵引治疗急性腰椎间盘突出症的临床疗效并探讨其作用机制。方法 148例患者随机分为治疗组和对照组各74例。对照组给予基础治疗和三维牵引,治疗组加用温针灸法,治疗10 d为1个疗程,共治疗2个疗程。比较两组的临床疗效、疼痛视觉模拟评分法评分(VAS)、日本骨科协会下腰痛功能评价表评分(JOA)和血清白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)水平。结果治疗组的总有效率97.30%高于对照组的89.19%(P <0.05);治疗后两组VAS评分和血清IL-1β、IL-6、hs-CRP水平均下降(均P <0.05),治疗第10日和20日时,治疗组的VAS评分和IL-1β、IL-6、hs-CRP水平均低于对照组(均P <0.05);两组JOA评分和直腿抬高试验评分均升高(均P <0.05),治疗第10日和20日时,治疗组的JOA评分和直腿抬高试验评分均高于对照组(均P <0.05)。结论温针灸法联合三维牵引治疗急性腰椎间盘突出症可以通过抑制炎症因子表达,从而缓解疼痛,提高临床疗效。
Objective: To observe the effects of warm needle moxibustion combined with three-dimensional traction on acute lumbar disc herniation. Methods: 148 patients were randomly divided into the treatment group and the control groups. The control group was given basic treatment and three-dimensional traction,and the treatment group was treated with warm acupuncture for 20 days. The following data was analyzed and compared : the clinical efficacy,VAS,JOA and the levels of serum IL-1β,IL-6 and hs-CRP. Results: The total effective rate of the treatment group was 97.30%,higher than 89.19% of the control group(P < 0.05). After treatment,the VAS scores and serum levels of IL-1β,IL-6 and hs-CRP in both groups decreased(all P < 0.05). On the 10 th and20 th days,those of the treatment group were lower than those of the control group(all P < 0.05). JOA scores and straight leg elevation test scores increased in both groups(P < 0.05). On the 10 th and 20 th days,those of the treatment group were higher than those of the control group(all P < 0.05). Conclusion: Warm needle moxibustion combined with three-dimensional traction on acute lumbar disc herniation can relieve pain and improve clinical efficacy by inhibiting the expression of inflammatory factors.
Objective: To observe the effects of warm needle moxibustion combined with three-dimensional traction on acute lumbar disc herniation. Methods: 148 patients were randomly divided into the treatment group and the control groups. The control group was given basic treatment and three-dimensional traction,and the treatment group was treated with warm acupuncture for 20 days. The following data was analyzed and compared : the clinical efficacy,VAS,JOA and the levels of serum IL-1β,IL-6 and hs-CRP. Results: The total effective rate of the treatment group was 97.30%,higher than 89.19% of the control group(P < 0.05). After treatment,the VAS scores and serum levels of IL-1β,IL-6 and hs-CRP in both groups decreased(all P < 0.05). On the 10 th and20 th days,those of the treatment group were lower than those of the control group(all P < 0.05). JOA scores and straight leg elevation test scores increased in both groups(P < 0.05). On the 10 th and 20 th days,those of the treatment group were higher than those of the control group(all P < 0.05). Conclusion: Warm needle moxibustion combined with three-dimensional traction on acute lumbar disc herniation can relieve pain and improve clinical efficacy by inhibiting the expression of inflammatory factors.
引文
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[3]杨滨,马华松,邹德威.腰椎间盘突出症概述[J].中国临床医生杂志,2011,39(1):18-21.
[4]Young IA,Hyman GS,Packia-Raj LN,et al.The use of lumbar epidural/transforaminal steroids for managing spinal disease[J].Journal of the American Academy of Orthopaedic Surgeons,2007,15(4):228.
[5]Tosteson AN,Skinner JS,Tosteson TD,et al.The cost effectiveness of surgical versus nonoperative treatment for lumbar disc herniation over two years:evidence from the Spine Patient Outcomes Research Trial(SPORT)[J].Spine,2008,33(19):2108-2115.
[6]Du J,Tang X,Xin J,et al.Outcomes of percutaneous endoscopic lumbar discectomy via a translaminar approach,especially for soft,highly down-migrated lumbar disc herniation[J].International Orthopaedics,2016,40(6):1247-1252.
[7]胥少汀,葛宝丰,徐印坎.实用骨科学[M].3版.北京:人民军医出版社,2005.
[8]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.
[9]胡有谷.腰椎间盘突出症[M].北京:人民卫生出版社,2002.
[10]Sarmah AK,Meyer MT,Boxall AB.A global perspective on the use,sales,exposure pathways,occurrence,fate and effects of veterinary antibiotics(VAs)in the environment[J].Chemosphere,2006,65(5):725-759.
[11]The Clinical Outcomes Committee of the Japanese Orthopaedic Association,The Subcommittee on Evaluation of Back Pain and Cervical Myelopathy,Fukui M,et al.JOA Back Pain Evaluation Questionnaire:initial report[J].Journal of Orthopaedic Science,2007,12(5):443-450.
[12]王玉龙.康复功能评定学[M].北京:人民卫生出版社,2013.
[13]陈杰.外周血IL-1β和IL-6水平与腰椎间盘突出症腰腿痛疼痛程度的临床研究[J].实用预防医学,2012,19(12):1877-1878.
[14]程维,甘宁.针刀治疗对腰椎间盘突出症患者血清IL-1β和IL-6的影响[J].中国中医急症,2013,22(8):1422-1423.
[15]Walsh A J,O′Neill CW,Lotz JC.Glucosamine HCl alters production of inflammatory mediators by rat intervertebral disc cells in vitro[J].Spine Journal,2007,7(5):601-608.
[14]胡蓓蕾,邹明,陈松芳,等.醒脑静对脑出血急性期神经功能的改善作用及对血清Tf与Ft的影响[J].中华中医药学刊,2016(2):507-509.
[16]任龙喜,梁喜斌,张彤童,等.经皮激光椎间盘减压术治疗腰椎间盘突出症的中期疗效观察[J].中国脊柱脊髓杂志,2007,22(11):302-306.
[17]郑寒丹,赵继梦,吴璐一,等.温针灸镇痛的临床应用与进展[J].中国组织工程研究,2015,19(42):6855-6860.