腰痹舒筋汤联合小针刀治疗老年腰椎间盘突出症临床研究
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摘要
目的:观察腰痹舒筋汤联合小针刀治疗老年腰椎间盘突出症的临床疗效。方法:选择本院2015年4月至2016年2月诊治的老年腰椎间盘突出症患者99例,按照随机数字表法分为对照组47例和联合组52例。对照组给予腰痹舒筋汤治疗,联合组给予腰痹舒筋汤联合小针刀治疗。观察其临床疗效,两组患者治疗前后视觉模拟疼痛评分(VAS评分)、Oswestyr功能障碍指数(ODI评分)、腰痛评分量表(JOA评分)、腰椎活动度、步行困难、趾肌力、白细胞介素-1β(interleukin-1β,IL-1β)、白细胞介素-6(interleukin-6,IL-6)、血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、躯体功能、物质生活、角色功能等变化情况,对患者进行6个月随访,观察其复发率。结果:对照组有效率为74. 47%,联合组有效率为92. 31%,两组有效率比较,差异具有统计学意义(P <0. 05);两组患者治疗后VAS评分比治疗前均降低,且联合组低于对照组,差异有统计学意义(P <0. 05);联合组治疗后JOA评分、ODI评分高于对照组,差异有统计学意义(P <0. 05);联合组治疗后腰椎活动度、步行困难、趾肌力等症状积分低于对照组,差异有统计学意义(P <0. 05);联合组治疗后IL-1β、IL-6、TNF-α水平低于对照组,差异有统计学意义(P <0. 05);联合组治疗后躯体功能、物质生活、角色功能等生活质量指标评分高于对照组,差异有统计学意义(P <0. 05);联合组复发率为5. 76%,对照组复发率为25. 53%,联合组复发率低于对照组,差异有统计学意义(χ2=7. 499,P=0. 006 <0. 05)。结论:腰痹舒筋汤联合小针刀治疗老年腰椎间盘突出症可提高患者生活质量,抑制血清炎性因子表达,改善患者临床症状,缓解疼痛,降低复发率。
Objective: To observe the clinical curative effect of Decoction for Lumbar Obstruction and Releasing Tendon combined with small needle knife on senile lumbar disc herniation. Methods: Ninety-nine elderly patients with lumbar intervertebral disc herniation diagnosed and treated in our hospital from April 2015 to February 2016 were divided into the control group with 47 cases and the combination group with 52 cases according to random number table method. The ones in the control group were treated with Decoction for Lumbar Obstruction and Releasing Tendon,while the ones in the combined group were treated with Decoction for Lumbar Obstruction and Releasing Tendon combined with small needle knife. The clinical effects,the changes of visual analogue pain score( VAS score),Oswestyr dysfunction index( ODI score),low back pain score( JOA score),lumbar mobility,walking difficulty,toe muscle strength,interleukin-1α( IL-1β),interleukin-6( IL-6),tumor necrosis factor-α( TNF-α),physical function,material life,and role Function before and after treatment were observed. The patients were followed up for 6 months to observe the recurrence rate. Results: The effective rate of the control group was 74. 47%,and that of the combined group was92. 31%. There was a significant difference between the two groups( P < 0. 05). The VAS scores of the two groups after the treatment were lower than those before the treatment,and the combined group was lower than the control group,and there was a significant difference between the two groups( P < 0. 05). The JOA and ODI scores of the combined group after the treatment were higher than those of the control group,and there was a significant difference between the two groups with a significant difference( P <0. 05). After the treatment,the scores of lumbar motion,walking difficulty and toe muscle strength in the combined group were lower than those in the control group,and all the differences were statistically significant( P < 0. 05). The levels of IL-1β,IL-6 and TNF-αn the combined group were lower than those in the control group,and all the differences were statistically significant( P < 0. 05). After the treatment,the scores of physical function,material life and role function in the combined group were higher than those in the control group,and all the differences were statistically significant( P < 0. 05). The recurrence rate was 5. 76%in the combined group and 25. 53% in the control group. The recurrence rate in the combined group was lower than that in the control group,and the difference was statistically significant( χ2= 7. 499,P = 0. 006 < 0. 05). Conclusion: Decoction for Lumbar Obstruction and Releasing Tendon combined with small needle knife has a remarkable efficacy on senile lumbar disc herniation,can improve the quality of life,inhibit the expression of serum inflammatory factors,improve the clinical symptoms,relieve pain and reduce the recurrence rate.
Objective: To observe the clinical curative effect of Decoction for Lumbar Obstruction and Releasing Tendon combined with small needle knife on senile lumbar disc herniation. Methods: Ninety-nine elderly patients with lumbar intervertebral disc herniation diagnosed and treated in our hospital from April 2015 to February 2016 were divided into the control group with 47 cases and the combination group with 52 cases according to random number table method. The ones in the control group were treated with Decoction for Lumbar Obstruction and Releasing Tendon,while the ones in the combined group were treated with Decoction for Lumbar Obstruction and Releasing Tendon combined with small needle knife. The clinical effects,the changes of visual analogue pain score( VAS score),Oswestyr dysfunction index( ODI score),low back pain score( JOA score),lumbar mobility,walking difficulty,toe muscle strength,interleukin-1α( IL-1β),interleukin-6( IL-6),tumor necrosis factor-α( TNF-α),physical function,material life,and role Function before and after treatment were observed. The patients were followed up for 6 months to observe the recurrence rate. Results: The effective rate of the control group was 74. 47%,and that of the combined group was92. 31%. There was a significant difference between the two groups( P < 0. 05). The VAS scores of the two groups after the treatment were lower than those before the treatment,and the combined group was lower than the control group,and there was a significant difference between the two groups( P < 0. 05). The JOA and ODI scores of the combined group after the treatment were higher than those of the control group,and there was a significant difference between the two groups with a significant difference( P <0. 05). After the treatment,the scores of lumbar motion,walking difficulty and toe muscle strength in the combined group were lower than those in the control group,and all the differences were statistically significant( P < 0. 05). The levels of IL-1β,IL-6 and TNF-αn the combined group were lower than those in the control group,and all the differences were statistically significant( P < 0. 05). After the treatment,the scores of physical function,material life and role function in the combined group were higher than those in the control group,and all the differences were statistically significant( P < 0. 05). The recurrence rate was 5. 76%in the combined group and 25. 53% in the control group. The recurrence rate in the combined group was lower than that in the control group,and the difference was statistically significant( χ2= 7. 499,P = 0. 006 < 0. 05). Conclusion: Decoction for Lumbar Obstruction and Releasing Tendon combined with small needle knife has a remarkable efficacy on senile lumbar disc herniation,can improve the quality of life,inhibit the expression of serum inflammatory factors,improve the clinical symptoms,relieve pain and reduce the recurrence rate.
引文
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[11]邓栋,钟启腾,李亦聪.浮针结合理筋正骨法治疗单纯颈、腰椎椎间盘突出症的临床观察[J].世界中医药,2017,12(12):3074-3077.
[12]陈扬声,赵晓,姚乃捷,等.针刺结合理筋正骨法治疗单纯颈、腰椎椎间盘突出症的临床观察[J].辽宁中医杂志,2017,10(6):1278-1280.
[13]张玮琛,龙欢,王杨.自拟行血舒筋汤外洗联合浮针治疗膝关节骨性关节炎急性期临床观察[J].中国中医急症,2016,25(11):2163-2165.
[14] DENKERT C,MINCKWITZ G V,DARB-ESFAHANI S,et al.Tumour-infiltrating lymphocytes and prognosis in different subtypes of breast cancer:a pooled analysis of 3771 patients treated with neoadjuvant therapy[J]. Lancet Oncology,2018,19(1):40-50.
[15]涂亦凤,傅立新.筋骨针结合气罐治疗腰椎间盘突出症的随机对照研究[J].针灸临床杂志,2017,33(9):34-37.
[16] QU N,ZHANG L,WU W L,et al. Bilaterality weighs more than unilateral multifocality in predicting prognosis in papillary thyroid cancer[J]. Tumor Biology,2016,37(7):8783-8789.
[17]刘文俊.舒筋汤经验方联合塞来昔布治疗膝骨性关节炎的临床效果及对TNF-α、VEGF、OPG水平的影响[J].四川中医,2017,20(8):116-118.
[18]高丙南.舒筋汤为主配合针刀疗法治疗瘀滞型肩周炎痛症疗效观察[J].陕西中医,2017,38(2):224-225.
[19] LIN T C,HWANG D K,LEE F L,et al. Visual prognosis of massive submacular hemorrhage in polypoidal choroidal vasculopathy with or without combination treatment.[J]. Journal of the Chinese Medical Association,2016,79(3):159-165.
[20]吴小辉,冯海波.桃红四物汤内服配合小针刀治疗第三腰椎横突综合征30例临床观察[J].中医药导报,2016,12(21):79-81.
[2]宋雪,杨大伟,张立源,等.神经妥乐平结合舒筋袪痹汤治疗腰椎间盘突出症105例疗效观察[J].世界中西医结合杂志,2017,12(4):554-556.
[3]崔玉蓬,姜梅卿,周福波,等.桃红四物汤联合手法治疗急性腰椎间盘突出症临床研究[J].国际中医中药杂志,2018,40(1):30-33.
[4] CHROM P,STEC R,SEMENIUKWOJTAS A,et al. Fuhrman Grade and Neutrophil-To-Lymphocyte Ratio Influence on Survival in Patients With Metastatic Renal Cell Carcinoma Treated With First-Line Tyrosine Kinase Inhibitors.[J]. Clinical Genitourinary Cancer,2016,14(5):457-464.
[5]石有才,王彤.龙脊活络丸结合轻手法推拿治疗青少年腰椎间盘突出症临床研究[J].国际中医中药杂志,2016,38(10):891-894.
[6]王利松,王佩琛,赵艳光.骨盆调整手法联合中药治疗腰椎间盘突出症伴骶髂关节错位疗效观察[J].现代中西医结合杂志,2018,27(9):972-975.
[7] SHANG A Q,WU J,BI F,et al. Relationship between HER2 and JAK/STAT-SOCS3 signaling pathway and clinicopathological features and prognosis of ovarian cancer[J]. Cancer Biology&Therapy,2017,18(5):314-316.
[8]刘东钱,胡迪,尚荣安,等.养血舒筋汤配合卧位平衡手法治疗椎动脉型颈椎病临床疗效及对治疗前后血液流变学影响[J].世界中医药,2017,12(1):96-99.
[9]王桃萍,程展道.正骨理筋手法配合中药内服外敷治疗腰椎间盘突出症临床研究[J].中国中医药信息杂志,2017,24(7):28-31.
[10] OKUMURA N,JHUND P S,GONG J,et al. Importance of Clinical Worsening of Heart Failure Treated in the Outpatient Setting:Evidence From the Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial(PARADIGM-HF)[J]. Circulation,2016,133(23):2254-2262.
[11]邓栋,钟启腾,李亦聪.浮针结合理筋正骨法治疗单纯颈、腰椎椎间盘突出症的临床观察[J].世界中医药,2017,12(12):3074-3077.
[12]陈扬声,赵晓,姚乃捷,等.针刺结合理筋正骨法治疗单纯颈、腰椎椎间盘突出症的临床观察[J].辽宁中医杂志,2017,10(6):1278-1280.
[13]张玮琛,龙欢,王杨.自拟行血舒筋汤外洗联合浮针治疗膝关节骨性关节炎急性期临床观察[J].中国中医急症,2016,25(11):2163-2165.
[14] DENKERT C,MINCKWITZ G V,DARB-ESFAHANI S,et al.Tumour-infiltrating lymphocytes and prognosis in different subtypes of breast cancer:a pooled analysis of 3771 patients treated with neoadjuvant therapy[J]. Lancet Oncology,2018,19(1):40-50.
[15]涂亦凤,傅立新.筋骨针结合气罐治疗腰椎间盘突出症的随机对照研究[J].针灸临床杂志,2017,33(9):34-37.
[16] QU N,ZHANG L,WU W L,et al. Bilaterality weighs more than unilateral multifocality in predicting prognosis in papillary thyroid cancer[J]. Tumor Biology,2016,37(7):8783-8789.
[17]刘文俊.舒筋汤经验方联合塞来昔布治疗膝骨性关节炎的临床效果及对TNF-α、VEGF、OPG水平的影响[J].四川中医,2017,20(8):116-118.
[18]高丙南.舒筋汤为主配合针刀疗法治疗瘀滞型肩周炎痛症疗效观察[J].陕西中医,2017,38(2):224-225.
[19] LIN T C,HWANG D K,LEE F L,et al. Visual prognosis of massive submacular hemorrhage in polypoidal choroidal vasculopathy with or without combination treatment.[J]. Journal of the Chinese Medical Association,2016,79(3):159-165.
[20]吴小辉,冯海波.桃红四物汤内服配合小针刀治疗第三腰椎横突综合征30例临床观察[J].中医药导报,2016,12(21):79-81.