推拿治疗腰椎间盘突出症的临床及其机理研究
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摘要
目的 通过临床观察研究，进一步探讨推拿对腰椎间盘突出症的确切疗效和作用机理。
方法 将临床诊断为PLD的50例患者，随机分为两组，其中治疗组30例，予以推拿治疗，对照组20例，予以三维立体牵引，两组均以30天为一疗程。
结果 临床观察发现，经治疗后，推拿能明显减少患者的症状总积分、VAS积分，升高直腿抬高度数，其有效率达93.33％，优于牵引组，与对照组比较差异显著(P＜0.05)，说明推拿治疗在改善临床症状方面优于牵引治疗。推拿组的实验数据表明，对升高的全血低切粘度、全血高切粘度、血浆粘度、红细胞聚集指数推拿有明显的降低作用。推拿组30例患者中有5例患者治疗前血清Ig含量显著高于正常值(P＜0.05)，经治疗后，全组病人血清Ig含量较前明显降低，有显著性差异(P＜0.01)，但变化均在正常范围内。
结论 临床研究表明：1．推拿治疗腰椎间盘突出症在改善临床症状方面优于牵引治疗。2．推拿具有改善血液流变学的作用。3．推拿可以调节机体免疫机能紊乱状态。对于推拿通过何种途径来进行免疫调节，有待进一步研究。
Object: To observe the therapeutic efficacy of Tui Na in treating Protrusion of Lumber Disc (PLD) and discuss deeply about its operating mechanism. Methods: 50 patients diagnosed PLD were divided into two groups by random, among these patients, therapeutic group (30) were treated by Tui Na, contract group (20) were treated by Traction, 30 days was a course of treatment. Results: The clinical observing shows that Tui Na could obviously reduce the cumulative scoring of clinical symptoms and of VAS of patients, and increase the number of the straight-leg lifting test. After Tui Na treatment, the effective rate was
up to 93.3% and the difference was significant compared to the contract group(P<0.05) .It explains that the treatment of Tui Na is better than Traction in improving clinical symptoms of patients. The experiment data of Tui Na group shows that Tui Na could obviously reduce the excessive hBL, hBH, hP and PAR. It also shows that Ig content in blood serum of 5 patients was higher than normal before Tui Na (P<0.05) . After treatment, Ig content in blood serum of therapeutic group was obviously lower than before
(P<0.01) .But the variety was within the scope of normal. Conclusion: Clinical study shows the follows: 1 .The curative effect of Tui Na is better than Traction group in treating PLD. 2.Tui Na has the function of improving the haemorheology. 3.Tui Na can regulate the abnormal autoimmune system and We should do further reach about how to do it.
方法 将临床诊断为PLD的50例患者，随机分为两组，其中治疗组30例，予以推拿治疗，对照组20例，予以三维立体牵引，两组均以30天为一疗程。
结果 临床观察发现，经治疗后，推拿能明显减少患者的症状总积分、VAS积分，升高直腿抬高度数，其有效率达93.33％，优于牵引组，与对照组比较差异显著(P＜0.05)，说明推拿治疗在改善临床症状方面优于牵引治疗。推拿组的实验数据表明，对升高的全血低切粘度、全血高切粘度、血浆粘度、红细胞聚集指数推拿有明显的降低作用。推拿组30例患者中有5例患者治疗前血清Ig含量显著高于正常值(P＜0.05)，经治疗后，全组病人血清Ig含量较前明显降低，有显著性差异(P＜0.01)，但变化均在正常范围内。
结论 临床研究表明：1．推拿治疗腰椎间盘突出症在改善临床症状方面优于牵引治疗。2．推拿具有改善血液流变学的作用。3．推拿可以调节机体免疫机能紊乱状态。对于推拿通过何种途径来进行免疫调节，有待进一步研究。
Object: To observe the therapeutic efficacy of Tui Na in treating Protrusion of Lumber Disc (PLD) and discuss deeply about its operating mechanism. Methods: 50 patients diagnosed PLD were divided into two groups by random, among these patients, therapeutic group (30) were treated by Tui Na, contract group (20) were treated by Traction, 30 days was a course of treatment. Results: The clinical observing shows that Tui Na could obviously reduce the cumulative scoring of clinical symptoms and of VAS of patients, and increase the number of the straight-leg lifting test. After Tui Na treatment, the effective rate was
up to 93.3% and the difference was significant compared to the contract group(P<0.05) .It explains that the treatment of Tui Na is better than Traction in improving clinical symptoms of patients. The experiment data of Tui Na group shows that Tui Na could obviously reduce the excessive hBL, hBH, hP and PAR. It also shows that Ig content in blood serum of 5 patients was higher than normal before Tui Na (P<0.05) . After treatment, Ig content in blood serum of therapeutic group was obviously lower than before
(P<0.01) .But the variety was within the scope of normal. Conclusion: Clinical study shows the follows: 1 .The curative effect of Tui Na is better than Traction group in treating PLD. 2.Tui Na has the function of improving the haemorheology. 3.Tui Na can regulate the abnormal autoimmune system and We should do further reach about how to do it.
引文
[1] 胡有谷．腰椎间突出症，北京：人民卫生出版社，1999，第2版：2．
[2] 中药新药临床研究指导原则，北京：中国医药科技出版社，1994，202．
[3] Smyth, M.G.: Clin. Orthop. 1977: 129: 9.
[4] Dilke, T.F.: Bri. Med. J. 1973; 2: 635.
[5] Murphy, RW. Nerve roots and spinal nerves in degenerative disk disease. Clin. Orthop. 1977; 129: 47.
[6] 胡有谷．腰椎间突出症，北京：人民卫生出版社，1999，第2版：131．
[7] Murphy, RW. Nerve roots and spinal nerves in degenerative disk disease. Clin Orthop 1977; 129: 46.
[8] Satoh D, Konno S, Nishiyama K et al. Presence and distribution of antigenantibody complexes in the herniated nucleus pulpous. Spine, 1999; 24(19):1980～1984.
[9] Yoshizawa H, Kobayashi S, Morita T. Chronic nerve root compression: Pathophysiologic mechanism of nerve root dysfunction. Spine, 1995; 20(4): 397～407.
[10] Lisak RP, Bealmear B. Interleukin—lalpha, but not interleukin—lbeta, is a coy—mitogen for neonatal Schwann cells in vitro and acts viainterleukin—l receptors. J Neuroimmunol, 1994; 55(2): 171～177.
[11] Lisak RP, Bealmear B. Antibodies to interleukin-l inhibits cytokine—induced proliferation lf neonatal rat Shwann cells in vitro. J Neuroimmunol, 1991: 31(2): 123～132.
[12] Meeting report: Inflammation and hyperalgesia: highlighting the team effort. TIPS, 1993; 14: 287～290.
[13] Naylar A. Enzymic and immunological activity in the intervertebraldisc. Orthop Clin N Am. 1975; 6: 51.
[14] 王葵光，胡有谷．腰椎间盘突出症的自身免疫状态．中华骨科杂志，1994；14(5)：258～262．
[15] Geha. R.S. et al. Celluar abnormalities in patients with elevated serum IgE levels. J Allery Clin Immunol, 1986; 78: 995.
[16] Hughes SE, Hall PA. Overview of the fibroblast growth factor and receptor families: complexity, functional research. Cardiovascular Res, 1993; 27(7): 1199.
[17] Goldie. I. Granulation tissue in the ruptured intervertebral disc. Acts Orthop Scand, 1959; 22: 302.
[18] Macnab. I. The mechanism of spondylogenic pain in cervical pain. In Oxford. Pergamon Press. edited by C. Hirsch&Y. Zoherman, 1971: 89～95.
[19] Doita M, Kanatani T, Harada T. Immunohistolgic study of the ruptured intervertebral disc of the lumbar spine. Spine, 1996; 21(2): 235.
[20] FujitaK, Nakagawa T, Hirabayashi K et al, Neurtral proteinases in human intervertebral disc: role in degeneration and probalble origin. Spine, 1993; 18: 1766.
[21] 邓相华，吴祖尧．腰椎间盘突症发病机理和硬膜外激素注射疗法．国外医学参考资料·外科学分册，1979；3：149～154．
[22] 潘崇海，陆建伟．保守疗法对腰椎间盘突出症的疗效及机理探讨．中国骨伤，2000：13(1)：30．
[23] 费季翔，陆珍千，刘志诚，等．从尿液中单胺类物质含量的改变观察推拿牵引治疗腰椎间盘突出症的镇痛机理．按摩与导引，1992；(1)：9～11．
[24] 费季翔，陆珍千，刘志诚，等．从血浆与尿中儿茶酚胺和它的代谢产物含量说明推拿的镇痛作用．颈腰痛杂志，1994；15(4)：199～200．
[25] 陈全珠，刘冰怀，焦洁，等．推拿牵引镇痛调整唾液中5—羟色胺的变化．疼痛学杂志，1995；3(4)：149～150．
[26] 刘志诚．推拿按摩镇痛和调整作用的研究，中国中医骨伤科杂志，1991；(5)：3～9
[27] 刘志诚，孙东，陈全珠，等．外周血儿茶酚胺在推拿牵引镇痛调整中的作用．中西医结合杂志，1986；(9)：540～542．
[28] 彭筱．按摩对血循环系统生化功能的影响．按摩与导引，1987；(5)；20．
[29] 王凌斗．微循环的正常结构、功能及调节．天津市医学科技情报研究所医学情报资料，1987；(1)：1．
[30] 韩济生．痛觉生理的某些进展．中西医结合软组织疼痛学学术会议论文汇编，1984；1．
[31] 胡三觉．局部刺激降底大鼠痛感受器反应性．针灸论文摘要选编，1987；290
[32] 龚正丰，姜宏，陈益群，等．镇痛牵引下脊柱推拿手法对腰椎间盘突出症血液流变学的影响．中医正骨，1997：9(3)：15—16．
[33] 林应强．推拿对腰椎间盘突出症血液流变学的影响．按摩与导引，2000；17(2)：7．
[34] 吕刚，王星铎．疼痛与神经损伤．中华骨科杂志，1996；6(3)：182．
[35] 蒋位庄．活血化瘀治则对模拟神经根炎治疗作用实验研究．中国骨伤，1987：(1)10．
[36] 李军，刘淼，朱丽萍，腰椎间盘突出症的自身免疫水平与腰腿痛严重程度的关系．西安医科大学学报，2000；21(2)：150～151．
[37] 王葵光，胡有谷．腰椎间盘突出症的自身免疫状态．中华骨科杂志，1994；14(5)：258～262．
[2] 中药新药临床研究指导原则，北京：中国医药科技出版社，1994，202．
[3] Smyth, M.G.: Clin. Orthop. 1977: 129: 9.
[4] Dilke, T.F.: Bri. Med. J. 1973; 2: 635.
[5] Murphy, RW. Nerve roots and spinal nerves in degenerative disk disease. Clin. Orthop. 1977; 129: 47.
[6] 胡有谷．腰椎间突出症，北京：人民卫生出版社，1999，第2版：131．
[7] Murphy, RW. Nerve roots and spinal nerves in degenerative disk disease. Clin Orthop 1977; 129: 46.
[8] Satoh D, Konno S, Nishiyama K et al. Presence and distribution of antigenantibody complexes in the herniated nucleus pulpous. Spine, 1999; 24(19):1980～1984.
[9] Yoshizawa H, Kobayashi S, Morita T. Chronic nerve root compression: Pathophysiologic mechanism of nerve root dysfunction. Spine, 1995; 20(4): 397～407.
[10] Lisak RP, Bealmear B. Interleukin—lalpha, but not interleukin—lbeta, is a coy—mitogen for neonatal Schwann cells in vitro and acts viainterleukin—l receptors. J Neuroimmunol, 1994; 55(2): 171～177.
[11] Lisak RP, Bealmear B. Antibodies to interleukin-l inhibits cytokine—induced proliferation lf neonatal rat Shwann cells in vitro. J Neuroimmunol, 1991: 31(2): 123～132.
[12] Meeting report: Inflammation and hyperalgesia: highlighting the team effort. TIPS, 1993; 14: 287～290.
[13] Naylar A. Enzymic and immunological activity in the intervertebraldisc. Orthop Clin N Am. 1975; 6: 51.
[14] 王葵光，胡有谷．腰椎间盘突出症的自身免疫状态．中华骨科杂志，1994；14(5)：258～262．
[15] Geha. R.S. et al. Celluar abnormalities in patients with elevated serum IgE levels. J Allery Clin Immunol, 1986; 78: 995.
[16] Hughes SE, Hall PA. Overview of the fibroblast growth factor and receptor families: complexity, functional research. Cardiovascular Res, 1993; 27(7): 1199.
[17] Goldie. I. Granulation tissue in the ruptured intervertebral disc. Acts Orthop Scand, 1959; 22: 302.
[18] Macnab. I. The mechanism of spondylogenic pain in cervical pain. In Oxford. Pergamon Press. edited by C. Hirsch&Y. Zoherman, 1971: 89～95.
[19] Doita M, Kanatani T, Harada T. Immunohistolgic study of the ruptured intervertebral disc of the lumbar spine. Spine, 1996; 21(2): 235.
[20] FujitaK, Nakagawa T, Hirabayashi K et al, Neurtral proteinases in human intervertebral disc: role in degeneration and probalble origin. Spine, 1993; 18: 1766.
[21] 邓相华，吴祖尧．腰椎间盘突症发病机理和硬膜外激素注射疗法．国外医学参考资料·外科学分册，1979；3：149～154．
[22] 潘崇海，陆建伟．保守疗法对腰椎间盘突出症的疗效及机理探讨．中国骨伤，2000：13(1)：30．
[23] 费季翔，陆珍千，刘志诚，等．从尿液中单胺类物质含量的改变观察推拿牵引治疗腰椎间盘突出症的镇痛机理．按摩与导引，1992；(1)：9～11．
[24] 费季翔，陆珍千，刘志诚，等．从血浆与尿中儿茶酚胺和它的代谢产物含量说明推拿的镇痛作用．颈腰痛杂志，1994；15(4)：199～200．
[25] 陈全珠，刘冰怀，焦洁，等．推拿牵引镇痛调整唾液中5—羟色胺的变化．疼痛学杂志，1995；3(4)：149～150．
[26] 刘志诚．推拿按摩镇痛和调整作用的研究，中国中医骨伤科杂志，1991；(5)：3～9
[27] 刘志诚，孙东，陈全珠，等．外周血儿茶酚胺在推拿牵引镇痛调整中的作用．中西医结合杂志，1986；(9)：540～542．
[28] 彭筱．按摩对血循环系统生化功能的影响．按摩与导引，1987；(5)；20．
[29] 王凌斗．微循环的正常结构、功能及调节．天津市医学科技情报研究所医学情报资料，1987；(1)：1．
[30] 韩济生．痛觉生理的某些进展．中西医结合软组织疼痛学学术会议论文汇编，1984；1．
[31] 胡三觉．局部刺激降底大鼠痛感受器反应性．针灸论文摘要选编，1987；290
[32] 龚正丰，姜宏，陈益群，等．镇痛牵引下脊柱推拿手法对腰椎间盘突出症血液流变学的影响．中医正骨，1997：9(3)：15—16．
[33] 林应强．推拿对腰椎间盘突出症血液流变学的影响．按摩与导引，2000；17(2)：7．
[34] 吕刚，王星铎．疼痛与神经损伤．中华骨科杂志，1996；6(3)：182．
[35] 蒋位庄．活血化瘀治则对模拟神经根炎治疗作用实验研究．中国骨伤，1987：(1)10．
[36] 李军，刘淼，朱丽萍，腰椎间盘突出症的自身免疫水平与腰腿痛严重程度的关系．西安医科大学学报，2000；21(2)：150～151．
[37] 王葵光，胡有谷．腰椎间盘突出症的自身免疫状态．中华骨科杂志，1994；14(5)：258～262．