循经推拿联合牵引法在改善腰椎间盘突出患者功能障碍中的应用
|
摘要
[目的]探讨循经推拿联合牵引法在改善腰椎间盘突出(lumbar disc herniation, LDH)患者功能障碍中的应用。[方法]选取2015年1月至2018年1月本院收治的LDH患者100例,依据随机数字表法分为循推组和常规组,每组50例,常规组给予常规对症和牵引治疗,循推组在此基础上给予循经推拿治疗,比较两组血液流变学、疼痛、功能障碍、治疗疗效。[结果]循推组和常规组治疗后全血低切黏度(whole blood low shear viscosity, WBLSV)、血浆黏度(plasma viscosity, PV)、全血高切黏度(whole blood high shear viscosity, WBHSV)、血小板聚集率(platelet aggregation rate, PAR)水平均明显低于治疗前,循推组治疗后WBLSV、PV、WBLSV、PAR水平明均显低于常规组,差异均有统计学意义(P<0.05);循推组和常规组治疗后1、3个月疼痛视觉模拟评分法(visual analogue score, VAS)、Oswestry功能障碍指数问卷表(Oswestry dysfunction index, ODI)评分均明显低于治疗前,循推组治疗后VAS、ODI评分均明显低于常规组,差异均有统计学意义(P<0.05);循推组治疗优良率明显高于常规组,差异有统计学意义(P<0.05)。[结论]循经推拿联合牵引法可有效改善LDH患者血液流变学,有利于缓解患者疼痛、功能障碍,且可提高患者疗效,值得临床作进一步推广。
[Objective] To discuss the application of massage along the meridians combined with traction in improving the dysfunction of patients with lumbar disc herniation(LDH). [Methods] 100 patients with LDH were selected from January 2015 to January 2018 in our hospital, according to the random number table method, they were divided into massage along group and routine group, 50 cases in each group, routine group was given routine symptomatic and traction treatment, on this basis, massage along group was given massage along the meridians treatment, and the hemorheology, pain, dysfunction and therapeutic effect were compared between the two groups. [Results] The after treatment whole blood low shear viscosity(WBLSV), plasma viscosity(PV),whole blood high shear viscosity(WBHSV), platelet aggregation rate(PAR) levels in massage along group and routine group were all significantly lower than those in the before treatment, the after treatment WBLSV, PV, WBHSV, PAR in massage along group were all significantly lower than those in routine group, the difference was statistically significant(P <0.05). The 1, 3 months after treatment pain visual analogue score(VAS) and Oswestry dysfunction index questionnaire(ODI) scores in massage along group and routine group were all significantly lower than those in the before treatment, the1, 3 months after treatment VAS, ODI scores in massage along group were all significantly lower than those in routine group, the difference was statistically significant(P<0.05). The treatment excellent rate of massage along group was significantly lower than that of routine group, the difference was statistically significant(P<0.05). [Conclusions] Massage along the meridians combined with traction can effectively improve the hemorheology in patients with LDH, it is helpful to relieve the pain and dysfunction of patients, and it can improve the therapeutic effect of patients,it 's worth for further clinical promotion.
[Objective] To discuss the application of massage along the meridians combined with traction in improving the dysfunction of patients with lumbar disc herniation(LDH). [Methods] 100 patients with LDH were selected from January 2015 to January 2018 in our hospital, according to the random number table method, they were divided into massage along group and routine group, 50 cases in each group, routine group was given routine symptomatic and traction treatment, on this basis, massage along group was given massage along the meridians treatment, and the hemorheology, pain, dysfunction and therapeutic effect were compared between the two groups. [Results] The after treatment whole blood low shear viscosity(WBLSV), plasma viscosity(PV),whole blood high shear viscosity(WBHSV), platelet aggregation rate(PAR) levels in massage along group and routine group were all significantly lower than those in the before treatment, the after treatment WBLSV, PV, WBHSV, PAR in massage along group were all significantly lower than those in routine group, the difference was statistically significant(P <0.05). The 1, 3 months after treatment pain visual analogue score(VAS) and Oswestry dysfunction index questionnaire(ODI) scores in massage along group and routine group were all significantly lower than those in the before treatment, the1, 3 months after treatment VAS, ODI scores in massage along group were all significantly lower than those in routine group, the difference was statistically significant(P<0.05). The treatment excellent rate of massage along group was significantly lower than that of routine group, the difference was statistically significant(P<0.05). [Conclusions] Massage along the meridians combined with traction can effectively improve the hemorheology in patients with LDH, it is helpful to relieve the pain and dysfunction of patients, and it can improve the therapeutic effect of patients,it 's worth for further clinical promotion.
引文
[1]Takasaki H.Comparable effect of simulated side bending and side gli-ding positions on the direction and magnitude of lumbar disc hydration shift:in vivo MRI mechanistic study[J].J Man Manip Ther,2015,23(2):101-108.
[2]Huliyappa HA,Singh RK,Singh SK,et al.Transdural herniated lumbar disc disease with muscle patch for closure of durotomy-A Brief review of literature[J].Neurol Neurochir Pol,2017,51(2):149-155.
[3]雷龙鸣,黄锦军,唐宏亮,等.背部循经推拿干预亚健康疲劳状态的临床观察[J].中华中医药学刊,2016,34(5):1034-1036.
[4]穆景颂,倪朝民.常见病康复诊疗规范---腰椎间盘突出症分级康复诊疗指南解读[J].安徽医学,2017,38(5):674-675.
[5]Kreiner DS,Hwang SW,Easa JE,et al.An evidence-based clinicalguideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy[J].The Spine Journal,2014,14(1):180-191.
[6]Sun D,Liu P,Cheng J,et al.Correlation between intervertebral disc degeneration,paraspinal muscle atrophy,and lumbar facet joints degeneration in patients with lumbar disc herniation[J].BMC Musculoskelet Disord,2017,18(1):167.
[7]Kreiner D S,Hwang S W,Easa J E,et al.An evidencebased clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy[J].Spine J,2014,14(1):180-191.
[8]张恩生.火针配合毫针治疗腰椎间盘突出症78例疗效观察[J].浙江中医药大学学报,2014,38(11):1331-1332.
[9]Fort NM,Aichmair A,Miller AO,et al.L5-S1 Achromobacter xy-losoxidans infection secondary to oxygen-ozone therapy for the treatment of lumbosacral disc herniation:Acase report and review of the literature[J].Spine,2014,39(6):E413-E416.
[10]霍龙,杜金辉,毕忠艳,等.中药熏蒸联合推拿针灸疗法治疗特勤人员腰椎间盘突出症的疗效观察[J].中国疗养医学,2018,27(2):152-154.
[11]张学武.小针刀联合推拿治疗腰椎间盘突出症疗效观察[J].中华中医药杂志,2014,29(6):2056-2057.
[12]陈珊.温针灸腰夹脊穴治疗腰椎间盘突出症临床分析[J].实用中医药杂志,2015,31(9):846-847.
[13]贾昕.苗药结合循经推拿治疗颈肩腰腿痛临床疗效分析[J].内科,2015,10(6):824-825.
[14]胡艳.循经点穴推拿联合电针治疗腰椎间盘突出症40例[J].针灸临床杂志,2015,31(12):22-24.
[15]Aichmair A,Du JY,Shue J,et al.Microdiscectomy for the treatment of lumbar disc herniation:an evaluation of reoperations and long-term outcomes[J].Evid Based Spine Care J,2014,5(2):77-86.
[16]潘畅,何薇,吴强,等.“四穴电针”对腰椎间盘突出症根性痛的镇痛效应及血液流变学的影响[J].中华临床医师杂志(电子版),2016,10(11):12-13.
[17]Altinkaya N,Cekinmez M.Lumbar multifidus muscle changes in unilateral lumbar disc herniation using magnetic resonance imaging[J].Skeletal Radiol,2016,45(1):73-77.
[18]刘家远,闫安.中频电疗结合循经点穴推拿治疗腰椎间盘突出症的疗效及对血浆NGF、SP水平的影响研究[J].浙江中医杂志,2015,50(10):749-750.
[19]黄奕斌,冯典毅,谢群峰,等.颈牵正骨循经取穴电针治疗神经根型颈椎病的临床观察[J].针灸临床杂志,2014,30(9):21-23.
[20]Yilmaz MZ,Sarihasan BB,Kelsaka E,et al.Comparison of the analgesic effects of paracetamol and tramadol in lumbar disc surgery[J].Turk J Med Sci,2015,45(2):438-442.
[2]Huliyappa HA,Singh RK,Singh SK,et al.Transdural herniated lumbar disc disease with muscle patch for closure of durotomy-A Brief review of literature[J].Neurol Neurochir Pol,2017,51(2):149-155.
[3]雷龙鸣,黄锦军,唐宏亮,等.背部循经推拿干预亚健康疲劳状态的临床观察[J].中华中医药学刊,2016,34(5):1034-1036.
[4]穆景颂,倪朝民.常见病康复诊疗规范---腰椎间盘突出症分级康复诊疗指南解读[J].安徽医学,2017,38(5):674-675.
[5]Kreiner DS,Hwang SW,Easa JE,et al.An evidence-based clinicalguideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy[J].The Spine Journal,2014,14(1):180-191.
[6]Sun D,Liu P,Cheng J,et al.Correlation between intervertebral disc degeneration,paraspinal muscle atrophy,and lumbar facet joints degeneration in patients with lumbar disc herniation[J].BMC Musculoskelet Disord,2017,18(1):167.
[7]Kreiner D S,Hwang S W,Easa J E,et al.An evidencebased clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy[J].Spine J,2014,14(1):180-191.
[8]张恩生.火针配合毫针治疗腰椎间盘突出症78例疗效观察[J].浙江中医药大学学报,2014,38(11):1331-1332.
[9]Fort NM,Aichmair A,Miller AO,et al.L5-S1 Achromobacter xy-losoxidans infection secondary to oxygen-ozone therapy for the treatment of lumbosacral disc herniation:Acase report and review of the literature[J].Spine,2014,39(6):E413-E416.
[10]霍龙,杜金辉,毕忠艳,等.中药熏蒸联合推拿针灸疗法治疗特勤人员腰椎间盘突出症的疗效观察[J].中国疗养医学,2018,27(2):152-154.
[11]张学武.小针刀联合推拿治疗腰椎间盘突出症疗效观察[J].中华中医药杂志,2014,29(6):2056-2057.
[12]陈珊.温针灸腰夹脊穴治疗腰椎间盘突出症临床分析[J].实用中医药杂志,2015,31(9):846-847.
[13]贾昕.苗药结合循经推拿治疗颈肩腰腿痛临床疗效分析[J].内科,2015,10(6):824-825.
[14]胡艳.循经点穴推拿联合电针治疗腰椎间盘突出症40例[J].针灸临床杂志,2015,31(12):22-24.
[15]Aichmair A,Du JY,Shue J,et al.Microdiscectomy for the treatment of lumbar disc herniation:an evaluation of reoperations and long-term outcomes[J].Evid Based Spine Care J,2014,5(2):77-86.
[16]潘畅,何薇,吴强,等.“四穴电针”对腰椎间盘突出症根性痛的镇痛效应及血液流变学的影响[J].中华临床医师杂志(电子版),2016,10(11):12-13.
[17]Altinkaya N,Cekinmez M.Lumbar multifidus muscle changes in unilateral lumbar disc herniation using magnetic resonance imaging[J].Skeletal Radiol,2016,45(1):73-77.
[18]刘家远,闫安.中频电疗结合循经点穴推拿治疗腰椎间盘突出症的疗效及对血浆NGF、SP水平的影响研究[J].浙江中医杂志,2015,50(10):749-750.
[19]黄奕斌,冯典毅,谢群峰,等.颈牵正骨循经取穴电针治疗神经根型颈椎病的临床观察[J].针灸临床杂志,2014,30(9):21-23.
[20]Yilmaz MZ,Sarihasan BB,Kelsaka E,et al.Comparison of the analgesic effects of paracetamol and tramadol in lumbar disc surgery[J].Turk J Med Sci,2015,45(2):438-442.