【作者】 陈镇英；

【导师】 黄桂成；

【作者基本信息】 南京中医药大学 ， 中医骨伤科学， 2013， 博士

【摘要】 背景与目的：随着我国人口的日益老龄化,老年性腰椎间盘突出症的患病率明显增高,本病由于患者年龄较大,基础疾病多,病程长等特点,给临床治疗带来了很大的困难。手术治疗风险大且容易复发,非手术治疗则成为了治疗该病的首选方法。中医药在治疗该病的研究中已被证实有良好的疗效。本课题选取肾虚寒湿型老年性腰椎间盘突出症患者为研究对象,探讨自拟温阳利湿汤治疗老年性腰椎间盘突出症的临床疗效,为中医药防治老年性腰椎间盘突出症提供理论依据。方法：选取香港陈氏跌打骨伤诊所2011年4月～2012年2月的老年性腰椎间盘突出症患者50例为研究对象,并随机分为两组,即治疗组和对照组,每组各25例,治疗组采用温阳利湿汤加减治疗,每日1剂,早晚分服；对照组口服腰痹通胶囊(连云港康缘药业生产),每次2粒,每日2次,连服4周,每周复诊评估一次,详细记录各组患者JOA评分、VAS评分、Oswestry功能障碍评分,并运用SPSS16.0软件对所得数据及临床疗效评定结果进行统计分析。结果：1.治疗组治疗前VAS平均分为7.51,治疗1周时VAS评分为7.04,治疗2周时为6.54,3周时5.66,4周时下降至4.68；对照组治疗前VAS平均为7.40,治疗1周时评分为7.16,治疗2周时为6.94,3周时分为6.44,4周VAS评分降至5.97。重复测量方差分析显示不同时间点的VAS评分差异有统计学意义(P=0.000<0.01),治疗组与对照组的VAS评分比较有显著性差异(P=0.000<0.01),提示治疗组的疼痛缓解程度优于对照组。2.治疗组治疗前JOA平均分为9.53,治疗1周时JOA评分为11.41,治疗2周时为11.47,3周时12.79,4周时上升至13.09；对照组治疗前JOA平均为9.59,治疗1周时评分为10.94,治疗2周时为10.92,3周时为12.38,4周JOA评分降至12.82。重复测量方差分析显示不同时间点的JOA评分差异有统计学意义(P=0.000<0.01),治疗组与对照组的JOA评分比较有统计学意义(P=0.000<0.01),结果提示治疗组的治疗效果优于对照组。3.治疗结束后,治疗组和对照组汉化Oswedtry功能障碍指数评分均明显低于治疗前(P=0.000<0.01),治疗组在治疗后评分低于对照组,差异具有显著性(P=0.003<0.01)。4.治疗组治愈4例,显效7例,有效8例,无效6例,总有效率为76%；对照组治愈3例,显效6例,有效8例,无效8例,总有效率68%。结果显示治疗组总效率高于对照组,但差异无统计学意义(P=0.529)。结论：温阳利湿法可较好消除腰椎间盘突出而引起的肿胀、渗出、粘连和疼痛等影响,有效改善腰椎间盘突出症患者的腰痛、下肢放射痛或麻木以及感觉障碍和肌力减退等症状和体征,提高老年患者的生活质量,且该治法疗效明确、安全可靠。更多还原

【Abstract】 Background and Objective:As the population aging increasingly in our country. The morbidity of senile Lumbar Intervertebral Disc Prolapse (LIDP) has been significantly increasing. It is a big problem to treating because of long nature history, complicate underlying diseases and the age of the patients, surgical treatment is risky and also easy to recurrence, so that conservative treatment is the first choice. Chinese Medicine can ensure the satisfactory outcome. The research chooses Senile Lumbar Intervertebral Disc Prolapse with kidney deficiency and cold-dampness syndrome, Discuss self-made warming yang and removing dampness decoction’ efficacy in treating Senile Lumbar Intervertebral Disc Prolapse, Provide theoretical basis for Chinese Medicine in treating Senile Lumbar Intervertebral Disc Prolapse.Methods:The research selected50patients who came from Hong Kong Chan’s Bonesetter Clinic and were divided into two groups randomly. The treatment group was treated by the traditional Chinese medicine of warming yang and removing dampness decoction,and the control group was treated by Yaobitong capsule.In the treatment procedure,all the patients were evaluated through VAS,JOA and Oswestry score.Then all the data and the clinical effect were analyzed by SPSS16.0.Results:This clinical study has not occurred during an adverse reactions and safety accidents.1. Before the treatment, The treatment group’s average VAS score is7.51, treating one week,the score is7.04, two weeks, the score is diminish to6.54, three weeks the VAS score is reduce to5.66, after four weeks’treatment, the score is down to4.68. As same as the treatment group, the control group’VAS score is also reduces gradually. Before the treatment, The control group’s average VAS score is7.40, treating one week,the score is7.16, two weeks, the score is diminish to6.94, three weeks the VAS score is reduce to6.44, after four weeks’ treatment, the score is down to5.97. Statistic shows the treatment group was better than control group in pain relieving(P<0.01).2. Before the treatment, The treatment group’s average JOA score is9.53, treating one week,the score is11.41, two weeks, the score is rise to11.47, three weeks the JOA score is up to12.79, after four weeks’treatment, the score is up to13.09. As same as the treatment group, the control group’ JOA score is also rise gradually. Before the treatment, The control group’s average JOA score is9.59, treating one week,the score is10.94, two weeks, the score is up to10.92, three weeks the VAS score is rise to12.38, after four weeks’treatment, the score is up to12.82.Statistic shows the treatment group’result was better than control group (P＜0.01).3. After the whole treatment, Chinese Oswestry Disability Index score in the treatment group and the control group were both lower than before treatment, and the scores difference before and after treatment in the treatment group were more obviously than the control group.4. In treatment group, Cure case number were4、8cases were markedly effective、10effective、3ineffective; In control group, Cure case number were3、9cases were markedly effective、8effective、5ineffective, The total effective rate was84%in treatment group and68%in control group with significant difference.Conclusion:Warming yang and removing dampness therapy can eliminate swelling exudation and relieve the pain which cause by LIDP after a fully course, It can obviously relieves the pain, lumbodynia leg radiating pain and anesthesia induced by LIDP.The effect of the therapy is prominence. It also has high security and reliability.更多还原