【作者】 陈锦辉；

【导师】 王诗忠；

【作者基本信息】 福建中医药大学 ， 针灸推拿学， 2011， 硕士

【摘要】 背景腰椎间盘突出症(Lumbar intervertebral disc herniation简称LIDH)是临床的常见病,多发病,是引起腰腿痛最常见的病因。据美国国家健康中心统计,成年人有80%遭受过腰痛的困扰,而腰椎间盘突症占门诊腰痛患者的15%-20%,其中80%-90%的腰椎间盘突出症病人可经非手术疗法治疗而愈,一般情况下,除了巨大型、骨化型、游离型和伴椎管狭窄的病例不宜进行非手术治疗外,以免可能引起或加重马尾神经损伤,一般腰椎间盘突出患者皆可用非手术治疗。绝大多数病人的首选治疗也是非手术治疗,主要方法包括推拿、针灸、理疗、牵引、中药、耳针等方法。而非手术治疗中,尤其是推拿手法治疗腰椎间盘突出症由于方法简便、舒适有效,无副作用,并发症少等优点,患者乐于接受,已被作为治疗腰椎间盘突出症的主要的方法之一。通督强脊三步七法是导师王诗忠主任医师继承了中医骨伤名老林如高前辈的学术思想和传承了国家骨伤名师王和鸣教授手法整脊疗伤的学术经验,并带领福建省第二人民医院脊柱康复科在十几年的临床与教学研究工作中经验的归纳总结出一种行之有效的治疗手段。本课题为了总结传承名老中医的经验,更好地推广应用,使得该手法更具科学性、规范化,故对其设立研究方案,观察该手法对腰椎间盘突出症治疗的临床特点、有效性,探讨通督强脊手法在治疗腰椎间盘突症临床疗效。目的通过临床随机对照研究探讨通督强脊三步七法治疗腰椎间盘突出症的临床疗效。通过脊柱测试评价训练系统(Tergumed)对腰椎间盘突出症患者的腰椎功能进行检测,分析通督强脊三步七法对腰椎等长收缩最大肌力的影响。方法将符合纳入标准的60例患者随机分为试验组(30例)和对照组(30例),试验组采用通督强脊三步七法治疗,对照组采用传统手法；两组患者均以每天治疗一次,每周六次,2周为1个观测周期。两组患者均采用临床疗效评定、国际通用的JOA评定量表、VAS评分量表及Tergumed检测的腰椎等长收缩最大肌力为观察指标,观察记录两组患者的临床症状、体征、治疗前后以及2个月后随访的评分,比较两组患者治疗前后以及2个月后随访的评分。统计学分析：资料收集、整理后,用SPSS13.0软件进行统计分析。计量数据以x±s表示,两组计量资料比较用卡方检验或t检验,计数资料用x2检验,等级资料用秩和检验,治疗前后对比用成组t检验,当P<0.05有显著性差异。以上数据若呈非正态分布或方差不齐,则采用非参数统计方法。结果1.治疗后临床疗效：两组患者治疗1疗程后比较其临床疗效比较,试验组和对照组总有效率分别为88.89%及81.48%,痊愈率分别是22.22%及14.81%,组间比较疗效无显著性差异(P>0.05),在无统计学意义。2.治疗后2个月临床疗效：2个月后随访观察其临床疗效比较,试验组和对照组复发率分别为7.41%及22.22%,组间疗效比较,在统计学上有显著性差异(P<0.05)。提示随访2个月后,通督强脊手法控制复发率优于传统手法(P<0.05,有统计学意义)。3.JOA评定量表评分：治疗1个疗程,试验组和对照组的JOA评定量表评分各自同治疗前比较均有显著的差异(P<0.05)；治疗后组间比较发现,试验组和对照组的JOA评定量表评分无显著性差异(P>0.05)。4.VAS评分量表评分：治疗1个疗程,试验组和对照组的痛阈改善各自同治疗前比较均有显著的疗效(P<0.05)；治疗后组间比较发现,试验组和对照组的痛阈改善无显著性差异(P>0.05)。5. Tergumed检测的腰椎等长收缩最大肌力：(1)治疗前,两组在腰椎前屈、后伸、左屈、右屈、左旋、右旋等长收缩最大肌力比较无显著差异(P>0.05)；(2)经一个疗程治疗后,在腰椎后伸等长收缩最大肌力,两组组间比较有显著差异(P<0.05)；其余各组等长收缩最大肌力两组组间比较无显著差异(P>0.05)。结论1.通督强脊三步七法与传统手法治疗腰椎间盘突出症1个疗程后,均有明显疗效,但两组统计学上无差异。2个月后随访观察显示,通督强脊三步七法组的复发率低于传统手法组；2个月后随访,通督强脊三步七法临床疗效优于传统手法,具有统计学意义(P<0.05)。2.通督强脊三步七法和传统手法治疗腰椎间盘突出症时,对腰椎等长收缩最大肌力都有明显的作用(P<0.05)。3.通督强脊三步七法对改善腰椎后伸等长收缩最大肌力优于传统手法(P＜0.05)。更多还原

【Abstract】 Significance:Lumbar intervertebral disc herniation (for short LIDH) is a common and frequent disease on the clinical, which is the most common cause to pain in waist and lower extremities. According to the United States national institutes of health statistics, adults have 80% suffered lumbago annoyance, and LIDH have 15%～20% of outpatient which are lumbago, including 80 to 90 percent of the LIDH patient should be cure by nonsurgical therapy, in the ordinary circumstances, except to huge type, ossification type, free type and companion stenosis cases unfavorable to the nonsurgical therapy, lest may cause or worsen horsetail nerve damage, general LIDH patients all chooses nonsurgical therapy.Most patients are the preferred treatment is also nonsurgical therapy, the main methods including massage, acupuncture, physiotherapy, traction, herb, earpins methods. Among the nonsurgical therapy, Due to Chinese massage treatment is simple and comfortable valid, no side effect, less complications, LIDH patients are willing to accepted, has been taken as the main treatment of LIDH.Tongdu Qiangji Three-seven Manipulation is an effective therapy,which is summed up my tutur WangShiZhong director doctor inherited famous clinics for Chinese elder’s academic thoughts and inheriting national famous clinics professor Traditional chiropractic’s academic experience, and lead Spinal Rehabilitation Division over ten years of clinical teaching and research work experience.This subject is to summarize the inheritance old doctor of traditional Chinese medicine experience, better promotion application, make this Manipulation more scientific, standardized, subject to the establishment of a research plan, to observe this Manipulation of lumbar intervertebral disc herniation treatment the clinical features, effectiveness, discusses Tongdu Qiangji Manipulation’s clinical curative effect in treatment of LIDH.Objective:Through clinical randomized controlled study Tongdu Qiangji Three-seven Manipulation treatments for the clinical curative effect of LIDH. Through the spine test evaluation training system (Tergumed) Testing to LIDH patients’ lumbar vertebral function, we could analysis the influence on the maximum musele strength of isometric contraction by Tongdu Qiangji Three-seven Manipulation.Methods:60 case with LIDH those met the inclusion criteria were randomly divided into two groups:the treatment group were performed Tongdu Qianji Manipulation,and the control group were performed traditional massage. Two groups of patients are in one time every day, six times every week,2 weeks for an observation period. Two groups of patients are used clinical curative effect evaluation, the universal JOA rating scale, VAS rating scale and Tergumed detection of lumbar maximum isometric muscle strength to observe index, observation records two groups the clinical symptoms, signs, treatment, and after 2 months follow-up of grading, compare two sets of patients, and after 2 months follow-up assessment. Statistical analysis:Data collection, sorting, using SPSS 13.0 soft to statistical analysis, Measurement data to x±s says, two groups of measurement data comparison with chi-square or t test, counting material wit X2 inspection, grade material use rank and inspection, compared with before and after the treatment group t test, when P< 0.05 significant differences. If above data in non-normal distribution or variance not neat, non-parameter statistics method is adopted.Results:1..After a course of treatmen of clinical efficacy:two groups of patients after a course of treatmen the clinical efficacy of treatment group and control group compared, total effective 88.89% and 81.48 respectively, recovery rate was 22.22% and 14.81%, effect comparison between groups no significant difference (P> 0.05).2. After 2 months of treatment of clinical curative effect:2 months after the follow-up clinical curative effect of comparison, treatment group and control group recurrence rate is respectively 7.41% and 22.22%; Two groups comparison in effect, statistically significant difference (P< 0.05). It show follow-up Tongdu Qiangji Three-seven Manipulation than traditional massage have apparent curative effect,(P< 0.05, there is significant)after two months.3. JOA rating scale score:After a course of treatment, treatment group and control group, the respective JOA rating scale score with before treatment significantly compared the difference (P< 0.05). After treatment, comparison between groups of group and control group JOA rating scale score no significant difference (P> 0.05).4. VAS rating scale score:After a course of treatment, treatment group and control group, the pain threshold compared with therapy improve each other before the curative effect significantly (P< 0.05). After treatment, comparison between treatment group and control group to improve pain threshold no significant difference (P> 0.05).Conclusion:1. After a course,the Tongdu Qiangji Three-seven Manipulation and traditional massage treatment of LIDH all have apparent curative effect, but two groups are no statistically different. After two months the follow-up observations indicate that Tongdu Qiangji Three-seven Manipulation’s recurrence rate less than traditional massage group, and significant (P< 0.05).2. The Tongdu Qiangji Three-seven Manipulation and traditional massage treatment of LIDH has the obvious function to3. The Tongdu Qiangji Three-seven Manipulation improve maximum isometric muscle strength is better than the traditional massage,and significant (P< 0.05).更多还原