补肾通痹汤配合骨盆牵引治疗中老年人肾虚寒湿型腰椎间盘突出症的临床观察

【作者】 贺超；

【导师】 王正；

【作者基本信息】 湖北中医学院 ， 中医骨伤科学， 2008， 硕士

【摘要】 背景:腰椎间盘突出症(prolapse of lumbar intervertebral discPLID)是当今国内外骨科临床的常见病。其主要症状是腰痛及下肢痛,一般具有临床症状重,病情易于反复的特点。剧烈或缠绵的疼痛不仅在生理上,还会在心理上给患者造成严重创伤,极大地影响了患者的日常生活和工作,甚者可致下肢瘫痪,从而使之丧失劳动与生活自理能力。国内有人统计,该病占门诊下腰痛就诊者的15%-20%。国外学者对2684名工作人员调查发现,其中患腰椎间盘突出症者占17.2%,仅在美国每年为腰腿痛患者付出的医疗费用及经济损失为160亿美元。目前腰椎间盘突出症的治疗方法主要分为非手术疗法与手术疗法,其中90%病人可采取非手术治疗,而且经非手术治疗能获得较显著的疗效,只有少数中央型或游离型腰椎间盘突出症及腰椎间盘脱出或经长期非手术治疗无效且严重影响正常生活或工作者,才行手术治疗。且腰椎间盘突出症的病理机制及临床表现比较复杂,手术有一定风险,必须严格掌握手术指征。非手术治疗方法繁多,中医、西医和中西医结合均有报道,效果都很好。但如果选择最佳方法,值得研究规范。随着目前医疗费用的提高,选择一种疗效可靠、费用合理的治疗方法是对广大患者最大的帮助。近年来,本人在导师襄樊市中医院名老中医王正老师的精心指导下,结合王正老师多年的临床经验,利用自拟中药方剂补肾通痹汤内服配合骨盆牵引治疗中老年人肾虚寒湿型腰椎间盘突出症取得了较好的疗效。目的:观察补肾通痹汤内服配合骨盆牵引在中老年人肾虚寒湿型腰椎间盘突出症患者治疗中的作用,并试图寻求非手术治疗中老年人肾虚寒湿型腰椎间盘突出症较有效的方法,制定一套诊断治疗中老年人肾虚寒湿型腰椎间盘突出症的简单合理而疗效确切的方案,从而在临床上推广应用。方法:收集2006年8月-2008年3月襄樊市中医院脊柱骨科及颈肩腰腿痛科的门诊及住院中老年(45-75岁)病人93例,经临床及影象学诊断为腰椎间盘突出症、中医诊断为痹证(肾虚寒湿型)者,按照就诊顺序及治疗方法的不同,随机分为治疗组和对照组,治疗组47例,对照组46例,经统计学分析,两组从性别,年龄,病情分级,突出节段,病程上均具有可比性(P＞0.05)。治疗组以自拟中药方剂补肾通痹汤内服配合骨盆牵引进行治疗,对照组以骨盆牵引法治疗,两组均严格卧硬板床休息,以两周为一个疗程,每组病人都经过4个疗程(8周)的治疗,并根据各组病例治疗前后以及两组治疗后的症状、体征变化制定临床观察表,进行疗效评分比较并进行统计学处理,以评价中药补肾通痹汤配合骨盆牵引治疗中老年人肾虚寒湿型腰椎间盘突出症的临床疗效。结果:两组治疗前后从行走及活动能力、腰腿疼痛的程度、直腿抬高试验和日常生活和工作等方面的不同程度表现比较,除对照组在生活及工作能力上经统计学检验P＞0.05,治疗前后无显著性差异以外,其余各项均有显著性差异(P＜0.05),经过治疗均取得较为显著的疗效;两组治疗后以上各项单项症状和体征进行比较,经统计学分析,均为P＜0.05,治疗组在症状体征改善方面优于对照组;两组从治疗后愈显率和总有效率上比较:治疗组治愈13例,显效17例,好转12例,无效5例,愈显率63.83%,总有效率89.36%,对照组治愈7例,显效14例,好转15例,无效10例,愈显率45.65%,总有效率78.26%。经统计学Ridit分析,U=9.27,P＜0.05,两组治疗后愈显率和总有效率均有显著性差异,治疗组明显优于对照组。结论:中药补肾通痹汤配合骨盆牵引在中老年人肾虚寒湿型腰椎间盘突出症的治疗上效优价廉,不破坏脊柱的稳定性,痛苦小,并发症少,是一个值得在临床上运用与推广的治疗方法。更多还原

【Abstract】 Backdrop:Prolapse of lumbar intervertebral disc(PLID) is a common disease of domestic and international orthopedic clinical. Its cardinal symptoms that lumbago and the lower limbs pain are having the negative influence to people’s daily life and the work, and which have already severely impair humanity’s physical and moral integrity. According to some national statistics, this sickness occupies the outpatients who service the under lumbago seeing a doctor 15% to 20%. Foreign scholars who investigate the discovery to 2684 staff find that contracts PLID to account for 17.2%. In the United States alone each year the medical expense which and the economic loss pays for the pain in waist and lower extremities patients is 16 billion U.S. dollars. At present the main PLID method of treatment divides into the non-surgery treatment and the surgery treatment, 90 % patients may adopt the non-surgery to treat, moreover the non-surgery treatment can obtain a remarkable curative effect. Only a few patients who’s normal life and work are serious influenced by PLID should take surgical therapy. Moreover the pathological mechanisms and clinical performance of PLID are quite complex, and the surgery has certain risks, so we must grasp the surgery to refer to strictly drafts. The non-surgery method of treatment is many, the domestic and foreign scholars have the reports, and the treatment results are good. But if choose the best method ,is worth studying the standard. Along with the present medical expense’s enhancement, to choose a reliable, reasonable costs of treatment for the patients is the biggest help. In recent years, we used the independently drawed up formula medicinal preparation Bushen Tongbi Decoction internal medicine to treat the middle-aged and old patients’ PLID to obtain a very good curative effect.Objective:To observe the Bushen Tongbi Decoction in the treatment of the middle-aged and old patients who suffered by Kidney empty cold-damp PLID with the role and try to find a non-surgical PLID treatment which is more effective, and then formulate a set to treat PLID for the middle-aged and old patients that is simply reasonable, and curative effect accurate plan, thus get up easy in the domestic profession promotion. Methods:To collect 93 middle-aged and old(45-75 years old) patients who come the Xiangfan Chinese medicine hospital seeing a doctor from August,2006 to March, 2008 for the pain in waist and low limbs. Divide these 93 patients into two gropes stochastically: the treatment grope has 47 examples and the control grope has 46 examples. The treatment grope take orally the traditional Chinese medicine Bushen Tongbi Decoction and coordinate pelvis hauling treatment, and the control grope are treated by the pelvis hauling government by law. Each grope of patients pass through 4 treatment course(8 weeks) around the treatment, and treat according to each grope of case changes the formulation clinical observation table, carry on curative effect grading. Then appraises the formula medicinal preparation Bushen Tongbi Decoction internal medicine to treat the middle-aged and old patients’ PLID the clinical curative effect.Results:After compareing the two gropes from several symptoms and signs for each grope. There is no significant difference before and after the treatment on the life and the ability to work in the control group(according to the statistical analysis, P> 0.05). And the remaining are significant differences(according to the statistical analysis, P <0.05), after the treatment has been made more significant effect; After comparing we find that the treatment group signs of improvement in symptoms than the control group(according to the statistical analysis, P <0.05);In the treatment grope: 13 examples are cured, 17 examples show good results, 12 examples change for the better,5 examples are invalid, the obviously leads is 63.83%, and the total effectiveness is 89.36%; In the control grope: 7 examples are cured, 14 examples show good results, 15examples change for the better, 10 examples are invalid, the obviously leads is 45.65 % , and the total effectiveness is 78.26%. The obviously leads and the total effectiveness of the two gropes are significance difference(according to the statistical analysis, P < 0.05 ).Conclusion:Formula medicinal preparation Bushen Tongbi Decoction internal medicine treats the middle-aged and old patients’ PLID the clinical curative effect to be remarkable and worth promoting.更多还原