正骨理筋手法配合中药内服外敷治疗腰椎间盘突出症临床研究

王桃萍 程展道

摘要：目的 觀察正骨理筋手法联合中药内服外敷治疗腰椎间盘突出症的临床疗效。方法 纳入腰椎间盘突出症患者240例，采用随机数字表法分为治疗组和对照组各120例。2组均卧床休息并进行功能锻炼。同时予麻黄附子细辛汤合独活寄生汤加减，每日1剂，每日3次，口服。并用布药袋包裹药渣，加入食醋200 mL，加热后置于腰骶部，每日2次，外敷。治疗组同时给予正骨理筋手法，对照组给予牵引，每周一、三、五各治疗1次。均4周为1个疗程，连续2个疗程。观察2组临床疗效、视觉模拟量表（VAS）评分和Oswestry功能障碍指数（ODI），检测血清一氧化氮（NO）水平。结果 与治疗前比较，治疗1、2个疗程后2组VAS评分、ODI显著降低（P<0.05）；治疗后同一时点比较，治疗组明显低于对照组（P<0.05）。治疗组总有效率为91.67%（110/120），对照组为83.33%（100/120），2组比较差异有统计学意义（Z=-2.103，P=0.036）。与治疗前比较，治疗后2组NO含量明显降低，差异有统计学意义（P<0.05）；治疗后治疗组NO水平低于对照组（t=7.843，P=0.041）。结论 正骨理筋手法配合中药内服外敷治疗腰椎间盘突出症疗效显著，其机制可能与降低血清NO水平有关。

关键词：腰椎间盘突出症；正骨理筋手法；中药；内服外敷

DOI：10.3969/j.issn.1005-5304.2017.07.007

中图分类号：R274.915.331 文献标识码：A 文章编号：1005-5304（2017）07-0028-04

Abstract： Objective To observe the clinical efficacy of bone-setting manipulation combined with TCM internal and external treatment for lumbar disc herniation. Methods Totally 240 cases with lumbar disc herniation were selected， and were divided into treatment group and control group according to the random number table method， with 120 cases in each group. Both groups were in bed for rest and did functional exercise. At the same time， modified Mahuang Fuzi Xixin Decoction combined with Duhuo Jisheng Decoction were given， 1 dose per day， three times a day， orally， and were wrapped with a cloth bag dregs， adding 200 mL of vinegar， placed in lumbosacral region afer heating， 2 times a day， external treatment. The treatment group was given bone-setting manipulation combined with TCM internal and external treatment， and the control group was given traction therapy， 1 time for Monday， Wednesday and Friday， 4 weeks as a course of treatment， for continuous 2 courses. The clinical efficacy， visual analogue scale （VAS）， Oswestry disability index （ODI）， and serum NO content were observed. Results Compared with before the treatment， VAS and ODI score decreased significantly after the first and second courses （P<0.05）； The treatment group was significantly lower than the control group at the same time after treatment （P<0.05）. The total effective rate was 91.67% （110/120） in treatment group， and 83.33% （100/120） in control group， with statistical significance （Z=-2.103， P=0.036）. Compared with before treatment， the NO level of the two groups significantly decreased after treatment， with statistical significance （P<0.05）. The NO level in the treatment group was lower than that in the control group after treatment （t=7.843， P=0.041）. Conclusion Bone-setting manipulation combined with TCM internal and external treatment have obvious efficacy for lumbar disc herniation， which may be related to down-regulating serum NO level.

Key words： lumbar disc herniation； bone-setting manipulation； TCM； internal and external treatment

腰椎间盘突出症（lumbar disc herniation，LDH）是由于椎间盘变性、纤维环破裂、髓核渗出压迫或免疫刺激神经根所表现的以下肢放射性痛为主的临床症候群，临床缺乏特异有效的治疗方案，给患者带来许多痛苦，严重者丧失生活自理能力。LDH易反复、病程长，目前保守治疗方案較多，但治疗后远期疗效满意度较低。笔者根据“骨错缝、筋出槽”理论和中医学辨证思想，以正骨理筋手法配合中药内服外敷治疗LDH，观察临床疗效及一氧化氮（NO）水平变化，旨在为临床研究提供依据。

1 资料与方法

1.1 一般资料

选取本院2015年1月-2016年6月针灸门诊LDH患者240例，采用随机数字表法分为治疗组和对照组各120例。其中男性140例，女性100例；年龄20～65岁，平均（46.68±13.52）岁；……