独活寄生汤联合腰椎手法治疗腰椎间盘突出症的临床研究

苏永强　屈亮　谭子文

[摘要] 目的 观察独活寄生汤联合腰椎手法治疗腰椎间盘突出症（LDH）的临床效果和安全性。 方法 纳入90例LDH患者，均来自北京市昌平区中西医结合医院骨伤科门诊，就诊时间为2015年3月～2016年6月，采用随机数字表法将患者随机分为试验组（45例）和对照组（45例），试验组应用独活寄生汤联合腰椎手法治疗，对照组应用双氯芬酸钠肠溶片联合腰椎牵引治疗。评价指标为日本骨科学会（JOA）腰痛总分、腰腿痛视觉模拟评分（VAS）、肝肾功能、不良事件/不良反应。 结果 治疗2周后，两组JOA腰痛总分均显著高于治疗前，腰腿痛VAS评分均显著低于治疗前，差异均有高度统计学意义（P < 0.01）。试验组治疗后JOA腰痛总分显著高于对照组（P < 0.01），腰腿痛VAS评分明显低于对照组（P < 0.05）。试验过程中两组患者安全性良好。 结论 独活寄生汤联合腰椎手法治疗LDH可改善患者临床症状、体征，短期疗效显著，安全性较好。

[关键词] 独活寄生汤；腰椎手法；腰椎间盘突出症；随机对照试验

[中图分类号] R681.57 [文献标识码] A [文章编号] 1673-7210（2017）07（a）-0085-04

[Abstract] Objective To observe the clinical effect and safety of Duhuo Jisheng Decoction combined with lumbar manipulation in the treatment of lumbar disc herniation （LDH）. Methods 90 cases of patients with LDH were enrolled， who came from Beijing Changping Hospital of Integrated Chinese and Western Medicine from March 2015 to June 2016. All the patients were randomly divided into experimental group （45 cases） and control group （45 cases） by random number table. The experimental group was treated by Duhuo Jisheng Decoction combined with lumbar manipulation， the control group was treated by Diclofenac Sodium Enteric-coated Tablets and lumbar traction. The evaluation indicators were Japanese orthopaedic association （JOA） backache total scores， visual analogue scale （VAS） of lumbocrural pain， hepatorenal function， adverse events or adverse reactions. Results After treatment for two weeks， the JOA backache total scores in the two groups were all higher than those before treatment， the VAS scores of lumbocrural pain in the two groups were all lower than those before treatment， the differences were all highly statistically significant （P < 0.01）. After treatment， the JOA backache total scores in the experimental group were significantly higher than those of control group （P < 0.01）， the VAS scores of lumbocrural pain in the experimental group were significantly lower than those of control group （P < 0.05）. During the study， the safety was good in both groups. Conclusion Duhuo Jisheng Decoction combined with lumbar manipulation in the treatment of LDH can improve the clinical symptoms and signs of patients， the short-term curative effect is reliable， and the safety is good.

[Key words] Duhuo Jisheng Decoction； Lumbar manipulation； Lumbar disc herniation； Randomized controlled trial

腰椎間盘突出症（lumbar disc herniation，LDH）是因腰椎间盘变性、纤维环破裂，髓核组织突出压迫和刺激神经根、马尾神经所引起的一种综合征，是导致腰腿痛最常见的原因之一，病变基础是椎间盘的退行性变[1]。男性多于女性，好发部位为L4～L5、L5～S1。80%以上的患者可通过非手术疗法减轻症状或者改善生活质量，非手术疗法主要包括中西药物治疗、牵引治疗、推拿治疗、针灸治疗、卧床休息等[2]。

在中医药临床实践中，中药与手法治疗LDH具有一定的特色与优势。独活寄生汤源自《备急千金要方》，主治痹证日久、肝肾亏虚、气血不足证，系统评价显示其单用或者联合其他疗法运用治疗LDH可显著改善临床症状，未发现明显不良反应[3]，而腰椎手法治疗LDH的系统评价也提示手法的治愈率、有效率优于牵引、药物、针灸、微波热疗等其他疗法[4]。……