论文部分内容阅读
目的:观察牵抖整脊法联合椎间盘方对腰椎间盘突出症（lumbar disc herniation，LDH）患者的临床早期疗效及血清中相关联的炎性因子血清浓度的影响。方法:将2021年1月1日至11月1日在广州医科大学附属中医医院骨伤科门诊或住院治疗的LDH患者，采用前瞻性研究，将40例符合研究标准的腰椎间盘突出症患者，按随机数字表法分为两组，每组20例。治疗组：男6例，女14例，年龄38～80（59.1±12.1）岁；对照组：男8例，女12例，年龄52～78（61.9±7.4）岁。对照组：采用卧床休息、贴敷疗法及相关理疗治疗等基础治疗持续2周；治疗组：在基础治疗的基础上行牵抖整脊法，并服用椎间盘方2周。观察两组患者在治疗前、后2周的疼痛［采用视觉模拟量表（Visual Analogue Scale，VAS）］评分、Oswestry功能障碍指数（Oswestry disability index，ODI）、血清中肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）、白细胞介素-6（interleukin-6，IL-6）指标的变化，以及观察患者血常规、肝肾功能、胃肠道反应、皮疹、药物过敏及其他不良反应等相关安全性指标。结果:经过2周的治疗，治疗组患者的VAS评分为（1.91±0.60）分，改善程度优于对照组［（2.77±0.65）分］，差异有统计学意义（n t=3.885，n P＜0.05）；治疗组的ODI为（21.80±4.76）%，改善程度优于对照组［（29.4±4.90）%］，差异有统计学意义（n t=3.671，n P＜0.05）；治疗组血清中的TNF-α浓度为（5.82±2.20）pg/ml，较同时期对照组［（6.83±2.67）pg/ml］显著降低，差异有统计学意义（n t=2.259，n P＜0.05）；治疗组血清中的IL-6浓度为（2.31±0.69）pg/ml，较同时期对照组［（3.35±1.93）pg/ml］显著降低，差异有统计学意义（n t=2.178，n P＜0.05）；经过2周治疗后，治疗组的VAS评分较治疗前明显改善［（1.91±0.60）分比（6.26±0.59）分］，差异有统计学意义（n t=23.948，n P＜0.05）；ODI较治疗前明显改善［（21.80±4.76）%比（61.90±5.41）%］，差异有统计学意义（n t=24.575，n P＜0.05）；TNF-α浓度较治疗前显著降低［（5.82±2.20）分比（8.90±3.16）］，差异有统计学意义（n t=6.254，n P＜0.05）；IL-6浓度较治疗前显著降低［（2.31±0.69）分比（5.09±2.60）分］，差异有统计学意义（n t=5.080，n P＜0.05）。经过2周治疗后，对照组的VAS评分较治疗前明显改善［（2.77±0.65）分比（6.25±0.64）分］，差异有统计学意义（n t=26.959，n P＜0.05）；ODI较治疗前明显改善［（29.40±4.90）%比（61.30±4.51）%］，差异有统计学意义（n t=20.422，n P＜0.05）；TNF-α浓度较治疗前显著降低［（6.83±2.67）分比（8.52±3.44）分］，差异有统计学意义（n t=4.554，n P＜0.05）；IL-6浓度较治疗前显著降低［（3.35±1.93）分比（4.68±2.49）分］，差异有统计学意义（n t=3.523，n P＜0.05）。两组患者在治疗过程中及治疗事件后均无严重不良反应发生。n 结论:牵抖整脊法联合椎间盘方能在早期缓解腰椎间盘突出症患者疼痛症状，并能早期达到功能康复的作用，同时在早期也能有效降低血清中相关炎性因子的浓度，是治疗腰椎间盘突出症一种安全有效的方法。“,”Objective:To observe the effect of traction and shaking chiropractic method combined with Zhuijianpanfang on early clinical efficacy and related inflammatory factors in patients with lumbar disc herniation (LDH).Methods:From January 1 to November 1, 2021, 40 patients with LDH who were treated at the clinic of Department of Orthopedics, The Affiliated TCM Hospital of Guangzhou Medical University or were hospitalized into this hospital were divided into a treatment group and a control group by the random number table method, with 20 cases in each group. The treatment group had 6 males and 14 females, and were 38 - 80 (59.1 ± 12.1) years old. The control group had 8 males and 12 females, and were 52 - 78 (61.9 ± 7.4) years old. The control group rested in bed and took sticking therapy and related physiotherapy for 2 weeks. On the basis of basic treatment, the treatment group took prone traction and shaking, spine and tendon regulation, and Zhuijianpanfang for 2 weeks. The scores of Visual Analogue Scale (VAS), the Oswestry disability indexes (ODI), and the serum levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were observed before and 2 weeks after the treatment. The related safety indicators, such as blood routine, liver and kidney function, gastrointestinal reaction, rash, drug allergy, and other adverse reactions, were observed.Results:After 2 weeks\' treatment, the VAS score and ODI of the treatment group were significantly better than those of the control group [(1.91±0.60) vs. (2.77±0.65) and (21.80±4.76)% vs. (29.4±4.90)%], with statistical differences (n t=3.885 and 3.671, both n P＜0.05); and the serum levels of TNF-α and IL-6 in the treatment group were obviously lower than those in the control group [(5.82±2.20) pg/ml vs. (6.83±2.67) pg/ml and (2.31±0.69) pg/ml vs. (3.35±1.93) pg/ml], with statistical differences (n t=2.259 and 2.178, both n P＜0.05). The VAS score, ODI, and serum levels of TNF-α and IL-6 after 2 weeks\' treatment were significantly better than those before the treatment in the treatment group [(1.91±0.60) vs. (6.26±0.59), (21.80±4.76)% vs. (61.90±5.41)%, (5.82±2.20) vs. (8.90±3.16), and (2.31±0.69) vs. (5.09±2.60); n t=23.948, 24.575, 6.254, and 5.080, all n P＜0.05] and in the control group [(2.77±0.65) vs. (6.25±0.64), (29.40±4.90)% vs. (61.30±4.51)%, (6.83±2.67) vs. (8.52±3.44), and (3.35±1.93) vs. (4.68±2.49); n t=26.959, 20.917, 4.554, and 3.523, all n P＜0.05], with statistical differences. During and after the treatment, no serious adverse reactions occurred in the two groups.n Conclusion:Traction and shaking chiropractic method combined with Zhuijianpanfang for patients with LDH can alleviate their pain, achieve functional recovery early, effectively reduce the concentrations of relevant inflammatory factors in serum early, so it is a safe and effective method for the treatment of LDH.