独活寄生汤加减联合手法治疗腰椎间盘突出症的临床观察

目的：观察独活寄生汤加减联合手法治疗腰椎间盘突出症的临床疗效.方法：将符合要求的138例腰椎间盘突出症患者随机分为2组,每组69例.治疗组应用独活寄生汤加减联合手法治疗;对照组采用牵引、理疗及口服非甾体类抗炎药和神经营养药物进行治疗.观察比较2组患者治疗前和治疗21 d后的腰部疼痛情况和腰部功能,同时比较2组患者的总体疗效及复发率.结果：①腰部疼痛情况.治疗前2组患者VAS评分比较,差异无统计学意义（6.49±1.22）分,（6.33±1.41）分,t=0.713,P=0.886];治疗后2组患者的VAS评分均降低,治疗组降低更明显（4.75±0.46）分,（3.71±0.68）分,t=10.522,P=0.005].②腰部功能.治疗前2组患者JOA评分比较,差异无统计学意义（10.50±1.23）分,（10.46±1.38）分,t=0.180,P=0.895];治疗后2组患者的JOA评分均增加,治疗组增加更明显（12.91±0.51）分,（8.77±0.64）分,t=42.023,P=0.005].③总体疗效.治疗组治愈36例,好转21例,有效8例,无效4例;对照组治愈19例,好转14例,有效16例,无效20例.治疗组总体疗效优于对照组治疗组95%CI为（0.334,0.471）,R=0.403;对照组95%CI为（0.529,0.666）,R=0.598].④复发情况.治疗后12个月内,治疗组3例复发,对照组11例复发,对照组复发率高于治疗组（χ2=5.088,P=0.024）.结论：独活寄生汤加减联合手法可有效缓解腰椎间盘突出症患者的疼痛症状,改善患者腰部功能,且复发率低,是治疗该病的有效方法.

Observation on the curative effect of oral application of DUHUO JISHENG decoction combined with manipulation in the treatment of lumbar disk herniation

Objective：To observe the clinical curative effect of oral application of DUHUO JISHENG decoction combined with manipula- tion on lumbar disk herniation（LDH）. Methods：One hundred and thirty-eight patients with LDH met the requirements were randomly divided into 2 groups,69 cases in each group. Patients in the treatment group were treated with oral application of DUHUO JISHENG decoction com- bined with manipulation ,while the others in the control group were treated with lumbar traction,physiotherapy and oral application of non-ster- oid anti-inflammatory drugs and neurotrophic drugs. The 2 groups were compared with each other in low back pain and lumbar performance be- fore the treatment and after 21-day treatment,meanwhile the total effect and recurrence rate were compared between the 2 groups. Results： There was no statistical difference in visual analogue score（VAS） between the 2 groups before the treatment（6.49 ＋/- 1.22 vs 6.33 ＋/- 1.41 points,t =0. 713,P = 0.886） ,while the VAS decreased in both of the 2 groups after the treatment,and the VAS decreased more significantly in the treatment group（4.75 ＋/-0.46 vs 3.71 ＋/-0.68 points,t = 10. 522, P = 0. 005 ）. There was no statistical difference in JOA score be- tween the 2 groups before the treatment（ 10.50 ＋/-1.23 vs 10.46 ＋/-1.38 points,t = 0. 180,P = 0. 895）,while the JOA score increased in both of the 2 groups after the treatment, and the JOA score increased more significantly in the treatment group（ 12.91 ＋/-0.51 vs 8.77 ＋/- 0.64 points, t = 42. 023, P = 0.005 ）. Thirty-six patients obtained an excellent result,21 good,8 fair and 4 poor in the treatment group;while 19 patients obtained an excellent result, 14 good, 16 fair and 20 poor in the control group. The treatment group surpassed the control group in the total curative effect （ treatment group ： 95 % CI（0. 334,0.471 ）, R = 0.403 ; control group ： 95 % CI （ 0. 529,0. 666 ）, R = 0.598 ）. Three patients with recrudescent symptoms of LDH were found in the treatment group,while 11 patients with recrudescent symptoms of LDH were found in the control group within 12 months after the treatment. The recurrence rate of the control group was higher than that of the treatment group （X^2 = 5. 088,P = 0.024）. Conclusion：The method of oral application of DUHUO JISHENG decoction combined with manipulation can relief the pain obviously and improve the lumbar performance with low recurrence rate, so it is an effective method for LDH.