不同作用方向的整复手法治疗腰椎间盘突出症 临床疗效观察

目的：比较向前方向作用的后伸卷腰扳动定位整复手法和向左右方向作用旋转扳动整复手法治疗腰椎间盘突出症的疗效。方法：腰椎间盘突出症209例，男131例，女78例；年龄20-79岁，其中50岁以上58例。膨出型92例，突出型69例，游离型48例。209例按随机数字表法分为治疗组（107例）和对照组（102例）：治疗组采用牵引治疗仪持续牵引30min后，用后伸卷腰扳动定位整复手法治疗；对照组采用牵引治疗仪持续牵引30min后，用旋转腰部扳动整复手法治疗。隔1d治疗1次，3次为1个疗程。观察患者的症状和体征（包括腰部疼痛与不适、下肢疼痛与麻木、大小便无力与会阴麻木、直腿抬高程度、下肢行走能力、工作生活能力），并按疗效标准比较两种治疗方法的治疗效果的差异。结果：两组患者均获随访，时间1～6个月，平均3．2个月。治疗1个疗程后，治疗组与对照组的症状与体征各方面较治疗前均有较大改善（P〈O．01），其中治疗组在腰部疼痛与不适、下肢行走能力方面优于对照组（P〈0．05）。按疗效评定标准：治疗组疗效优于对照组，两组疗效比较差异有统计学意义（P〈0．01）。膨出型治疗组47例，对照组45例，治疗组优于对照组（P〈0．05）；突出型治疗组35例，对照组34例，治疗组比对照组有效率高，但差异无统计学意义（P〉0．05）。游离型治疗组25例，对照组23例，对照组比治疗组有效率高，但差异无统计学意义（P〉0．05）。结论：后伸卷腰扳动定位整复手法比旋转扳动整复手法治疗腰椎间盘突出症的整体疗效满意，但游离型的腰椎间盘突出症选择旋转扳动整复手法更好。

The observe of clinical effect of treating lumbar intervertebral disc herniation by bone setting manipulation of different directions

Objective: To compare the effect between lumbar backwards flexion manipulation and rotating manipulation for treating lumbar intervertebral disc herniation. Methods: Two hundred and nine patients of lumbar intervertebral disc herniation, male 131,female 78,the age from 20 to 79 years old,58 cases of all these patients age above 50.According to diagnosis the ladder of the 92 cases bulging type,69 hernia type,48 cases free type. The patients were randomly divided into treatment group(107 cases) and control group(102 cases). All the patients were treated with the three-dimensional computer-controlled traction therapeutic apparatus,with continued traction for 30 minutes. After traction,lumbar backwards flexion manipulation and rotating manipulation were respectively adopted in treatment group and control group(on alternate days one time,3 times as a course of treatment).The symptoms and signs (including back pain and discomfort,lower limb pain and numbness,powerless urination and defecation,numbness in perineum,straight-leg raising degree,ability of lower extremity walking,work and live) of patients were observed after treatment.Results: All the patients were followed up from 1 to 6 months with an average of 3.2 months. After treatment,the symptoms and signs of patients have markedly improved(P<0.01),but the lower back pain and discomfort,lower limb walking ability in treatment group were better than control group(P<0.05). According therapeutic criteria, the effect of treatment group was better than of control group(P<0.01). In cases with bulging type,47 in treatment group and 45 in control group,the effect of treatment group was better than of control group(P<0.05); in cases with hernia type,35 in treatment group and 34 in control group,there was no significantly difference in effect between two groups(P>0.05);in cases of free type,25 in treatment group and 23 in control group, there was no significantly difference in effect between two groups(P>0.05). Conclusion: The global effect of lumbar backwards flexion manipulation was satisfactory than rotating manipulation for treating lumbar intervertebral disc herniation. But rotating manipulation suited to free type.