中药结合腰背肌稳定性训练对微创术后腰椎间盘突出症疗效的影响

目的：观察独活寄生汤加减结合腰背肌稳定性训练对微创术后腰椎间盘突出症疗效的影响。方法：将180例腰椎间盘突出症患者以治疗先后按照随机数字表法随机分为两组，治疗组90例采用射频热凝联合臭氧消融术后辅以内服独活寄生汤加减及腰背肌稳定性训练等治疗。对照组90例单纯射频热凝联合臭氧消融术治疗。应用VAS、JOA、及分级疗效评定进行治疗前后及组间观察指标比较和疗效评价。结果：治疗前后两组患者VAS比较：治疗2周及3个月时，两组患者VAs评分均较治疗前明显改善，差异具有统计学意义（P〈0．05）；治疗2周及3个月时，治疗组患者VAS评分改善较显著，与对照组比较差异具有统计学意义（P〈0.05）。治疗前后两组患者JOA比较：治疗2周及3个月时，两组患者JOA评分均较治疗前明显改善，差异具有统计学意义（P〈0．05）；治疗2周及3个月时，治疗组患者JOA评分改善较显著，与对照组比较差异具有统计学意义（P〈0．05）。两组疗效比较：治疗3个月时治疗组优良（治愈＋显著进步）率86．67％，对照组优良率73．33％，两组优良率比较差异有统计学意义（P〈0．05）。两组复发率比较：1年后随访，治疗组复发3例，复发率3．33％；对照组复发10例，复发率11．11％。两组复发率比较差异有统计学意义（P〈0．05）。结论：微创术后早期介入内服中药及腰背肌稳定性训练等治疗，有助于提高腰椎间盘突出症患者本体感觉功能及运动控制能力，增强腰椎协调性及稳定性，消除炎症反应，缓解疼痛，促进腰椎功能恢复，减少病情复发。

Therapeutic Effect of Traditional Chinese Medicine Combined with Stability Lumbodorsal Muscles Exercises for Treating Lumbar Disc Herniation after Minimally Invasive Surgery

Objective：To observe the therapeutic effect of Duhuojisheng decoction combined with stability lumbodorsal muscles exercises for treating lumbar intervertebral disc herniation （LDH） after minimally invasive surgery. Methods：All 180 patients of LDH were randomly divided into 2 groups according to treatment sequence, 90 cases of treatment group were treated by radiofrequency thermocoagulation combined with ozone and Duhuojisheng decoction combined with stability lumbodorsal muscles exercises. The other 90 cases of control group were only treated by radiofrequency thermocoagulation combined with ozone. The scores of VAS, JOA and efficacy were used to evaluate therapeutic effects before and after treatment. Results：The scores of VAS in the two groups were improved signifieantly after treatment than before （P〈0.05）.The scores of VAS in treatment group were improved significantly than control group two weeks and three months after treatment （P〈0.05）. The scores of JOA in the two groups were improved significantly after treatment than before （P〈0. 05）. The scores of JOA in treatment group were improved significantly than control group two weeks and three months after treatment （P〈0.05）. The excellent rate （cure ＋ improvement） was 86.67% and 73.33% in the treatment group and control group respectively 3 months after treatment. There was statistically significantly difference between the two groups （P〈0.05）. After one year followed-up, there were three cases of recurrence in the treatment group, and the rate of recurfence was 3.33%. There were ten cases of recurrence in the control group, and the rate of recurrence was 11.11%. There was statistically significantly difference in the rate of recurrence between the two groups （P〈0.05）. Conclusion： The methods of Duhuojisheng decoction combined with stability lumbodorsal muscles exercises are effective for treating LDH after minimally invasive surgery for its abilities to improve proprioceptive function and motion control ability, to strengthen the coordination and stability of the lumbar spine, to eliminate in{lamination reaction, to relieve pain, to promote the lumbar functional recovery, and to reduce disease recurrence.