椎间盘源性腰腿痛诊治规范化研究  

Standardized study of diagnosis and treatment for discogenic lumbago-leg pain

作　　者：蒋位庄[1] 周卫[1] 张禄堂[1] 张世民[1] 章永东[1] 李星[1] 

机构地区：[1]中国中医研究院骨伤科研究所,北京100700

出　　处：《中国骨伤》2004年第11期643-646,共4页China Journal of Orthopaedics and Traumatology

基　　金：国家中医药管理局科研基金课题 (编号 :92 2 1C4)

摘　　要：目的 :评价椎间盘源性腰腿痛病名及分型诊治的实用价值。明确中医药和手法辨证施治为主的非手术和手术适应证 ,寻找中西医结合诊治该证的切入点。方法 :经近 2 0 0 0例住院病人诊疗经验的总结 ,制订出椎间盘膨出 (Ⅰ型 )、弹力型突出 (Ⅱ型 )、退变失稳型 (Ⅲ型 )、增生狭窄型 (Ⅳ型 )、软骨板破裂 (Ⅴ型 )五个病理类型及诊治标准。根据中医辨证论治原则 ,制订出气滞血瘀、湿热痹痛、风寒湿困和肝肾亏损四个中医证型。结果 :从 1997- 2 0 0 2年 12月对 6 6 8例分型治疗结果中看出 ,采取中医药手段为主的非手术治疗率为 6 8% ,其中Ⅱ型为 90 % ,Ⅲ型为 6 9% ,Ⅳ型为 4 4 % ,Ⅴ型 4 3%。以中医药非手术治疗的优良率达 79%。经非手术治疗无效的 2 13例改为手术治疗的优良率为 94 %。经非手术效果不良者 ,使手术目的性更明确故显效率高。结论 :椎间盘源性腰腿痛分型治疗有利于发挥中医药治疗优势 ,降低了手术率 ,提高手术的正确性和目的性 。Objective:To evaluate the practical significance of classification of diagnosis and treatment for discogenic lumbago-leg pain and to determine the indications of nonoperative and operative treatment with traditional chinese medicine and manipulative methods,according to symptomatic differentiation,so as to seek the contacting point of the integrated treatment of western medicine and TCM.Methods:Based on the experienced summarization of diagnosis and treatment of 2 000 inpatients,five pathological types and standard of diagnosis and treatment were established:disc bulge type(type Ⅰ),elastic herniation type(type Ⅱ),degenerative unstability type(typeⅢ),hyperplasia stenosis type(type Ⅳ)and cartilage endplate rupture type(type Ⅴ).Four types syndrome of TCM were also formulated based on the principle of treatment according to syndrome differentiation of TCM,namely type of stagnancy of qi and blood stasis,type of disturbance due to wind-cold-dampness,and type of deficiency of liver-kidney.Results:Among 668 patients,the rate of nonoperative treatment was 68%,out of them,type Ⅱ was 90%,type Ⅲ 69%,type Ⅳ 44% and type Ⅴ43%.The markedly effective rate treated with nonoperative treatment of TCM reached 79%.The failed 213 patients were retreated with surgical operation,and the rate of excellent and good was 94%.In the way the objective of operation would be more precise and the rate of excellent and good would be higher.Conclusion:The classification treatment for lumbar discogenic lumbago-leg pain is beneficial to development of TCM advantages,and to raising the total curative rate,so as to provide the reliable theoretical basis for the treatment of lumbago-leg pain with the combined method of western medicine and TCM.

关 键 词：椎间盘源性腰腿痛 非手术治疗 中医药 诊治规范 分型治疗 肝肾 气滞血瘀 亏损 效率 优势 

分 类 号：R681[医药卫生—骨科学] R274[医药卫生—外科学]