腰椎间盘突出症患者脊柱推拿后症状恶化的临床特点分析  

Clinical characteristics analysis of lumbar disc herniation with symptom aggravated caused by spinal manipulative therapy

作　　者：赵锋[1] 裴军朋 刁攀 孟志丽 孙园[1] 黄省利[1] 

机构地区：[1]西安交通大学第二附属医院骨科,陕西西安710004

出　　处：《中国骨伤》2017年第3期252-255,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目地:探讨脊柱推拿治疗导致腰椎间盘突出症症状恶化的临床特点。方法 :自2012年1月至2013年12月,收治了10例因行脊柱推拿治疗导致腰椎间盘突出症状加重的患者,男5例,女5例;年龄46~68岁,其中7例年龄>50岁。对10例患者的临床资料进行分析,包括年龄、性别、临床症状、体征、影像学表现、手术治疗情况和预后。结果:10例患者在行脊柱推拿治疗前症状持续时间为4~15年,行脊柱推拿治疗后24 h内出现腰腿痛症状的加重,MRI示明显的椎间盘突出,其中L4-L5节段7例。从症状加重到手术治疗的平均时间为23.1 d,无围手术期并发症发生,在术后数天内神经根痛明显缓解。随访期间,10例患者均恢复了行走能力,8例症状完全缓解,2例症状得到显著改善。结论:提出了脊柱推拿治疗腰椎间盘突出的5种危险因素,为按摩师在行脊柱推拿治疗前提供参考,并且这类患者手术治疗效果良好。Objective：To discuss the characteristics of lumbar disc herniation（LDH） with symptom aggravated caused by spinal manipulative therapy（SMT）. Methods：Detailed clinical profiles of a total number of 10 LDH patients with symptoms aggravated after SMT were reviewed including 5 males and 5 females with age from 46 to 68 years old,7 patients of them were more than 50 years old. The clinical data of 10 patients were analyzed involving age,gender,clinical symptoms,signs,imaging findings,surgical treatment and prognosis. Laminectomy and discectomy were performed,and follow-up was carried out in all patients. Results：The duration of symptoms in all the patients before SMT was 4 to 15 years. After the therapy,an acute exacerbation of back and radicular pain was observed within 24 hours. MRI showed intervertebral disc herniation,7 patients were observed in L4-L5. The time internal between the exacerbation of presentation and surgery was 23.1 days. No perioperative complications occurred. All the patients were relieved of radicular pain a few days after surgery. During postoperative follow up,all patients regained the ability to walk; Eight patients reported a complete resolution of presentation and the rest two patients were significantly improved. Conclusion：SMT should be prohibited in some LDH patients to prevent neurological damages,in whom there are 5 possible risk factors.

关 键 词：腰椎 椎间盘移位 推拿 脊柱 症状加重 危险因素 

分 类 号：R681.53[医药卫生—骨科学]