腰曲与腰椎管狭窄症的相关性及整脊疗效分析  

Correlation Between Lumbar Curvature and Lumbar Spinal Stenosis and Analysis of Efficacy of Chiropractic Therapy

作　　者：林远方 庄娟娟[1] 陈伟梅[1] 周灵通 郑晓斌[1] 韦以宗 LIN Yuan-Fang;ZHUANG Juan-Juan;CHEN Wei-Mei;ZHOU Ling-Tong;ZHENG Xiao-Bin;WEI Yi-Zong(Shenzhen Traditional Chinese Medicine Hospital,Shenzhen 518000 Guangdong,China;Guangming Orthopedics Hospital in Changping District of Beijing,Beijing 100000,China)

机构地区：[1]深圳市中医院,广东深圳518000 [2]北京市昌平区光明骨伤医院,北京100000

出　　处：《广州中医药大学学报》2019年第9期1335-1338,共4页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：深圳市科创委基金项目（编号：深科技创新[2016]148号）;深圳市政府医疗卫生三名工程“韦以宗教授中医整脊团队”项目（编号：SZSM201612059）

摘　　要：【目的】探讨腰椎曲度(简称腰曲,指腰椎侧位X片弓形面积)与腰椎管狭窄症(LSS)的相关性并观察整脊疗法的临床疗效。【方法】选取60例LSS患者并给予整脊疗法(即腰椎定点杠杆正骨法结合以宗四维牵引辨证调曲治疗),2周为1个疗程,连续治疗2个疗程后观察治疗前后腰椎侧位X片弓形面积、CT椎管容积的变化,探讨腰曲与椎管狭窄的关系,分析治疗前后日本骨科协会(JOA)下腰痛评分的变化情况,并评价临床疗效。【结果】(1)1例因个人原因未坚持治疗至2个疗程,予以剔除。(2)治疗后,59例患者中,痊愈7例,显效36例,有效13例,无效3例,总有效率为94.9%。(3)治疗后,患者的JOA评分升高,腰椎弓形面积及L4和L5椎管面积/椎体面积均增大,差异均有统计学意义(P<0.05)。(4)Spearman相关分析结果表明,在治疗前后,腰曲(腰椎弓形面积)与JOA评分、L4椎管面积/椎体面积、L5椎管面积/椎体面积之间均存在不同程度相关关系,且均呈正相关,差异均有统计学意义(P<0.05)。【结论】整脊疗法治疗LSS能够取得较好的疗效,而整体改善腰椎曲度或许是整脊疗法取效的关键。Objective To explore the relationship between lumbar curvature(referring to lumbar vertebrae X-ray imaging arch area)and lumbar spinal stenosis and to observe the clinical efficacy of chiropractic therapy in treating lumbar spinal stenosis.Methods Sixty patients with lumbar spinal stenosis were treated with chiropractic therapy by lumbar vertebrae fixed-point lever orthopedics and Yizong four-dimensional traction dialectical adjustment.Two weeks constituted one treatment course and the treatment covered 2 continuous courses.Before and after treatment,the changes of arch area showed by X-ray imaging and spinal canal volume showed by CT were observed for the exploration of the relationship between lumbar curvature and lumbar spinal stenosis.The Japanese Orthopedics Association(JOA)scores of lower back pain before and after treatment were detected for the evaluation of the therapeutic effect.Results(1)One case was excluded for failing in completing the two courses for the personal reasons.(2)Among the 59 cases,7 cases were cured,36 were markedly effective,13 were effective,and 3 were ineffective after treatment,and the total effective rate was 94.9%.(3)After treatment,JOA scores were increased,and arch area of lumbar vertebrae as well as spinal canal volume(the ratio of spinal canal cross-sectional area to vertebral body cross-sectional area)of lumbar vertebra 4 and 5(L4 and L5)was also increased,the difference being statistically significant(P<0.05 compared with those before treatment).(4)The Spearman correlation analysis showed that arch area of lumbar vertebrae was positively correlated with the JOA scores,L4 spinal canal volume,and L5 spinal canal volume to various degrees before and after treatment,and the difference was statistically significant(P<0.05).Conclusion Chiropractic therapy exerts certain effects for the treatment of lumbar spinal stenosis,and the key therapeutic mechanism may be related with the comprehensive improvement of lumbar curvature.

关 键 词：腰椎管狭窄 腰曲 整脊疗法 点线正骨调曲 

分 类 号：R618.55[医药卫生—外科学]