魏氏二步七法手法对腰椎间盘突出症患者脊柱-骨盆三维影像学参数的影响  

Effect of Wei’s Two-Step Seven Manipulations on Spinal-pelvic Three-dimensional Imaging Parameters in Patients with Lumbar Disc Herniation

作　　者：薛彬[1,2] 刘涛 奚小冰[1] 李飞跃[1] 孔令军[3] 周鑫[3] 朱清广 房敏[2] XUE Bin;LIU Tao;XI Xiaobing;LI Feiyue;KONG Lingjun;ZHOU Xin;ZHU Qingguang;FANG Min(The Ruijin Hospital Afiliated to Shanghai JiaoTong University School of Medicine,Shanghai,200025;School of Acupuncture,Moxibustion and Tuina,Shanghai University of Traditional Chinese Medicine;Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine)

机构地区：[1]上海交通大学医学院附属瑞金医院,上海市200025 [2]上海中医药大学针灸推拿学院 [3]上海中医药大学附属岳阳中西医结合医院

出　　处：《中医杂志》2023年第4期365-369,共5页Journal of Traditional Chinese Medicine

基　　金：国家中医药管理局中医药创新团队及人才支持计划(ZYYCXTD-C-202008);上海市临床重点专科建设项目(shslczdzk04802);上海市科学技术委员会科技计划(21Y21920300,20YF1427500)。

摘　　要：目的 观察魏氏二步七法手法对腰椎间盘突出症患者脊柱-骨盆三维影像学参数的影响。方法 72例腰椎间盘突出症患者随机分为干预组和对照组各36例,干预组予魏氏二步七法手法治疗,对照组予常规推拿手法治疗,每周治疗3次,共治疗4周。治疗前后进行脊柱-骨盆三维影像学检测,影像学指标包括骨盆侧倾、腰椎前凸角、骨盆入射角、骨盆倾斜角、骶骨倾斜角、矢状面垂直轴,脊柱椎体空间位置指标包括L5轴向旋转、L5矢量位移(x)、L5矢量位移(y)、L4轴向旋转、L4矢量位移(x)、L4矢量位移(y)。于治疗前及治疗2周、4周时进行疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数问卷表(ODI)评分。结果 最终纳入分析干预组35例,对照组34例。与本组治疗前比较,治疗后两组患者骨盆侧倾、矢状面垂直轴均减小,干预组治疗后腰椎前凸角增大(P<0.001);干预组在改善骨盆侧倾、矢状面垂直轴方面优于对照组(P<0.001)。干预组在改善L4和L5轴向旋转、L5矢量位移(x)、L5矢量位移(y)方面亦优于对照组(P<0.05或P<0.01)。与本组治疗前比较,治疗2周、4周时两组患者VAS评分和ODI评分均降低(P<0.001)。治疗4周后干预组VAS评分、ODI评分均低于对照组(P<0.05)。结论 魏氏二步七法手法较常规推拿手法可更好地促进恢复脊柱-骨盆生物力学平衡,这可能也是其在减轻疼痛及功能障碍方面优于常规推拿手法的原因之一。Objective To observe the effect of Wei’s two-step seven manipulations on spinal-pelvic three-dimensional imaging parameters in patients with lumbar disc herniation(LDH).Methods A total of 72 LDH patients were randomly divided into two groups;36 cases in the manipulation group were treated with Wei’s two-step seven manipulations,while 36 cases in the control group were treated with conventional tui na,and both groups were treated three times a week for 4 consecutive weeks.Spinal-pelvic three-dimensional imaging was performed before and after treatment,and the parameters included lateral pelvic tilt(LPT),lumbar lordotic angle(LL),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),and sagittal vertical axis(SVA);vertebral spatial position indexes included L5axial rotation,L5 vector displacement(x),L5 vector displacement(y),L4 axial rotation,L4 vector displacement(x),and L4 vector displacement(y).Pain visual analogue score(VAS) and Oswestry disability index questionnaire(ODI) score before and after 2-and 4-week treatment were measured.Results Finally,35 cases in the manipulation group and 34 cases in the control group were included in the analysis.After treatment,LPT and SVA values decreased in both groups,while LL value increased in the manipulation group(P<0.001),with more change in the manipulation group in terms of LPT and SVA values(P<0.001).Regarding the L4 and L5 axial rotation,L5 vector displacement(x),and L5 vector displacement(y),much more improvements were found in the manipulation group than in the control group(P<0.05 or P<0.01).Compared to those before treatment,the VAS score and ODI score significantly decreased in both groups when measured after 2-and 4-week treatment(P<0.001).After 4 weeks of treatment,the VAS score and ODI index of patients in the manipulation group were significantly lower than those in the control group(P<0.05).Conclusion Wei’s two-step seven manipulations can effectively promote the recovery of spine-pelvis biomechanical balance than conventional tuina,which may be one o

关 键 词：腰椎间盘突出症 推拿手法 疼痛视觉模拟评分 OSWESTRY功能障碍指数 魏氏二步七法 全身骨骼三维建模成像 

分 类 号：R274.9[医药卫生—中西医结合]