基于可穿戴式惯性传感器对中医综合疗法治疗气滞血瘀型腰椎间盘突出症的疗效评价研究  

Wearable Inertial Sensors-based Efficacy Evaluation of Comprehensive Traditional Chinese Medicine Therapy for Lumbar Disc Herniation Due to Qi-stagnation and Blood-stasis

作　　者：姚俊杰 商强强 王宇峰 栗嘉徽 刘畅[1] 庞婷婷 YAO Junjie;SHANG Qiangqiang;WANG Yufeng;LI Jiahui;LIU Chang;PANG Tingting(College of Acupuncture and Tuina,Changchun University of Chinese Medicine,Changchun 130117,China;Department of Tuina,Jilin Provincial Hospital of Traditional Chinese Medicine/the Affiliated Hospital of Changchun University of Chinese Medicine,Changchun 130021,China)

机构地区：[1]长春中医药大学针灸推拿学院,吉林省长春市130117 [2]吉林省中医院、长春中医药大学附属医院推拿科,吉林省长春市130021

出　　处：《中国全科医学》2023年第27期3450-3455,共6页Chinese General Practice

基　　金：国家中医药管理局中医药创新团队及人才支持计划项目(ZYYCXTD-D-202001);吉林省教育厅科学研究项目(JJKH20220870KJ);吉林省中医药科技项目(2022020)。

摘　　要：背景临床中,中医保守治疗对腰椎间盘突出症(LDH)患者有明确疗效,其起效机制和生物力学效应是目前研究的热点。目的应用可穿戴式惯性传感器对气滞血瘀型LDH患者治疗前后的步态进行分析,通过生物力学的方法验证中医综合疗法的作用优势。方法纳入2020年6月—2021年12月在长春中医药大学附属医院推拿科住院治疗且入院诊断为LDH的40例患者为研究对象,采用中医综合治疗方法进行治疗。收集患者的年龄、性别、下肢疼痛侧、基线BMI、住院时间、患者治疗前后的腰痛相关量表评分,并于治疗前后采用可穿戴式惯性传感器收集步态分析相关参数。结果40例患者中,男18例,女22例,18例下肢疼痛侧在左侧,8例下肢疼痛侧在右侧,14例下肢疼痛侧为双侧。患者平均年龄(52.3±15.2)岁,平均BMI(25.2±4.2)kg/m2,平均住院时间(17.5±6.2)d。治疗后共35例有效或显效,5例无效,总体有效率为87.5%。与治疗前相比,患者治疗后疼痛视觉模拟评分、腰椎Oswestry功能障碍指数降低,日本骨科协会评估治疗分数升高(P<0.05);患者治疗后步频、步速、步幅、步行周期、摆动相占比、胫骨和足底冲击力升高,支撑相占比降低(P<0.05);患者治疗后髋关节内收外展、髋关节旋转、膝关节内外翻、膝关节旋转、踝关节旋转活动度下降(P<0.05);患者治疗后骨盆侧倾指数、骨盆侧斜指数、髋关节内收外展指数、髋关节屈伸指数、髋关节旋转指数、膝关节旋转指数、踝关节内外翻指数、踝关节屈伸指数、踝关节旋转指数升高(P<0.05)。40例LDH患者经中医综合治疗后,未出现不良反应及毒副作用,在随访过程中有5例患者症状反复或再次入院治疗。结论中医综合疗法可明显改善气滞血瘀型LDH患者的疼痛、功能障碍,增加步行状态中的动态稳定性,是安全有效的保守治疗方案。Background Conservative traditional Chinese medicine(TCM)treatment has clinically proven to have a clear curative effect on lumbar disc herniation(LDH),and its mechanism of action and biomechanical effects are the hot spots in current research.Objective To perform a wearable inertial sensors-based gait analysis in LDH patients with qi-stagnation and blood-stasis before and after treatment,and to verify the advantages of comprehensive TCM therapy by biomechanical methods.Methods This study selected 40 inpatients with an admission diagnosis of LDH treated with comprehensive TCM therapy from Tuina Department,the Affiliated Hospital of Changchun University of Chinese Medicine from June 2020 to December 2021.The patients'age,gender,the lower limb with pain,baseline body mass index,hospitalization time and pre-and post-treatment scale scores for low back pain were collected.Gait parameters were collected by wearable inertial sensors at pre-and posttreatment.Results Among the 40 patients,18 were males and 22 were females.Eighteen patients had pain in the left lower limb,8 had pain in the right lower limb,and the other 14 had pain in both lower limbs.Patients had a mean age of(52.3±15.2)years,a mean body mass index of(25.2±4.2)kg/m2,and a mean length of hospitalization of(17.5±6.2)days.The treatment was effective or marketed effective in 35 cases,ineffective in 5 cases,achieving an overall response rate of 87.5%.The Visual Analogue Scale score and Oswestry Disability Index decreased,and the Japanese Orthopaedic Association Score increased after treatment compared with the baseline levels(P<0.05).After treatment,the patient's cadence,speed,stride length,gait cycle,swing phase percentage,shank and foot shock impact increased,and the stance phase percentage decreased(P<0.05).The range of motion of hip abduction and adduction,hip rotation,knee varus and valgus,knee rotation and ankle rotation decreased(P<0.05).Increased pelvic obliquity index,pelvic tilt index,hip abduction and adduction degrees,hip flexion and extension

关 键 词：椎间盘移位 椎间盘突出 步态分析 中医药疗法 推拿 脊柱 针灸疗法 治疗结果 

分 类 号：R681.53[医药卫生—骨科学] R242[医药卫生—外科学]