骶管封闭术联合四步松解法治疗腰椎间盘突出症的临床疗效及作用机制研究  

Clinical Efficacy and Mechanism of Sacral Canal Injection Combined with Four-step Manipulation in the Treatment of Lumbar Disc Herniation

作　　者：周承亮 徐锋 张伟刚 陈勇 蒋铭 张强 汤国庆 Zhou Chengliang;Xu Feng;Zhang Weigang;Chen Yong;Jiang Ming;Zhang Qiang;Tang Guoqing(Kunshan Traditional Chinese Medicine Hospital Affiliated to Yangzhou University,Jiangsu,Kunshan 215300,China)

机构地区：[1]扬州大学附属昆山市中医医院,江苏昆山215300

出　　处：《中国中医急症》2023年第8期1360-1363,1372,共5页Journal of Emergency in Traditional Chinese Medicine

基　　金：国家自然科学基金青年科学基金项目(81802180);苏州市卫生青年骨干人才“全国导师制”培训项目(Qngg2022052);昆山市重点研发计划(社会发展)(KS2226)。

摘　　要：目的 观察骶管封闭术联合四步松解法治疗腰椎间盘突出症的临床疗效,并探讨其作用机制。方法120例腰椎间盘突出症患者随机分为两组各60例,治疗组行骶管封闭术联合四步松解法治疗,对照组予单纯口服非甾体消炎药治疗,比较两组患者治疗前后视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)评分、日本骨科协会评分(JOA)及血清炎性细胞因子肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)和白细胞介素-6(IL-6)水平;治疗14 d后,采用改良MacNab标准进行疗效评定。结果 治疗后治疗组每个时间节点VAS评分均比治疗前降低(P <0.05),对照组治疗后1 d与治疗前比较,差异无统计学意义(P> 0.05),但治疗后3、7、14 d时,与治疗前比较,差异有统计学意义(P <0.05),治疗后两组ODI、JOA评分均比治疗前显著降低(P <0.05)。组间比较,治疗组VAS评分在治疗后1、3、7 d时均低于对照组(P <0.05),治疗后14 d,两组差异无统计学意义(P> 0.05);治疗组每个时间节点ODI评分、JOA评分均较对照组低,其中第7天比较,差异有统计学意义(P <0.05),第14天比较,差异无统计学意义(P> 0.05)。治疗后两组患者血清TNF-α、IL-1β和IL-6水平较治疗前均有下降(P <0.05),且每个时间节点治疗组血清TNF-α、IL-1β和IL-6水平均较对照组低(P <0.05)。治疗组优良率为88.33%,明显高于对照组的66.67%(P <0.05)。结论 骶管封闭术联合四步松解法治疗LDH疗效确切且持久,其机制可能与降低周围炎症因子水平有关。Objective:To observe the clinical effect of sacral canal injection combined with four-step manipula⁃tion in the treatment of lumbar disc herniation,and to explore its mechanism.Methods:Patients with lumbar disc herniation who received sacral canal injection combined with four-step manipulation and oral NSAIDS alone were retrospectively collected,including 60 cases of sacral canal injection combined with four-step manipulation and 60 cases of oral NSAIDS alone.The changes of Visual Analogue Scale(VAS),Oswestry Disability Index(ODI),Japa⁃nese Orthopaedic Association Scores(JOA)and serum levels of inflammatory cytokines tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)and interleukin-6(IL-6)were compared between the two groups before and af⁃ter treatment.Moreover,according to modified MacNab criteria,clinical efficacy evaluation was conducted 14 days after treatment.Results:The VAS score of each time point in the treatment group after treatment was lower than that before treatment(P<0.05);the difference between before and after a day of treatment in the control group was not statistically significant(P>0.05),but at 3,7 and 14 days after treatment,the difference was statistically signifi⁃cant(P<0.05).The ODI score and JOA score of both groups after treatment were significantly lower than before treatment(P<0.05).Compared between groups,the VAS scores in the treatment group were lower than those in the control group at 1,3 and 7 days after treatment(P<0.05),and there was no significant difference between the two groups at 14 days after treatment(P>0.05).The ODI score and JOA score of each time point in the treatment group were lower than those in the control group,and the difference was statistically significant on the 7th day(P<0.05)but showed no statistically significant difference at 14th day(P>0.05).After treatment,the serum levels of TNF-α,IL-1βand IL-6 decreased in both groups compared with before treatment(P<0.05),and the serum TNF-α,IL-1βand IL-6 levels in the treatment group in each time po

关 键 词：腰椎间盘突出症 骶管封闭 四步松解法 临床疗效 

分 类 号：R681.53[医药卫生—骨科学]