乌头汤加味联合盐酸替扎尼定片治疗椎间盘源性腰痛风寒瘀阻证临床观察  

Effect of modified Wutou Decoction combined with tizanidine hydrochloride tablets on discogenic low back pain of wind-cold stasis syndrome

作　　者：李绍康 樊袁笑 曹晓雯 赵洁[1] 朱森 刘陟清 LI Shaokang;FAN Yuanxiao;CAO Xiaowen;ZHAO Jie;ZHU Sen;LIU Zhiqing(Department of Acupuncture,Shanghai Pudong Gongli Hospital,Shanghai 200135)

机构地区：[1]上海市浦东新区公利医院针灸科,上海浦东200135

出　　处：《河北中医》2024年第4期548-551,557,共5页Hebei Journal of Traditional Chinese Medicine

基　　金：浦东新区卫生系统重中之重中医重点专病建设资助项目(编号:PDZY-2018-0617)。

摘　　要：目的观察乌头汤加味联合盐酸替扎尼定片治疗椎间盘源性腰痛(DLBP)风寒瘀阻证的临床疗效。方法选择2018年1月至2021年6月期间收治的130例DLBP风寒瘀阻证患者为研究对象,按照随机数字表法分为2组,对照组65例予以盐酸替扎尼丁片口服治疗,治疗组65例在对照组用药基础上联合乌头汤加味治疗。2组均治疗4周后统计疗效,比较2组治疗前后疼痛症状[采用简式麦吉尔疼痛问卷量表(SF-MPQ)进行评价,包括疼痛评级指数(PRI)、视觉模拟评分(VAS)及现在疼痛状况(PPI)]、腰椎功能[采用日本骨科协会(JOA)下腰痛评分进行评价,包括临床体征、主观症状及日常生活动作]及实验室指标[包括血清白细胞介素1β(IL-1β)、IL-6、肿瘤坏死因子α(TNF-α)、6-酮-前列腺素F_(1α)(6-keto-PGF_(1α))及血栓素B_(2)(TXB_(2))]水平变化情况。结果治疗组总有效率93.8%(61/65),对照组总有效率80.0%(52/65),治疗组疗效优于对照组(P<0.05)。与本组治疗前比较,2组治疗后SF-MPQ量表中PRI、VAS、PPI评分均降低(P<0.05),且治疗组治疗后PRI、VAS、PPI评分均低于对照组(P<0.05)。与本组治疗前比较,2组治疗后JOA下腰痛临床体征、主观症状及日常生活动作评分均升高(P<0.05),且治疗组治疗后临床体征、主观症状及日常生活动作评分均高于对照组(P<0.05)。与本组治疗前比较,2组治疗后血清IL-1β、IL-6、TNF-α及TXB 2水平均降低(P<0.05),6-keto-PGF 1α水平均升高(P<0.05),且治疗组治疗后血清IL-1β、IL-6、TNF-α及TXB 2水平均低于对照组(P<0.05),6-keto-PGF 1α水平高于对照组(P<0.05)。结论乌头汤加味联合盐酸替扎尼定片治疗DLBP风寒瘀阻证疗效确切,可有效缓解患者疼痛症状,改善腰椎活动功能,抑制炎症反应,改善机体微循环,安全可靠。Objective To investigate the clinical efficacy of modified Wutou Decoction combined with tizanidine hydrochloride tablets in the treatment of discogenic low back pain(DLBP)of wind-cold stasis syndrome.Methods A total of 130 patients with DLBP of wind-cold stasis syndrome treated in our hospital from January 2018 to June 2021 were randomly assigned into treatment group(n=65)and control group(n=65).All patients were given oral tizanidine hydrochloride tablets,those in the treatment group were treated with modified Wutou Decoction.The efficacy of the two groups was statistically analyzed after 4 weeks of treatment.The changes in pain symptoms(the Short-Form McGill Pain Questionnaire[SF-MPQ]score including pain rating index[PRI],visual analogue scale[VAS]score and present pain status[PPI]),lumbar function(Japanese Orthopaedic Association[JOA]for low back pain scoreincluding clinical signs,subjective symptoms and daily life movements)and laboratory indexes(serum interleukin-1β[IL-1β],IL-6,tumor necrosis factor-α[TNF-α],6-keto-prostaglandin F_(1α)[6-keto-PGF_(1α)]and thromboxane B_(2)[TXB_(2)])before and after treatment were included as comparators between groups.Results The total effective rate in the treatment group was better than that of the control group(93.8%[61/65]vs 80.0%[52/65],P<0.05).The scores of PRI,VAS and PPI in SF-MPQ scale after treatment in the two groups were significantly decreased compared with those before treatment(P<0.05),and which were more lower in the treatment group than in the control group(P<0.05).After treatment,the scores of clinical signs,subjective symptoms and daily life activities in JOA scale in the two groups were significantly increased(P<0.05),and which in the treatment group were significantly higher than those of the control group(P<0.05).After treatment,the levels of serum IL-1β,IL-6,TNF-αand TXB 2 in the two groups were significantly decreased(P<0.05),which were significantly lower in the treatment group than in the control group(P<0.05).The level of 6-keto-PGF 1αwas

关 键 词：腰痛 椎间盘 中西医结合疗法 替扎尼定 乌头汤 

分 类 号：R681.5[医药卫生—骨科学]