腰椎间盘突出症中医循证实践指南  

An Evidence-based Guideline on Treating Lumbar Disc Herniation with Traditional Chinese Medicine

作　　者：秦晓宽 孙凯 徐卫国[2] 高景华[1] 姜宏[3] 陈薇[4] 张玲 李振华[6] 李无阴 袁普卫 杨克新[1] 童培建[9] 钟远鸣[10] 朱晓峰[11] 万小明[12] 何承建[13] 王艳国 徐西林[15] 黄勇[16] 张智海 黄异飞 郭伟 曹俊岭[20] 冯天笑 王旭 尹煜辉 王浩[22] 孙传睿 肖想玉 魏戌[22] 朱立国[1] QIN Xiaokuan;SUN Kai;XU Weiguo;GAO Jinghua;JIANG Hong;CHEN Wei;ZHANG Ling;LI Zhenhua;LI Wuyin;YUAN Puwei;YANG Kexin;TONG Peijian;ZHONG Yuanming;ZHU Xiaofeng;WAN Xiaoming;HE Chengjian;WANG Yan'guo;XU Xilin;HUANG Yong;ZHANG Zhihai;HUANG Yifei;GUO Wei;CAO Junling;FENG Tianxiao;WANG Xu;YIN Yuhui;WANG Hao;SUN Chuanrui;XIAO Xiangyu;WEI Xu;ZHU Liguo(Department of Spine II,Wangjing Hospital,China Academy of Chinese Medical Sciences,Beijing 100102,China;Department of Orthopedics,Tianjin Hospital,Tianjin 300211,China;Department of Orthopedics,Suzhou Hospital of Traditional Chinese Medicine,Suzhou 215002,China;Centre for Evidence-Based Chinese Medicine,Beijing Uni-versity of Chinese Medicine,Beijing 100029,China;Department of Epidemiology and Health Statistics,School of Public Health,Capital Medical University,Beijing 100069,China;Department of Orthopedics,Affiliated Hospital of Changchun University of Chinese Medicine,Changchun 130021,China;Luoyang Orthopedic Hospital of Henan Province,Luoyang 471002,China;Department of Orthopedics,Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang 712000,China;Institute of Orthopedics and Traumatology,The First Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310060,China;Department of Orthopedic Spine,The First Affiliated Hos-pital of Guangxi University of Chinese Medicine,Nanning 530023,China;Department of Chinese Medicine,The First Affiliated Hospital of Jinan University,Guangzhou 510630,China;Department of Orthopedics,The Affili-ated Hospital of Jiangxi University of Traditional Chinese Medicine,Nanchang 330006,China;Department of Orthopedics,Hubei Provincial Hospital of Traditional Chinese Medicine,Wuhan 430061,China;Department of Massage and Rehabilitation,Second Teaching Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300250,China;Department of Orthopedics,The Third Affiliated Hospital of Heilongjiang University of Chinese Medicine,Harbin 150030,China;Department of Orthopedics,Hospital of Chengdu University of Traditiona

机构地区：[1]中国中医科学院望京医院脊柱二科,北京100102 [2]天津市天津医院矫形一病区,天津300211 [3]苏州市中医医院骨科,浙江苏州215002 [4]北京中医药大学循证医学中心,北京100029 [5]首都医科大学公共卫生学院流行病与卫生统计学系,北京100069 [6]长春中医药大学附属医院骨科中心,吉林长春130021 [7]河南省洛阳正骨医院(河南省骨科医院),河南洛阳471002 [8]陕西中医药大学附属医院骨伤科,陕西咸阳712000 [9]浙江中医药大学附属第一医院骨伤科,浙江杭州310060 [10]广西中医药大学第一附属医院脊柱骨科,广西南宁530023 [11]暨南大学附属第一医院中医科,广东广州510630 [12]江西中医药大学附属医院骨伤科,江西南昌330006 [13]湖北省中医院骨伤科,湖北武汉430061 [14]天津中医药大学第二附属医院推拿科,天津300250 [15]黑龙江中医药大学附属第三医院骨科,黑龙江哈尔滨,150030 [16]成都中医药大学附属医院骨科,四川成都610081 [17]中国中医科学院广安门医院骨科,北京100053 [18]新疆维吾尔自治区中医医院骨一科,新疆乌鲁木齐830000 [19]中国人民解放军空军特色医学中心中西医结合正骨科,北京100036 [20]北京中医院大学东直门医院药剂科,北京100700 [21]北京中医药大学研究生院,北京100029 [22]中国中医科学院望京医院学术发展处,北京100102 [23]山东中医药大学第一临床医学院,山东济南250355

出　　处：《西部中医药》2024年第5期1-15,共15页Western Journal of Traditional Chinese Medicine

基　　金：国家重点研发计划项目(2021YFC1712800,2021YFC1712803);中国中医药循证能力提升项目(ZZ13-024-7);国家中医药传承创新团队项目(ZYYCXTD-C-202003)。

摘　　要：背景:腰椎间盘突出症是导致腰痛最常见的原因之一,给患者和社会带来了沉重的经济负担。对绝大部分患者而言,保守治疗是首选。中医药是保守治疗的重要组成部分,日益受到国际的关注。方法:组建多学科专家组成的工作组,通过系统文献检索和专家共识确定指南需解决的临床问题,采用GRADE方法对证据质量和推荐意见强度进行分级。结果:指南最终形成20条推荐意见,涉及身痛逐瘀汤、肾着汤、四妙散、独活寄生汤、腰痹通胶囊、腰痛宁胶囊、恒古骨伤愈合剂、手法、针刀、针刺、电针、中医传统功法(太极拳、八段锦、易筋经)及联合西医常规治疗。西医常规治疗包括非甾体抗炎药物、营养神经类药物、牵引等。结论:这是第一部严格按照国内外规范采用GRADE方法制订的中医药治疗腰椎间盘突出症的中医循证指南,希望指南中推荐意见可以帮助医护工作者更好地照护腰椎间盘突出症患者。Background:Lumbar disc herniation(LDH),as one of the most common causes of lower back pain,imposes a heavy economic burden on patients and society.Conservative management is the first-line choice for the majority of LDH patients.Traditional Chinese medicine(TCM)is an important part of conservative treatment and has attracted more and more international attention.Methods:We formed a guideline panel of multidisciplinary experts.The clinical questions were identified on the basis of a systematic literature search and a consensus meeting.We searched the literature for direct evidence on the management of LDH,and assessed its certainty generated recommendations using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach.Results:The guideline panel made twenty recommendations,which covered use of Shentong Zhuyu Tang,Shenzhuo Tang,Simiao San,Duhuo Jisheng Tang,Yaobitong capsule,Yaotongning capsule,Henggu bone injury healing agent,manipulation,needle knife,acupuncture,electroacupuncture,Chinese exercise techniques(Tai Chi,Baduanjin,or Yijinjing)and integrative medicine,such as combined non-steroidal anti-inflammatory drugs,neural nutrition,and traction.Conclusion:This is the first LDH treatment guideline for TCM and integrative medicine with a systematic search,synthesis of evidence,and using the GRADE method to rate the quality of evidence.We hope these recommendations can help healthcare workers care for LDH patients.

关 键 词：循证实践指南 腰椎间盘突出症 中医药 中西医结合 

分 类 号：R274.9[医药卫生—中西医结合]