尺胫针结合丹鹿通督片加麦肯基疗法对腰椎间盘突出症合并马尾神经损伤患者的临床研究  

Clinical Study of Ulnar Tibial Needling Combined with Danlu Tongdu Tablet and McKenzie Therapy in Treatment of LDH Complicated with Cauda Equina Nerve Injury

作　　者：王向向 张立颖 张健 李利霞[4] WANG Xiangxiang;ZHANG Liying;ZHANG Jian;LI Lixia(The Third Hospital of Shijiazhuang,Shijiazhuang 050011,China;The Second Hospital of Shijiazhuang,Shijiazhuang 050056,China;Shijiazhuang Ping An Hospital,Shijiazhuang 050025,China;Hebei Provincial Hospital of Traditional Chinese Medicine,Shijiazhuang 050013,China)

机构地区：[1]石家庄市第三医院,河北石家庄050011 [2]石家庄市第二医院,河北石家庄050056 [3]石家庄市平安医院,河北石家庄050025 [4]河北省中医院,河北石家庄050013

出　　处：《针灸临床杂志》2024年第6期47-52,共6页Journal of Clinical Acupuncture and Moxibustion

基　　金：河北省中医药管理局科研计划项目,编号:2020277。

摘　　要：目的:探讨尺胫针结合丹鹿通督片加麦肯基疗法对腰椎间盘突出症合并马尾神经损伤患者的疗效及对镇痛效应和致疼因子及ERK、p-P38表达的影响。方法:90例腰椎间盘突出症合并马尾神经损伤患者随机分为对照组与研究组,每组各45例。对照组患者采用丹鹿通督片结合麦肯基疗法进行治疗,研究组在丹鹿通督片结合麦肯基疗法治疗的基础上给予尺胫针治疗,连续治疗4周后统计临床疗效。比较对照组和研究组治疗前后Frankel脊髓损伤评分、VAS疼痛评分、血清前列腺素E2(PGE2)、5-羟色胺(5-HT)以及一氧化氮(NO)等致疼因子表达水平以及血清细胞外调节蛋白激酶(ERK)和磷酸化-P38丝裂原活化蛋白激酶(p-P38MAPK)表达水平。结果:研究组治疗总有效率91.11%(41/45)显著高于对照组的73.33%(33/45),差异具有统计学意义(P<0.05);治疗结束后研究组下肢放射性疼痛、麻木无力、大便无力和排尿不畅评分低于对照组,差异具有统计学意义(P<0.05);治疗结束后研究组Frankel脊髓损伤评分高于对照组,差异具有统计学意义(P<0.05);研究组VAS,评分低于对照组,差异具有统计学意义(P<0.05);治疗结束后研究组血清PGE2、5-HT以及NO含量低于对照组,差异具有统计学意义(P<0.05);治疗结束后研究组血清ERK、p-P38MAPK表达水平低于对照组,差异具有统计学意义(P<0.05)。结论:尺胫针结合丹鹿通督片加麦肯基疗法对腰椎间盘突出症合并马尾神经损伤患者疗效更佳,有助于修复马尾神经损伤,降低致疼因子的表达,从而减轻患者腰腿疼痛症状,其机制可能与影响ERK、p-P38MAPK的表达有关。Objective:To investigate the efficacy and analgesic effect of ulnar tibia needling combined with Danlu Tongdu Tablet and McKenzie therapy in treatment of lumbar disc herniation(LDH) complicated with cauda equina nerve injury,and to explore its influence to the pain-inducing factors of ERK and p-P38.Methods:90 patients with lumbar disc herniation complicated with cauda equina nerve injury were randomly divided into the control group and the study group,with 45 cases in each group.The control group was treated with Danlu Tongdu Tablet combined with McKenzie therapy;on which basis,the study group was also treated with ulnar tibia needling.Therapeutic effect was evaluated after 4 weeks of continuous treatment.Frankel spinal cord injury score,VAS pain score,serum prostaglandin E2(PGE2),5-hydroxytryptamine(5-HT),nitric oxide(NO) and other pain-inducing factors,as well as the expressions of serum extracellular regulatory protein kinase(ERK) and phosphorylated-P38 mitogen activated protein kinase(p-P38MAPK) were compared between before and after the treatment in the two groups.Results:The total effective rate was 91.11%(41/45) in the study group,which was significantly higher than 73.33%(33/45) in the control group(P<0.05).The scores for lower limb radiation pain,numbness and weakness,difficulty in bowel movement,and difficulty in urinating were lower in the study group than those in the control group after the treatment(P<0.05).The Frankel spinal cord injury score was higher(P<0.05),and the VAS score was lower in the study group than that in the control group after the treatment(P<0.05).The serum levels of PGE2,5-HT and NO were lower in the study group than those in the control group after the treatment(P<0.05).The expressions of serum ERK and p-P38MAPK were lower in the study group than those in the control group after the treatment(P<0.05).Conclusion:The combination of Danlu Tongdu Tablet and ulnar tibial needling combined with Mackenzie therapy has a better therapeutic effect on patients with lumbar disc herniation c

关 键 词：腰椎间盘突出症 丹鹿通督片 尺胫针 麦肯基疗法 马尾神经损伤 致痛因子 细胞外调节蛋白激酶 磷酸化-P38丝裂原活化蛋白激酶 

分 类 号：R246.2[医药卫生—针灸推拿学]