独活寄生汤加减结合俯卧位成角牵引下定点推拿手法治疗寒湿型腰椎间盘突出症的疗效及安全性研究  

Efficacy and safety of modified Duhuo Jisheng Decoction combined with fixed-point massage technique under prone position angulation traction for the treatment of cold-dampness type lumbar disc herniation

作　　者：朱云峰 刘怀省 李武强 朱波涛 梁晓 李牧野 张一丹 常改荣 ZHUYun-feng;LIU Huai-sheng;LI Wu-qiang;ZHU Bo-tao;LIANG Xiao;LI Mu-ye;ZHANG Yi-dan;CHANG Gai-rong(Department of Spine,Sanmenxia Wuqiang Hospital of Traditional Chinese Medicine,Sanmenxia 472000,Henan,CHINA;Department of Orthopedics,Puyang Hospital of Traditional Chinese Medicine,Puyang 457000,Henan,CHINA)

机构地区：[1]三门峡武强中医院脊柱科,河南三门峡472000 [2]濮阳市中医院骨科,河南濮阳457000

出　　处：《海南医学》2025年第5期665-671,共7页Hainan Medical Journal

基　　金：2021年河南省卫生健康委国家中医临床研究基地科研专项项目(编号:2021JDZY109)。

摘　　要：目的 研究独活寄生汤加减结合俯卧位成角牵引下定点推拿手法治疗寒湿型腰椎间盘突出症的疗效及安全性。方法 选取2021年8月至2023年11月三门峡武强中医院收治的96例寒湿型腰椎间盘突出症患者作为研究对象,按随机数字表法分为推拿组、汤药组和联合组各32例。三组患者均予以俯卧位成角牵引,在此基础上,推拿组患者施以定点推拿手法治疗,汤药组患者施以独活寄生汤加减治疗,联合组患者施以定点推拿联合独活寄生汤加减治疗,均治疗12周,并随访3个月。比较三组患者治疗12周的效果,治疗前及治疗12周后证候评分、腰背伸肌群力学性能,治疗前、治疗1周、治疗4周、治疗12周后及随访时视觉疼痛模拟评分法(VAS)、日本骨科协会(JOA)评分、Oswestry功能障碍指数(ODI),观察三组患者治疗期间的安全性。结果 治疗12周后,联合组患者的治疗优良率为90.63%,明显高于推拿组的68.75%及汤药组的65.63%,差异均有统计学意义(P<0.05);治疗12周后联合组患者的腰背酸痛、下肢麻木、脊背强直证候积分明显低于推拿组、汤药组,差异均有统计学意义(P<0.05);治疗12周后联合组患者的腰背屈/伸峰力矩比值为(64.06±8.08)%,明显低于推拿组的(68.62±8.45)%及汤药组的(69.09±9.07)%,平均功率、前峰力矩分别为(25.06±3.59) W、(71.89±8.28) Nm,明显高于推拿组的(22.93±4.11) W、(66.81±9.02) Nm及汤药组的(22.08±3.90) W、(65.60±10.94) Nm,差异均有统计学意义(P<0.05);治疗1周、治疗4周、治疗12周后及随访时,联合组患者的VAS评分和ODI指数明显低于推拿组及汤药组,JOA评分明显高于推拿组及汤药组,差异均有统计学意义(P<0.05);联合组、汤药组和推拿组患者的不良反应总发生率分别为9.38%、6.25%、9.38%,差异无统计学意义(P>0.05)。结论 独活寄生汤加减结合在俯卧位成角牵引下定点推拿治疗寒湿型腰椎间盘突出症效果显著,�Objective To investigate the efficacy and safety of modified Duhuo Jisheng Decoction combined with fixed-point massage technique under prone position angulation traction for the treatment of cold-dampness type lumbar disc herniation.Methods A total of 96 patients with cold-dampness type lumbar disc herniation admitted to Sanmenxia Wuqiang Hospital of Traditional Chinese Medicine from August 2021 to November 2023 were selected as the research subjects.According to a random number table method,the patients were randomly divided into a massage group(n=32),a decoction group(n=32),and a combined group(n=32),which were treated with fixed-point massage therapy,modified Duhuo Jisheng Decoction,and fixed-point massage therapy combined with modified Duhuo Jisheng Decoction on the basis of prone-position angulation traction,respectively.All patients were treated for 12 weeks and followed up for 3 months.The efficacy of the three groups of patients were compared after 12 weeks of treatment,as well as the scores of symptoms,the mechanical properties of the lumbar extensor muscle group before and 12 weeks after treatment,and the Visual Analog Scale(VAS),Japanese Orthopaedic Association(JOA)score,and Oswestry Disability Index(ODI)before treatment,at 1 week,4 weeks,and 12 weeks after treatment,as well as during follow-up.The safety of the three groups of patients during the treatment period was observed. Results After 12 weeks of treatment, the excellentand good rate in the combined group was 90.63%, which was significantly higher than 68.75% in the massagegroup and 65.63% in the decoction group (P<0.05). After 12 weeks of treatment, the scores of symptoms such as backpain, numbness in the lower limbs, and rigidity in the spine in the combined group were significantly lower than those inthe massage group and the decoction group (P<0.05). The ratio of lumbar flexion/extension peak torque in the combinedgroup after 12 weeks of treatment was (64.06±8.08)%, which was significantly lower than (68.62±8.45)% in themassage group and (

关 键 词：腰椎间盘突出症 寒湿型 独活寄生汤 推拿 腰椎功能 疗效 

分 类 号：R681.53[医药卫生—骨科学]