基于LASSO-偏相关分析探讨解结除痹中医外治法对腰椎间盘突出症患者步行生物力学特征的影响  

Exploration on the effects of traditional Chinese medicine external treatment of resolving tendon nodules and arthralgia on walking biomechanical characteristics in patients with lumbar disc herniation based on LASSO-partial correlation analysis

作　　者：姚俊杰 孙明 商强强[2] 常天瀛 孙雅蕙 江晶蕾 吴兴全[2] 丛德毓[2] YAO Junjie;SUN Ming;SHANG Qiangqiang;CHANG Tianying;SUN Yahui;JIANG Jinglei;WU Xingquan;CONG Deyu(College of Acupuncture and Tuina,Changchun University of Chinese Medicine,Changchun 130117,China;Department of Tuina,The Affiliated Hospital of Changchun University of Chinese Medicine,Changchun 130021,China;Evidence-based Medicine Center,The Affiliated Hospital of Changchun University of Chinese Medicine,Changchun 130021,China)

机构地区：[1]长春中医药大学针灸推拿学院,长春130117 [2]长春中医药大学附属医院推拿科,长春130021 [3]长春中医药大学附属医院循证医学中心,长春130021

出　　处：《中华中医药杂志》2025年第2期524-529,共6页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家重点研发计划项目(No.2018YFC1706000);长春中医药大学附属医院基本中医药循证能力建设项目(2024);吉林省中医药科技项目(No.2024038)。

摘　　要：目的:分析解结除痹中医外治法对腰椎间盘突出症(LDH)的临床疗效及步行生物力学特征的影响。方法:纳入2020年1月1日至2023年12月31日就诊于长春中医药大学附属医院推拿科且采用解结除痹中医外治法治疗的70例LDH患者,分析基线资料,治疗前后步行生物力学特征参数、疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)腰痛评分、Oswestry功能障碍指数(ODI),采用LASSO回归及偏相关分析筛选与治疗相关的关键生物力学因素。结果:与治疗前比较,患者治疗后VAS评分和ODI显著降低(P<0.01),JOA评分显著升高(P<0.01),总有效率为87.14%(61/70);步行状态中,部分足底压力有显著变化(P<0.01,P<0.05),部分关节活动度显著降低(P<0.01),部分对称指数升高(P<0.01,P<0.05)。LASSO回归分析中,前后足负荷比与骨盆、髋、膝、踝关节活动度相关[λ=0.3793,log(λ)=-0.9694],大趾负荷比与髋关节活动度相关[λ=0.6143,log(λ)=-0.4873],T2-T5趾负荷比与骨盆、膝关节活动度相关[λ=0.1943,log(λ)=-1.6384],跖骨头Ⅰ负荷比与膝关节活动度相关[λ=0.4464,log(λ)=-0.8065];偏相关分析中,前后足负荷比与髋关节旋转、膝关节内外翻、踝关节屈伸角度呈显著相关性(P<0.05,P<0.01),T2-T5趾负荷比与踝关节旋转角度呈显著正相关(P<0.01),跖骨头Ⅰ负荷比与踝关节旋转角度呈显著负相关(P<0.01)。结论:解结除痹中医外治法可有效缓解LDH患者疼痛和功能障碍,其机制可能与改善关节功能和活动度,优化足底压力分布及其负反馈调节有关。Objective:To analyze the effects of traditional Chinese medicine external treatment of resolving tendon nodules and arthralgia(RTNA)on the clinical efficacy and walking biomechanical characteristics in patients with lumbar disc herniation(LDH).Methods:From January 1,2020 to December 31,2023,70 patients with LDH who were treated with external treatment of RTNA in the Department of Tuina,The Affiliated Hospital of Changchun University of Chinese Medicine were enrolled.Baseline data,biomechanical characteristic parameters of walking before and after treatment,visual analogue scale(VAS)for pain,Japanese Orthopaedic Association(JOA)low back pain score,and Oswestry disability index(ODI)were analyzed.LASSO regression and partial correlation analysis were used to screen the key biomechanical factors related to the treatment.Results:Compared with before treatment,the VAS score and ODI of the patients significantly decreased after treatment(P<0.01),the JOA score significantly increased(P<0.01),and the total effective rate was 87.14%(61/70).In the walking state,part of the plantar pressure was significantly changed(P<0.01,P<0.05),part of the joint range of motion(ROM)was significantly decreased(P<0.01),and the symmetry index was increased(P<0.01,P<0.05).LASSO regression analysis showed that the ratio of forefoot and hindfoot load was correlated with the ROM of the pelvis,hip,knee,and ankle[α=0.3793,log(λ)=-0.9694],and the load ratio of the big toe was correlated with the ROM of the hip[λ=0.6143,log(λ)=-0.4873].The load ratio of toes at T2-T5 was correlated with the ROM of pelvis and knee[λ=0.1943,log(λ)=-1.6384],and the load ratio of metatarsal head I was correlated with the ROM of knee[λ=0.4464,log(λ)=-0.8065].In the partial correlation analysis,the ratio of forefoot and hindfoot load was significantly correlated with hip rotation,knee varus and valgus,and ankle flexion and extension angles(P<0.05,P<0.01).The load ratio of T2-T5 toes was significantly positively correlated with the ankle rotation angle(P<0.01),and

关 键 词：椎间盘突出 生物力学 足底压力 LASSO回归 中医外治法 解结除痹 

分 类 号：R274.9[医药卫生—中西医结合]