基于专家调查的推拿联合易筋经干预腰椎间盘突出症临床方案  

Treatment Protocol of Lumbar Disc Herniation with Tuina Combined with Yijinjing Based on Expert Survey

作　　者：郭蕾 王程 周鑫[3,4] 田育魁 摆雪 朱清广 房敏[4,5] 刘俊昌[1] GUO Lei;WANG Cheng;ZHOU Xin;TIAN Yukui;BAI Xue;ZHU Qingguang;FANG Min;LIU Junchang(Xinjiang Medical University,Urumqi,Xinjiang 830017,China;Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830054,China;Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China;Tuina Research Institute,Shanghai Research Institute of Traditional Chinese Medicine,Shanghai 200437,China;Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China)

机构地区：[1]新疆医科大学,新疆乌鲁木齐830017 [2]新疆医科大学附属中医医院,新疆乌鲁木齐830054 [3]上海中医药大学附属岳阳中西医结合医院,上海200437 [4]上海市中医药研究院推拿研究所,上海200437 [5]上海中医药大学附属曙光医院,上海200437

出　　处：《康复学报》2025年第2期176-182,189,共8页Rehabilitation Medicine

基　　金：新疆维吾尔自治区“天山英才”培养计划科技创新团队计划项目(2022TSYCTD0008);新疆维吾尔自治区重点研发项目(2022B03011-3);新疆医科大学研究生创新创业项目(CXCY 2024003);国家中医药管理局高水平中医药重点学科建设项目(ZYYZDXK-2023061)。

摘　　要：目的基于专家问卷调查法构建推拿联合易筋经干预腰椎间盘突出症(LDH)临床方案。方法在文献调研的基础上制订了专家函询问卷。采用德尔菲法对推拿联合易筋经干预LDH的临床方案进行2轮专家咨询,通过问卷回收率、专家权威系数(Cr)等指标分析专家的积极性和权威性;通过条目的均数(M)、标准差(S)、满分比(K)分析专家对指标体系意见的集中程度;采用变异系数(CV)和肯德尔协调系数(Kendall's W)评估专家评分的变异程度及评价意见的协调一致性。采用复合决策机制(同时满足M<4分、K<0.8、CV>0.25条件的指标予以删除,综合考虑专家的删除意见)构建推拿联合易筋经干预腰椎间盘突出症的临床方案。结果2轮专家咨询问卷回收率100%;专家权威系数分别为0.73、0.82;最终形成的问卷条目M值4.42~4.87,K值0.54~0.88,CV值0.07~0.16;Kendall's W从第1轮0.331、0.567,提升至第2轮0.504、0.695。推拿联合易筋经干预LDH临床方案要求推拿时医师需保持精神专注,对腰、髋和臀部进行整体治疗;易筋经应着重练习掌托天门、倒拽九牛尾、九鬼拔马刀、青龙探爪、卧虎扑食5个核心动作,至少1次/d,10~15 min/次,持续4周,练习时要配合调息、调神、调心。结论推拿联合易筋经干预LDH临床方案可为临床规范化治疗LDH提供参考。Objective To construct a clinical protocol for the intervention of lumbar disc herniation(LDH)with Tuina combined with Yijinjing based on expert questionnaire survey.Methods An expert consultation questionnaire was developed based on literature research.The Delphi method was used to conduct two rounds of expert consultations on the clinical protocol for the intervention of LDH with Tuina combined with Yijinjing.The participation and authority of experts were analyzed through indicators such as questionnaire response rate and expert authority coefficient(Cr).The concentration of expert opinions on the indicator system was analyzed through the mean(M),standard deviation(S),and full-mark ratio(K)of the items.The coefficient of variation(CV)and Kendall's harmony coefficient(Kendall's W)were used to evaluate the variation degree of expert scores and the coordination and consistency of evaluation opinions.The clinical protocol was constructed using a comprehensive decision-making mechanism:(1)indicators that simultaneously satisfy the conditions of M<4 points,K<0.8,and CV>0.25 were deleted;(2)integrating expert opinions for item removal.Finally,a clinical protocol combining Tuina and Yijinjing for the intervention of LDH was formed.Results Expert consultation data showed a 100%questionnaire response rate in both rounds;the expert authority coefficients were 0.73 and 0.82,respectively.The final M values of the items after two rounds ranged from 4.42 to 4.87,with K values ranging from 0.54 to 0.88 and CV values ranging from 0.07 to 0.16.Kendall's W increased from 0.331 and 0.567 in the first round to 0.504 and 0.695 in the second round.The clinical protocol for the intervention of LDH with Tuina combined with Yijinjing requires the physician to maintain mental focus during Tuina and perform holistic treatment on the waist,hips,and buttocks;Yijinjing should focus on practicing five core movements,including holding the heavens with palms,pulling nine cow tails backwards,pulling nine horse knives like a ghost,grasping with

关 键 词：腰椎间盘突出症 推拿 易筋经 临床方案 德尔菲法 

分 类 号：R244.1[医药卫生—针灸推拿学]