正骨手法对伴有骨盆旋转腰椎间盘突出症患者的腰椎-骨盆参数的影响及临床疗效观察  

lumbar spine and pelvis in LDH patients with pelvic rotation and the observation of clinical curative effect

作　　者：周红海[1] 杨钦 何心愉 李东阳 李季霖 陆庆旺 黄杨竣 ZHOU Honghai;YANG Qin;HE Xinyu;LI Dongyang;LI Jilin;LU Qingwang;HUANG Yangjun(College of Bone Injury,Guangxi University of Chinese Medicine,Nanning 530001;The Twelfth Department of Orthopedic,Foshan Hospital of Traditional Chinese Medicine,Foshan 528000)

机构地区：[1]广西中医药大学骨伤学院,南宁530001 [2]佛山市中医院骨十二科,佛山528000

出　　处：《颈腰痛杂志》2025年第2期238-243,共6页The Journal of Cervicodynia and Lumbodynia

基　　金：国家自然科学基金项目(81660800)。

摘　　要：目的观察腰椎坐位定点旋转复位法联合改良骨盆牵引侧推法对伴有骨盆旋转腰椎间盘突出症(LDH)患者的腰椎-骨盆相关参数的影响以及症状、功能的改善。方法选取2020年4月至2021年4月就诊的腰椎间盘突出症患者,通过X线片评估筛选出30例伴有骨盆旋转的腰椎间盘突出症患者作为治疗组,另选取30例正常体检志愿者作为对照组。治疗组给予常规手法松解后,予腰椎坐位定点旋转复位法联合改良骨盆牵引侧推法进行复位;对照组不作任何干预。比较治疗组的治疗前、后与对照组的疼痛视觉模拟评分法(VAS)评分、日本骨科协会评估治疗分数(JOA)评分以及骨盆倾斜角(PI)、骨盆倾斜度(PT)、腰椎前凸角(LL)、骶骨倾斜角(SS)、腰椎冠状面Cobb角、冠状位骨盆倾斜角、左右髋部宽度比率等腰椎-骨盆力学参数的变化。结果纳入对象在治疗前与对照组,在SS、PT、LL、左右髂骨宽度比、冠状位骨盆倾斜角、腰椎Cobb角等腰椎-骨盆参数的差异均具有统计学意义(P<0.05);经治疗后,纳入对象的SS、PT、LL、左右髂骨宽度比、冠状位PT等参数以及JOA评分、VAS评分等疗效评分得到明显改善,差异有统计学意义(P<0.05),相关参数值向正常对照组靠近;PI、腰椎Cobb角等参数差异无统计学意义(P>0.05)。结论与正常志愿者相比,伴有骨盆旋转的LDH患者的PI值更小,SS、LL值也较小,推测PI、LL、SS值较小的人群更易患腰椎间盘突出症;腰椎、骨盆正骨手法联合可以有效改善LDH患者的SS、PT、LL、左右髂骨宽度比、冠状位骨盆倾斜角等参数,并且向正常人相对应的腰椎-骨盆参数靠近,对于重塑腰椎-骨盆生物力学平衡具有一定的临床意义;手法治疗可以在一定程度上改善此类LDH患者的临床症状及日常活动功能。Objective To observe the effect of lumbar spine sitting fixed-point rotation reduction combined with modified pelvic traction lateral push method on the lumbar-pelvic related parameters of patients with lumbar disc herniation(LDH)accompanied by pelvic rotation,as well as the improvement of symptoms and functions.Methods Patients with lumbar disc herniation were selected from April 2020 to April 2021,and 30 patients with lumbar disc herniation accompanied by pelvic rotation through X-ray evaluation were selected as the treatment group.Another 30 normal physical examination volunteers were selected as control group.After the treatment group was given conventional manual relaxation,the lumbar spine seated fixed-point rotation reduction method combined with the modified pelvic traction lateral push method was used for reduction;the control group did not make any intervention.The visual analogue scale(VAS)score,Japanese Orthopaedic Association(JOA)score,pelvic incidence(PI),pelvec tilt(PT),lumbar lordosis(LL),sacral slope(SS),coronal Cobb angle of the lumbar spine,coronal pelvic inclination angle,and left and right hip width ratios of the treatment group before and after treatment were compared with the control group.Results Before treatment,the included subjects had statistically significant differences in lumbar-pelvic parameters such as SS,PT,LL,left and right ilium width ratio,coronal pelvic inclination angle,and lumbar Cobb angle(P<0.05);After treatment,the included subjects’SS,PT,LL,left and right iliac width ratio,coronal pelvic inclination and other parameters,as well as the efficacy scores such as JOA score and VAS score,were significantly improved,and the difference was statistically significant(P<0.05).The parameter values were closer to the normal control group,and there were no statistically significant differences in parameters such as PI and Cobb angle of the lumbar spine(P>0.05).Conclusion Compared with normal volunteers,LDH patients with pelvic rotation have lower PI values,and lower SS and LL value

关 键 词：腰椎间盘突出症 骨盆旋转 腰椎-骨盆参数 生物力学平衡 腰椎旋转复位法 骨盆牵引侧推法 

分 类 号：R274[医药卫生—中医骨伤科学]