青少年腰椎间盘突出症两种中医疗法的比较△

Comparison of two kinds of traditional Chinese medicine therapy for lumbar disc herniation in adolescents

摘要:

[目的] 比较两种中医疗法治疗青少年腰椎间盘突出症 （adolescent lumbar disc herniation, ALDH） 的临床效果。[方法]选取本院 2020 年 2 月—2022 年 3 月就诊的 ALDH 患者 104 例，采用随机数字表法将其分为两组，52 例采用平脊法治疗， 包括优值牵引、中药熏洗、手法松解和脊柱整体手法治疗；另外 52 例采用常规治疗，包括优值牵引、中药熏洗、常规手法治疗。比较两组临床和影像资料。[结果]平脊组临床愈合时间显著早于常规组 [(253.2±26.8) d vs (272.6±29.5) d，P＜0.001]。随访时间平均（15.3±3.7）个月。与治疗前相比，末次随访时，两组腰痛 VAS、腿痛 VAS 评分、ODI 均显著降低（P＜0.05），末次随访时，平脊组腰痛 VAS [(1.5±0.3) vs (2.6±0.5), P＜0.001]、腿痛 VAS 评分 [(1.8±0.4) vs (2.9±0.6), P＜0.001]、ODI [(8.2±1.7) vs (13.6±2.5), P＜0.001] 均显著优于常规组。影像方面，与治疗前相比，末次随访时，两组椎管占位率、T1 骨盆角（thoracic pelvic angle, TPA）、 骨盆倾斜角 （pelvic tilt, PT）、骶骨倾斜角 （sacral slope, SS）、腰椎前凸角 （lumbar lordosis, LL）、胸椎后凸角 （thoracic kyphosis, TK） 均显著改善，末次随访时，平脊组椎管占位率 [(2.0±0.3)% vs (3.5±0.6)%, P＜0.001] 、TPA [(15.3±2.4)° vs (18.6±3.5)°, P＜ 0.001]、PT [(14.2±1.8)° vs (16.7±2.5)°, P＜0.001] 、SS [(29.4±6.1)° vs 25.8±4.9)°, P＜0.001]、LL [(37.6±6.7)° vs (30.5±5.3)°, P＜0.001] 、 TK [(25.9±5.8)° vs (20.3±4.6)°, P＜0.001] 均显著优于常规组。[结论]平脊疗法治疗 ALDH 疗效确切，可改善功能障碍程度，减轻腰痛、腿痛，改善脊柱-骨盆矢状位参数。

Abstract:

[Objective] To compare the clinical outcomes of two kinds of traditional Chinese medicine (TCM) therapy for adolescent lumbar disc herniation (ALDH). [Methods] A total of 104 ALDH patients who underwent non-surgical treatment in our hospital from February 2020 to March 2022 were included into this study, and divided into two groups by random number table method. Of them, 52 patients were treated by Pingji method, including optimal traction, TCM fumigation, manual release and holistic spinal manipulation, while the other 52 patients received conventional treatment, involving optimal traction, TCM fumigation and conventional manual treatment. Clinical and imaging data were compared between the two groups. [Results] The Pingji group got clinical cure significantly earlier than conventional group [(253.2±26.8) d vs (272.6±29.5) d, P＜0.001]. The follow-up period was of (15.3±3.7) months on an average, and lower back pain and leg pain VAS scores, as well as the ODI score in both groups were significantly decreased at the last follow-up compared with those before treatment (P＜0.05). At the last follow-up, the Pingji group was significantly superior to the conventional group in terms of lower back pain VAS [(1.5±0.3) vs (2.6±0.5), P＜0.001], leg pain VAS score [(1.8±0.4) vs (2.9±0.6), P＜0.001] and ODI score [(8.2±1.7) vs (13.6±2.5), P＜0.001]. As for imaging evaluation, the spinal canal occupation rate, T1-pelvic angle (TPA), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), and thoracic kyphosis (TK) were significantly improved at the latest follow-up compared with those before treatment. At the last follow-up, the Pingji group also was significantly better than the conventional group in terms of canal occupying rate [(2.0±0.3)% vs (3.5±0.6)%, P＜0.001], TPA [(15.3±2.4)° vs (18.6±3.5)°, P＜0.001], PT [(14.2±1.8)° vs (16.7±2.5)°, P＜0.001], SS [(29.4±6.1)° vs (25.8±4.9)°, P＜0.001], LL [(37.6±6.7)° vs (30.5±5.3)°, P＜0.001], TK [(25.9±5.8)° vs (20.3±4.6)°, P＜0.001]. [Conclusion] The Pingji therapy is effective in the treatment of AL-DH patients, which can improve the function, reduce back pain and leg pain, and regain the spinopelvic sagittal balance.