坐位腰椎旋转复位法治疗退行性腰椎滑脱症的临床研究

发布时间：2017-12-31 14:44

本文关键词：坐位腰椎旋转复位法治疗退行性腰椎滑脱症的临床研究　出处：《北京中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：观察退行性腰椎滑脱症的流行病学特点,研究坐位腰椎旋转复位法治疗退行性腰椎滑脱症的临床疗效,探讨坐位腰椎旋转复位法的操作规范,并进行临床推广应用,为退行性腰椎滑脱症治疗康复一体化方案的建立提供有效的参考。方法：应用大样本多中心随机对照的方法进行临床研究,将535例退行性腰椎滑脱症患者分为两组,其中试验组267例,对照组268例。试验组以坐位腰椎旋转复位法配合腰椎康复操进行治疗,对照组以仰卧位腰椎牵引配合腰围制动的方法进行治疗,每组治疗3周。在病例筛选入组当天、治疗期间及三次随访共12个时间点进行观察,记录JOA腰痛疾患疗效评定标准及腰痛VAS评分等指标,并用SAS统计软件对数据进行分析评价。结果：(1)纳入病例中男性128例,占24.15%,女性402例,占75.85%,女性发病率远高于男性；年龄方面56～60岁患者161例,占30.7%,61-65岁患者150例,占28.6%,即56～65年龄区间患者最多；滑脱椎体L4滑脱317例,占60.2%,L3滑脱108例,占20.5%,L5滑脱83例,占15.7%,以L4滑脱最多；滑脱方向中前滑脱451例,占86.1%,向后滑脱73例,占13.9%,以前滑脱最常见；病程方面1年以内的有211例,占39.9%,1至5年的220例,占41.6%,即病程以0-5年最多。(2)疗程结束试验组262例患者中临床控制74例,显效18例,有效83例,无效87例,总有效率为66.79%,愈显率35.11%；对照组265例患者中临床控制73例,显效17例,有效51例,无效124例,总有效率为53.21%,愈显率33.97%,经秩和检验,有显著的统计学意义,说明在退行性腰椎滑脱症的治疗中坐位腰椎旋转复位法显著优于腰椎牵引疗法。(3)疗程结束和随访6个月时两组间JOA评分比较,经t检验,P0.01,均具有显著的统计学差异,说明坐位腰椎旋转复位法在改善退行性腰椎滑脱症患者的症状体征方面明显优于腰椎牵引法,且中短期疗效稳定。(4)在腰痛症状改善方面,从第5次访视时,两组间腰痛VAS评分开始有差异,说明在第10天左右试验组疼痛改善程度开始优于对照组。在VAS评分减基线的分析中,从访视2-访视9,腰痛VAS评分相对基线的变化值在两组的差异有统计学意义(P0.05)。这种差异在3次随访时也存在(P0.01),证实了坐位腰椎旋转复位法在改善腰痛方面显著优于腰椎牵引疗法。结论：(1)退行性腰椎滑脱症最常见于55～65岁的中老年人群,女性发病率远高于男性,滑脱椎体以L4最多,其次是分别是L3、L5,滑脱方向以前滑脱最常见,且病程以0-5年最常见。(2)疗程结束与随访6个月,坐位腰椎旋转复位法配合腰椎康复操对退行性腰椎滑脱症的疗效均显著优于腰椎牵引配合腰围制动,中短期疗效稳定。(3)坐位腰椎旋转复位法对退行性腰椎滑脱症疗效显著,主要表现在对患者临床症状和体征(JOA评分)的改善方面。
[Abstract]:Objective: to observe the epidemiological characteristics of degenerative lumbar spondylolisthesis, to study the clinical effect of rotatory reduction of lumbar spine in sitting position for degenerative lumbar spondylolisthesis, and to discuss the operation standard of rotatory reduction of lumbar spine in sitting position. In order to provide an effective reference for the establishment of an integrated rehabilitation program for the treatment of degenerative lumbar spondylolisthesis methods: a large sample of multi-center randomized control method was used to carry out clinical research. 535 cases of degenerative lumbar spondylolisthesis were divided into two groups: the experimental group (267 cases) and the control group (268 cases). The control group was treated with lumbar traction in supine position combined with waist circumference immobilization for 3 weeks in each group. 12 time points were observed during treatment and three follow-up visits on the day of selection of cases. The evaluation criteria of JOA low back pain and the VAS score of low back pain were recorded. The data were analyzed and evaluated by SAS software. Results 1) 128 male patients were included in the study. The incidence rate of female was much higher than that of male. There were 161 patients aged 56 ~ 60 years old, 150 patients aged from 30.7 to 61-65 years old, accounting for 28.6patients, that is, the most patients in the 56 ~ 65 age range. There were 317 cases of L4 spondylolisthesis, 108 cases of L3 spondylolisthesis, 83 cases of L5 slippage, accounting for 15.7%, the most of which was L4 spondylolisthesis. In the direction of slippage, 451 cases were anterior slippage (86.1%), 73 cases were backward slippage (13.9%). The course of disease within one year there were 211 cases, accounting for 39.9% of 1 to 5 years of 220 cases, accounting for 41.6% cases. That is to say, the course of disease ended with 0-5 years maximum.) in the trial group, 74 cases were clinically controlled, 18 cases were effective, 83 cases were effective, 87 cases were ineffective. The total effective rate was 66.79%. The obvious rate was 35.11%; In the control group, 73 cases were clinically controlled, 17 cases were effective, 51 cases were effective, and 124 cases were ineffective. The total effective rate was 53.21 and the effective rate was 33.97. There was significant statistical significance, indicating that in the treatment of degenerative lumbar spondylolisthesis, the rotatory reduction of lumbar spine in the sitting position was significantly better than that in the treatment of lumbar traction therapy. (3) at the end of the course of treatment and 6 months follow-up, the JOA scores of the two groups were compared. There were significant statistical differences between the two groups by t test (P 0.01), which indicated that the rotation reduction method in the sitting position was superior to the lumbar traction method in improving the symptoms and signs of degenerative lumbar spondylolisthesis. In the aspect of improving the symptoms of low back pain, the VAS score of low back pain between the two groups began to differ from the fifth visit. The results showed that the pain improvement of the trial group was better than that of the control group on the 10th day or so. In the analysis of the baseline of VAS score reduction, from visit 2-9. The difference of VAS score relative to baseline in the two groups was statistically significant (P 0.05). This difference was also found in 3 follow-up visits (P 0.01). It is proved that the rotatory reduction of lumbar vertebrae in sitting position is superior to lumbar traction therapy in improving low back pain. Conclusion: 1) degenerative lumbar spondylolisthesis is most common in the middle and old people aged 55 to 65 years. The incidence of spondylolisthesis in females was much higher than that in males. L4 was the most common type of spondylolisthesis, followed by L3L5, which was the most common in the direction of spondylolisthesis. And the course of disease in 0-5 years the most common course of treatment and follow up for 6 months, sitting lumbar rotation reduction method combined with lumbar rehabilitation exercise in the treatment of degenerative lumbar spondylolisthesis were significantly better than lumbar traction combined with waist immobilization. In the short and medium term, the effect of rotatory reduction of lumbar vertebrae on degenerative lumbar spondylolisthesis was significant, mainly in the improvement of JOA score of clinical symptoms and signs of the patients with degenerative lumbar spondylolisthesis.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R244.1

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