冯氏脊柱手法治疗腰椎间盘突出症的随机对照临床研究

发布时间：2018-01-09 07:11

本文关键词：冯氏脊柱手法治疗腰椎间盘突出症的随机对照临床研究　出处：《中国中医科学院》2016年硕士论文　论文类型：学位论文

【摘要】：目的：数千年来,脊柱手法治疗腰椎间盘突出症(LDH)疗效明显,但很难在随机对照临床研究中得到证实。本实验中,作者尝试设计了随机对照临床研究方案,探讨脊柱手法治疗腰椎间盘突出症患者的临床意义。方法：收集178例腰椎间盘突出症患者的临床资料并随机分成观察组(89例)和对照组(87例),其中观察组(3例)和对照组(15例)因放弃治疗或选择手术等原因未能完成实验。所有入选患者,均经影像学明确证实存在腰椎间盘突出,且临床上有腰部疼痛和相应神经反射区域的放射痛。所有患者均给予卧床休息、脱水、消炎镇痛等常规保守治疗。观察组接受纠正“骨错缝”的冯氏脊柱手法。对照组则接受由同一医生施予模拟冯氏手法的脊柱安慰手法。观察如下指标：①对治疗前后(1D、20D)观察组和对照组分别进行症状学评价(Oswestry腰及下肢功能障碍调查表即ODI指数)、神经根刺激体征(RS值)和结构力学紊乱体征(PS值)等的量化评分。②用腰椎MRI检查对治疗前后两组突出间盘形态的量化观察。结果：两组患者在20天治疗后症状、0DI指数、RS值和PS值均有一定程度的改善.但观察组治疗后数值明显优于对照组ODI (t=-3.51, p=0.00**) RS (t=-2.89, p=0.02*);治疗前后差值的比较中,观察组明显优于对照组ODI(t=2.45,p=0.02"),RS (t=2.54, p=0.01*) PS (t=2.59, p=0.01*)。另一方面,通过治疗前后影像学对比,突出髓核”形态及结构指标变化无统计学意义。结论：冯氏脊柱手法对腰椎间盘突出症缓解症状具有肯定的促进作用。但患者症状改变与“突出髓核”形态及结构学变化并无显著相关性,从而进一步证明,保守治疗的重点应从突出髓核转移到恢复脊柱功能和建立代偿平衡。
[Abstract]:Objective: for thousands of years, spinal manipulation in the treatment of lumbar disc herniation (LDH) curative effect is obvious, but it is difficult to be confirmed in a randomized controlled clinical study. In this experiment, the author tries to design a randomized controlled clinical study, to investigate the clinical significance of spinal manipulation in the treatment of lumbar disc herniation patients. Methods: clinical the data of 178 cases of patients with lumbar disc herniation were randomly divided into observation group (89 cases) and control group (87 cases), the observation group (3 cases) and control group (15 cases) due to surgical treatment or failed to finish the experiment. The reasons are these patients were confirmed by imaging presence of lumbar disc herniation, and clinical waist pain and corresponding nerve reflex area radiation pain. All patients were treated with bed rest, dehydration, anti-inflammatory and analgesic conventional conservative treatment. The observation group received the correct bone fractures of the spinal manipulation of Feng. As the group was accepted by the same doctor to simulate Feng's manipulation of spinal comfort technique. The following parameters were observed: before and after treatment (1D, 20D) observation group and control group were symptom evaluation (Oswestry waist and lower limb disability questionnaire ODI index), nerve root irritation signs (RS value) and structural mechanics signs of disorder (PS) score etc. using lumbar MRI examination to observe two groups of quantitative intervertebral disc morphology before and after treatment. Results: two groups of patients in the 20 days of symptoms after treatment, 0DI index, RS value and PS value were improved to a certain extent. But the observation group after treatment was significantly higher than the control value group ODI (t=-3.51, p=0.00**) RS (t=-2.89, p=0.02*); the difference between before and after treatment, the observation group was significantly better than the control group (ODI t=2.45, p=0.02), RS (t=2.54, p=0.01*) PS (t=2.59, p=0.01*). On the other hand, through the contrast imaging process before and after the treatment. No significant changes of morphology and structure parameters of nucleus pulposus. Conclusion: the significance of "Feng's spinal manipulation has positive effect on the symptoms of lumbar disc herniation remission. But patients symptoms change with nucleus pulposus" morphology and structure changes have no significant correlation, which further proved that the conservative treatment should focus on nucleus transfer to restore the spinal function and establish the compensation balance.

【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R244.1

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