四维牵引调曲法治疗退变性腰椎滑脱症的疗效评价

发布时间：2018-04-20 05:29

本文选题：退变性腰椎滑脱症 + 四维牵引　；参考：《广州中医药大学》2016年硕士论文

【摘要】：目的：为了更好地了解退变性腰椎滑脱症(Degenerative lumbar Spondylolisthesis,DLS),本课题总结了中西医在DLS的发病机制及治疗方法方面的研究进展。鉴于目前DLS的发病机制尚未明确,四维牵引调曲法的疗效及治疗机制尚缺乏深入的研究,故本课题通过前瞻性随机对照试验,客观对比四维牵引调曲法与传统骨盆牵引对DLS的治疗效果,为四维牵引调曲法治疗DLS提供科学的应用数据,并明确四维牵引调曲法的治疗特点,探讨四维牵引调曲法的操作规范,以期进一步推广及应用,为临床治疗DLS提供新的方法。方法：本研课题文献研究部分通过回顾近年来相关文献,探讨及总结了中西医对DLS发病机制及治疗的研究进展。临床研究部分为前瞻性随机对照试验,将符合纳入标准的64例DLS患者采用简单随机分组的方式随机分为治疗组(32例)和对照组(32例)。治疗组采用四维牵引调曲法治疗(每周5次,3周为1个疗程),对照组采用骨盆牵引治疗(每周5次,3周为1个疗程)。临床疗效方面,分别比较两组完成治疗时和治疗后3个月的Oswestry功能障碍指数问卷表(Oswestry Disability Index, ODI)、疼痛视觉模拟评分表(Visual Analogue Scales, VAS)的差异；影像学方面,比较两组完成治疗时和治疗后3个月的腰椎滑脱率的差异。结果：治疗组和对照组患者治疗后及治疗后3个月时的ODI评分及VAS评分均较治疗前明显改善(P0.01),而四维牵引调曲法组治疗后、治疗后3个月时的ODI及VAS评分改善程度优于骨盆牵引组(P0.01)。在腰椎滑脱率方面,骨盆牵引组治疗前、治疗后及治疗后3个月时腰椎滑脱率无明显差异(P0.05)；而四维牵引调曲法组治疗后腰椎滑脱率优于治疗后3个月时(P0.01)、治疗后3个月时腰椎滑脱率优于治疗前(P0.05)。结论：四维牵引调曲法较骨盆牵引更有效地改善DLS患者的临床症状,短期疗效较稳定。骨盆牵引在改善症状方面虽有一定治疗效果,但对滑脱腰椎无复位作用；而四维牵引调曲法不仅疗效较好,而且对滑脱椎体有一定的复位作用,短期随访疗效优于治疗前。
[Abstract]:Objective: in order to better understand the degenerative lumbar Spondylolisthesis-DLSs, the research progress in the pathogenesis and treatment of DLS was summarized. In view of the fact that the pathogenesis of DLS is not clear, and the curative effect and therapeutic mechanism of four-dimensional traction modulation method are still lacking, this study has passed a prospective randomized controlled trial. Objective comparison was made between four-dimensional traction and traditional pelvic traction in the treatment of DLS, which provided scientific data for the treatment of DLS with four-dimensional traction, and defined the therapeutic characteristics of four-dimensional traction and warping. To discuss the operation standard of four dimensional traction modulation method in order to popularize and apply it further and provide a new method for clinical treatment of DLS. Methods: in the part of literature research of this subject, the research progress on the pathogenesis and treatment of DLS was discussed and summarized by reviewing the relevant literature in recent years. The clinical study was conducted in a prospective randomized controlled trial. 64 DLS patients who met the inclusion criteria were randomly divided into treatment group (n = 32) and control group (n = 32). The treatment group was treated with four-dimensional traction and moxibustion (5 times a week for 3 weeks as a course of treatment) and the control group was treated with pelvic traction (5 times a week for 3 weeks as a course of treatment). In terms of clinical efficacy, the difference of Oswestry dysfunction index (Oswestry Disability Index), visual analogue scale (VAS), visual Analogue scales (VAS) between the two groups was compared between the two groups at the time of treatment and 3 months after treatment. The rate of lumbar spondylolisthesis was compared between the two groups at the end of treatment and 3 months after treatment. Results: after treatment and 3 months after treatment, the ODI score and VAS score of the patients in the treatment group and the control group were significantly improved compared with those before treatment. The improvement of ODI and VAS scores at 3 months after treatment was better than that in pelvic traction group (P 0.01). In terms of lumbar spondylolisthesis rate, the pelvic traction group before treatment, There was no significant difference in the rate of lumbar spondylolisthesis after treatment and 3 months after treatment, but the rate of lumbar spondylolisthesis in the four-dimensional traction modulation group was better than that in the treatment group at 3 months after treatment and the lumbar spondylolisthesis rate at 3 months after treatment. Conclusion: compared with pelvic traction, four-dimensional traction is more effective in improving the clinical symptoms of DLS patients, and the short-term curative effect is more stable. Although pelvic traction has some therapeutic effect on improving symptoms, it has no reduction effect on lumbar spondylolisthesis, while four-dimensional traction and warping method not only has good effect, but also has certain reduction effect on spondylolisthesis body. The short-term follow-up effect is better than that before treatment.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R274.9

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