补肾壮筋汤合腰椎小关节松解治疗脊神经后支源性下腰痛的疗效观察

发布时间：2018-05-14 02:21

本文选题：补肾壮筋汤 + 腰椎小关节松解术　；参考：《湖北中医药大学》2016年硕士论文

【摘要】：目的比较腰椎小关节松解与补肾壮筋汤配合腰椎小关节松解治疗脊神经后支源性下腰痛的疗效差异,以探讨补肾壮筋汤配合腰椎小关节松解治疗的优越性,为选择最合适的脊神经后支源性下腰痛治疗方案提供理论依据;同时对腰椎小关节松解的操作过程进行回顾,总结腰椎小关节松解的操作技巧。方法收集湖北省中医院骨科住院部2014年5月至2015年10月经同一组骨科医师收治的腰痛患者,符合病例诊断标准的脊神经后支源性下腰痛患者有65例,随访成功的患者有50例:其中行腰椎小关节松解、超短波及配合锻炼腰背部肌肉治疗的患者有25例(称为对照组);行腰椎小关节松解、口服中草药辩证方、超短波及配合锻炼腰背部肌肉共同治疗的患者有25例(称为治疗组),对这两组共50名病人进行回顾性分析。用统计学方法对两组患者在住院治疗前、后分别填写的JOA评分表,进行的VAS评分,和治疗后3个月随访所获得的分值进行计算,分析经不同治疗后的疗效区别;同时通过回顾50例腰椎小关节松解的操作过程,体会和归纳总结该松解手法的操作技巧。结果两组患者在年龄和性别方面有比较意义,治疗前二者疼痛和功能障碍评分,经统计学计算,均有P0.05,无显著差别,有可比性;在治疗2周后两组分别与其治疗前比较VAS评分明显下降、JOA评分明显上升,提示了采取腰椎小关节松解、超短波及锻炼腰背肌和较对照组加用经中医辩证加减的补肾壮筋汤两种方式在治疗脊神经后支源性下腰痛时,均可以明显减轻患者疼痛和改善功能活动;所有病人3个月后随访发现,与治疗前相比VAS评分均减少、JOA评分均提高,同时还发现加用经中医辩证加减的补肾壮筋汤组的患者VAS评分相比于对照组减少的多一些,JOA评分在生理功能、疼痛、健康自评、活力、社会功能等5个项目得分均高于对照组。结论单纯运用腰椎小关节松解配合理疗及锻炼腰背肌和在运用对照组治疗的同时加以口服经中医辩证加减的补肾壮筋汤两种治疗方式均可在近期内明显改善脊神经后支源性下腰痛患者的疼痛、功能活动及生活质量,但治疗组疼痛程度较对照组减轻的多。同时运用补肾壮筋汤配合腰椎小关节松解治疗脊神经后支源性下腰痛对患者远期(治疗后3个月)的疼痛缓解和功能、生活质量等方面均优于对照组。通过观察、体会、总结腰椎小关节松解手法操作技巧,从而指导临床操作。腰椎小关节松解手法具有操作精准、简洁,微创,康复快,耗时短,低费用,副作用小等优点,值得推广应用。
[Abstract]:Objective to compare the curative effect of lumbar facet joint release and Bushen Zhuangjin decoction combined with lumbar facet joint release in the treatment of low back pain caused by posterior branch of spinal nerve, and to explore the advantages of Bushen Zhuangjin decoction combined with lumbar facet joint release. To provide a theoretical basis for the selection of the most suitable treatment scheme for spinal nerve posterior branch low back pain, and to review the operation process of lumbar facet joint release and summarize the operative skills of lumbar facet joint release. Methods from May 2014 to October 2015, 65 patients with low back pain from the same group of orthopaedic physicians in the Department of Orthopaedics, Hubei traditional Chinese Medicine Hospital, were collected. 50 patients were followed up successfully: among them, 25 patients were treated with lumbar facet joint loosening, ultrashort wave therapy and combined exercise of lumbar back muscles (called control group); Lumbar facet joint release, oral Chinese herbal medicine dialectical prescription, There were 25 cases of ultrashort wave and combined exercise of waist and back muscles (called treatment group). A retrospective analysis was made on 50 patients in these two groups. The JOA scores, the VAS scores and the scores obtained after 3 months follow-up were calculated by statistical method before and after hospitalization, and the difference of curative effect between the two groups was analyzed. At the same time, by reviewing the operation process of 50 cases of lumbar facet joint release, experience and summarize the operation skill of the loosening manipulation. Results there was significant difference in age and sex between the two groups. Before treatment, the scores of pain and dysfunction of the two groups were statistically calculated, there was no significant difference and comparability between the two groups. After 2 weeks of treatment, the VAS scores in the two groups decreased significantly compared with those before treatment, indicating that the lumbar facet joint should be loosened. Ultrashort wave and exercise of psoas dorsalis muscle and compared with control group can obviously relieve the pain and improve the function of the patients when they are treated with Bushen Zhuangjin decoction which is dialectically added and subtracted by traditional Chinese medicine in the treatment of low back pain caused by the posterior branch of the spinal nerve. All the patients were followed up for 3 months. Compared with before treatment, the VAS scores decreased and the VAS scores increased. At the same time, it was also found that the scores of VAS in the group of tonifying kidney Zhuangjin decoction with dialectical addition and subtraction of traditional Chinese medicine were higher than those in the control group in five items: physiological function, pain, health self-evaluation, vitality, social function and so on. Conclusion only using lumbar facet joint loosening combined with physiotherapy and exercise of lumbar dorsal muscles and taking oral tonifying kidney Zhuangjin decoction with traditional Chinese medicine dialectical addition and subtraction can obviously improve Jishen spirit in the near future. Pain in patients with low back pain caused by posterior branches, Functional activities and quality of life, but the pain degree of the treatment group than the control group more alleviated. At the same time, Bushen Zhuangjin decoction combined with lumbar facet joint release to treat spinal nerve posterior branch of low back pain patients long-term (3 months after treatment) pain relief and function, quality of life are better than the control group. Through observation, experience, summary of lumbar facet joint loosening manipulation skills, so as to guide the clinical operation. The loosening manipulation of lumbar facet joint has the advantages of precise operation, simple operation, minimally invasive, quick recovery, short time consuming, low cost, little side effect and so on, so it is worth popularizing and applying.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R274.9

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