杠杆定位手法治疗腰椎间盘突出症的疗效观察

《按摩与康复医学》2021年第12卷第1期Chinese Manipulation and Rehabilitation Medicine,2021,Vol.12No.1•43••医学康复•分析对腰椎间盘突出症缓和使用脊柱短杠杆微调手法结合常规西医药物治疗的临床疗效和安全性李明明（佛山市中医院，广东佛山528000）［摘要］目的：分析探讨脊柱短杠杆微调手法结合常规西医药物治疗腰间盘突出症的临床效果以及应用安全性。

方法：选取2017年6月-2019年6月本院收治的腰椎间盘突出症患者110例，采用抽签法将其随机均分为观察组和对照组各55例。

观察组采用脊柱短杠杆微调手法结合常规西医药物疗法，对照组仅给予常规西医药物治疗。

比较两组患者疗效，治疗前后患者疼痛程度、生活质量变化情况；随访6个月，比较不良反应和复发率。

结果：观察组总有效率高于对照组(P<0.05)；治疗后，两组患者的VAS、SF-36评分均较治疗前改善(P<0.05),且观察组治疗后的VAS、SF-36评分显著优于对照组(P<0.05)；治疗及随访期间，两组患者均未发生严重不良反应，观察组中复发率明显低于对照组(P<0.05)0结论：在常规西医药物基础上应用脊柱短杠杆微调手法治疗腰椎间盘突出症操作简便、安全性高，可显著提高临床疗效，积极改善患者疼痛程度，提高生活质量，且有利于降低复发率，有较高推广价值。

［关键词］腰间盘突出；脊柱短杠杆微调手法；西药；疼痛程度；生存质量；安全性［中图分类号1R681.533.1［文献标识码］B［文章编号］1008-1879(2021)01-0043-04DOI:10.19787/j.issn.l008-1879.2021.01.014To Analyze the Clinical Efficacy and Safety of Short Spine Lever Fine-Tuning Combined with Conventional Western Medicine in the Treatment of Lumbar Disc HerniationLI Ming-ming(Foshan Traditional Chinese Medicine Hospital,Foshan Guangdong528000)Abstract Objective:To analyze and discuss the clinical effect and safety of spinal short lever fine-tuning combined with conventional western medicine in the treatment of lumbar disc herniation.Methods:110patients with lumbar disc herniation admitted to our hospital from June2017to June2019were selected and randomly divided into observation group and control group with55cases each by lottery.The observation group was treated with short spine lever fine tuning combined with conventional western medicine therapy,while the control group was treated with conventional western medicine therapy only.The effects of the two groups were compared,and the changes of pain degree and quality of life before and after treatment were compared.The adverse reactions and recurrence rates were compared after6months of follow-up.Results:The total effective rate of control group was higher than that of control group(P<0.05). After treatment,VAS and SF-36scores of patients in both groups were improved compared with those before treatment(P<0.05),and VAS and SF-36scores in the observation group were significantly better than those in the control group(P<0.05).During treatment and follow-up,no serious adverse reactions occurred in the two groups,and the recurrence rate in the observation group was significantly lower than that in the control group(P<0.05).Conclusion:On the basis of conventional western medicine,the application of spine short lever fine tuning technique in the treatment of lumbar disc herniation is easy to operate and safe, which can significantly improve the clinical efficacy,positively improve the pain degree of patients,improve the quality of life,and is beneficial to reduce the recurrence rate,which is of high promotion value.Keywords Lumbar disc prominent;Spinal short lever fine-tuning manipulation;Western medicine;Pain level;Quality of life;Security腰椎间盘突岀症是由外伤或腰椎间盘病变等原因引起的常见骨科疾患，腰椎间盘单纯性突岀也称为纤维破裂髓核突出症⑴。

·临床研究·杠杆定位手法治疗腰椎间盘突出症的临床研究谢云兴１，吕立江２，杜红根１，姚俊丞１（１．浙江省中医院，浙江　杭州　３１０００６；２．浙江中医药大学第三临床医学院，浙江　杭州　３１００５３）摘　要　目的：探讨杠杆定位手法治疗腰椎间盘突出症（ｌｕｍｂａｒｄｉｓｃｈｅｒｎｉａｔｉｏｎ，ＬＤＨ）的临床疗效。

方法：ＬＤＨ患者９３例，随机分为杠杆定位组和腰椎斜扳组。

２组患者均先采用柔筋手法松解肌肉痉挛，然后杠杆定位组采用杠杆定位手法治疗、腰椎斜扳组采用腰椎斜扳手法治疗。

隔天治疗１次，６次为１个疗程，共治疗２个疗程。

分别于治疗前和治疗结束后，采用日本骨科协会（Ｊａｐａ ｎｅｓｅＯｒｔｈｏｐｅｄｉｃＡｓｓｏｃｉａｔｉｏｎ，ＪＯＡ）腰痛评分评价患者腰痛程度，采用Ｏｓｗｅｓｔｒｙ功能障碍指数（Ｏｓｗｅｓｔｒｙｄｉｓａｂｉｌｉｔｙｉｎｄｅｘ，ＯＤＩ）评分评价患者腰椎功能，采用Ｓｅｚｅ氏法测量腰椎曲度值，采用Ｆｅｒｇｕｓｏｎ’ｓ法测量腰骶角；并在治疗结束后，参照《中医病证诊断疗效标准》中ＬＤＨ疗效评价标准评价综合疗效。

对２组患者的评价和测量结果进行比较。

结果：治疗前，２组患者ＪＯＡ腰痛评分比较，差异无统计学意义［（１１．２３±１．４９）分，（１１．１３±１．３４）分，ｔ＝－０．３５４，Ｐ＝０．７２４］；治疗结束后，２组患者ＪＯＡ腰痛评分均较治疗前增加，且杠杆定位组高于腰椎斜扳组［（２１．２９±３．９８）分，（１８．７４±４．２０）分，ｔ＝３．５９０，Ｐ＝０．００１］。

治疗前，２组患者腰部ＯＤＩ评分比较，差异无统计学意义［（４６．１７±２．００）分，（４６．２２±１．８９）分，ｔ＝－０．１１７，Ｐ＝０．９０７］；治疗结束后，２组患者腰部ＯＤＩ评分均较治疗前降低，且杠杆定位组低于腰椎斜扳组［（２０．５５±８．３４）分，（２６．８０±１０．３６）分，ｔ＝－３．２０９，Ｐ＝０．００２］。

腰椎牵引联合杠杆定位手法治疗腰椎间盘突出症的效果
田宗佳
【期刊名称】《医学理论与实践》
【年(卷),期】2024(37)3
【摘要】目的:探讨腰椎牵引联合杠杆定位手法治疗腰椎间盘突出症患者的效果。

方法:选取我院2021年1月—2022年6月120例腰椎间盘突出症患者,按照简单
随机化法分为对照组60例,采用腰椎牵引联合平面用力推拿手法;观察组60例,采
用腰椎牵引治疗联合杠杆定位手法。

观察两组临床疗效、疼痛程度、腰椎功能、表面肌电信号及腰椎活动度。

结果:观察组总有效率高于对照组(P<0.05);治疗后观察
组患者VAS评分较对照组低,JOA评分均较对照组高(P<0.05);治疗后观察组患者
竖脊肌、多裂肌IEMG、RMG、MF高于对照组(P<0.05),腰椎活动度(前屈、后伸、左右侧屈、旋转)均大于对照组(P均<0.05)。

结论:腰椎牵引联合杠杆定位手法治疗腰椎间盘突出症患者可有效提高治疗效果,缓解疼痛,促进腰椎功能恢复,改善核心肌群募集能力与耐疲劳性能,改善腰椎活动度。

【总页数】4页(P426-429)
【作者】田宗佳
【作者单位】湖北省恩施市中心医院骨伤科
【正文语种】中文
【中图分类】R274.34
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2.电针脊神经根外出口联合杠杆定位手法治疗腰椎间盘突出症40例
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2021年2月第23卷第1期February 2021 ,V〇l. 23 ,No. 1湖北中医药大学学报Journal of Hubei University of Chinese Medicine.89•短杠杆手法配合牵引对腰椎间盘突出症患者疼痛、腰椎间孔横径的影响朱干，李明明，陈东军，张盛强，高群兴，彭加友，丁灿群，王旭(广东省佛山市中医院推拿科，广东佛山528000)摘要：目的观察短杠杆手法配合牵引对腰椎间盘突出症患者疼痛、腰椎间孔横径的影响。

方法 将本院收治的90例椎间盘突出症患者随机分为对照组与实验组各45例，对照组采用常规推拿肌肉松解疗法，实验组在对照组治疗基础上加用短杠杆手法配合牵引进行治疗。

比较两组患者治疗前后腰椎影像学参数、腰痛视觉模拟评分（VAS)和Oswestry功能障碍指数（ODI)评分，临床疗效与生活质量结果实验组临床有效率显著高于对照组(f><0.05 );治疗后，两组VAS、OD丨评分均低于治疗前，且实验组VAS、ODI评分均低于对照组(P<0.05 );实验组腰椎间孔前后径、侧隐窝宽度均高于对照组，腰椎间孔横径低于对照组(户<0_05 );实验组生活质量量表(SF-36)评分均高于对照组(P<0.05 )。

结论短杠杆手法配合牵引治疗腰椎间盘突出症患者可有效加快患者腰椎功能恢复，降低VAS和ODI评分，改善腰椎间孔横径和前后径，提高生活质量。

关键词：腰椎间盘突出症;短杠杆手法；牵引；腰椎间孔;视觉模拟评分中图分类号：R274.9 文献标识码：B doi: 10. 3969/j.issn. 1008-987x. 2021.01.24Effects of short lever manipulation combined with traction on pain and lumbar foraminal transverse diameter in patients with lumbar disc herniationZHU Gan,LI Mingming,CHEN Don^jun，ZHANG Shengqiang,GAO Qunxing，PENG Jiayou，DING Canqun，WANG Xu (Department of Massage, Foshan Hospital of Traditional Chinese Medicine of Guangdong Province, Foshan 528000)Abstracts：Objective To observe the effects of short lever manipulation combined with traction on pain and lumbar foraminal transverse diameter in patients with lumbar disc herniation (LDH ). Methods A total of 90 LDH patients were randomly divided into two groups 45 cases in each group.Control group underwent routine massage muscle relaxation therapy, while experimental group was additionally treated with short lever manipulation combined with traction. The lumbar imaging parameters,scores of visual analogue scale ( VAS ) and Oswestry dysfunction index ( ODI),clinical effect and quality of life before and after treatment were compared between the two groups. Results The effective rate of clinical treatment in experimental group was higher than that in control group (P<0.05 )；after treatment, scores of VAS and ODI in both groups were decreased, which were lower in experimental group than control group (P<0.05 )；lumbar foraminal anterior-posterior diameter and lateral recess width in experimental group were higher than those in control group,while lumbar foraminal was lower than that in control group (P<0.05 )； scores of short form 36 health survey ( SF-36 ) in experimental group were higher than those in control group (P<0.05 ). Conclusion Short lever manipulation combined with traction in the treatment of LDH patients can effectively accelerate the recovery of lumbar function, reduce scores of VAS and ODI, improve lumbar foraminal transverse diameter and anterior-posterior diameter, and improve the quality of life.Keywords：lumbar disc herniation；short lever manipulation；traction；lumbar intervertebral foramen；VAS score基金项目：广东省佛山市医学类科技攻关项目（项目编号:AH2018N092 )。