本文關(guān)鍵詞：坐位腰椎旋轉(zhuǎn)復(fù)位法治療退行性腰椎滑脫癥的臨床研究　出處：《北京中醫(yī)藥大學(xué)》2016年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 退行性腰椎滑脫癥 坐位腰椎旋轉(zhuǎn)復(fù)位法 臨床療效 流行病學(xué)

【摘要】：目的：觀察退行性腰椎滑脫癥的流行病學(xué)特點(diǎn),研究坐位腰椎旋轉(zhuǎn)復(fù)位法治療退行性腰椎滑脫癥的臨床療效,探討坐位腰椎旋轉(zhuǎn)復(fù)位法的操作規(guī)范,并進(jìn)行臨床推廣應(yīng)用,為退行性腰椎滑脫癥治療康復(fù)一體化方案的建立提供有效的參考。方法：應(yīng)用大樣本多中心隨機(jī)對(duì)照的方法進(jìn)行臨床研究,將535例退行性腰椎滑脫癥患者分為兩組,其中試驗(yàn)組267例,對(duì)照組268例。試驗(yàn)組以坐位腰椎旋轉(zhuǎn)復(fù)位法配合腰椎康復(fù)操進(jìn)行治療,對(duì)照組以仰臥位腰椎牽引配合腰圍制動(dòng)的方法進(jìn)行治療,每組治療3周。在病例篩選入組當(dāng)天、治療期間及三次隨訪共12個(gè)時(shí)間點(diǎn)進(jìn)行觀察,記錄JOA腰痛疾患療效評(píng)定標(biāo)準(zhǔn)及腰痛VAS評(píng)分等指標(biāo),并用SAS統(tǒng)計(jì)軟件對(duì)數(shù)據(jù)進(jìn)行分析評(píng)價(jià)。結(jié)果：(1)納入病例中男性128例,占24.15%,女性402例,占75.85%,女性發(fā)病率遠(yuǎn)高于男性；年齡方面56～60歲患者161例,占30.7%,61-65歲患者150例,占28.6%,即56～65年齡區(qū)間患者最多；滑脫椎體L4滑脫317例,占60.2%,L3滑脫108例,占20.5%,L5滑脫83例,占15.7%,以L4滑脫最多；滑脫方向中前滑脫451例,占86.1%,向后滑脫73例,占13.9%,以前滑脫最常見(jiàn)；病程方面1年以?xún)?nèi)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)療程結(jié)束試驗(yàn)組262例患者中臨床控制74例,顯效18例,有效83例,無(wú)效87例,總有效率為66.79%,愈顯率35.11%；對(duì)照組265例患者中臨床控制73例,顯效17例,有效51例,無(wú)效124例,總有效率為53.21%,愈顯率33.97%,經(jīng)秩和檢驗(yàn),有顯著的統(tǒng)計(jì)學(xué)意義,說(shuō)明在退行性腰椎滑脫癥的治療中坐位腰椎旋轉(zhuǎn)復(fù)位法顯著優(yōu)于腰椎牽引療法。(3)療程結(jié)束和隨訪6個(gè)月時(shí)兩組間JOA評(píng)分比較,經(jīng)t檢驗(yàn),P0.01,均具有顯著的統(tǒng)計(jì)學(xué)差異,說(shuō)明坐位腰椎旋轉(zhuǎn)復(fù)位法在改善退行性腰椎滑脫癥患者的癥狀體征方面明顯優(yōu)于腰椎牽引法,且中短期療效穩(wěn)定。(4)在腰痛癥狀改善方面,從第5次訪視時(shí),兩組間腰痛VAS評(píng)分開(kāi)始有差異,說(shuō)明在第10天左右試驗(yàn)組疼痛改善程度開(kāi)始優(yōu)于對(duì)照組。在VAS評(píng)分減基線的分析中,從訪視2-訪視9,腰痛VAS評(píng)分相對(duì)基線的變化值在兩組的差異有統(tǒng)計(jì)學(xué)意義(P0.05)。這種差異在3次隨訪時(shí)也存在(P0.01),證實(shí)了坐位腰椎旋轉(zhuǎn)復(fù)位法在改善腰痛方面顯著優(yōu)于腰椎牽引療法。結(jié)論：(1)退行性腰椎滑脫癥最常見(jiàn)于55～65歲的中老年人群,女性發(fā)病率遠(yuǎn)高于男性,滑脫椎體以L4最多,其次是分別是L3、L5,滑脫方向以前滑脫最常見(jiàn),且病程以0-5年最常見(jiàn)。(2)療程結(jié)束與隨訪6個(gè)月,坐位腰椎旋轉(zhuǎn)復(fù)位法配合腰椎康復(fù)操對(duì)退行性腰椎滑脫癥的療效均顯著優(yōu)于腰椎牽引配合腰圍制動(dòng),中短期療效穩(wěn)定。(3)坐位腰椎旋轉(zhuǎn)復(fù)位法對(duì)退行性腰椎滑脫癥療效顯著,主要表現(xiàn)在對(duì)患者臨床癥狀和體征(JOA評(píng)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.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R244.1

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