本文關(guān)鍵詞：馮氏脊柱手法治療腰椎間盤突出癥的隨機對照臨床研究　出處：《中國中醫(yī)科學(xué)院》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 腰椎間盤突出癥 馮氏脊柱手法 ODI功能障礙指數(shù) 核磁共振

【摘要】：目的：數(shù)千年來,脊柱手法治療腰椎間盤突出癥(LDH)療效明顯,但很難在隨機對照臨床研究中得到證實。本實驗中,作者嘗試設(shè)計了隨機對照臨床研究方案,探討脊柱手法治療腰椎間盤突出癥患者的臨床意義。方法：收集178例腰椎間盤突出癥患者的臨床資料并隨機分成觀察組(89例)和對照組(87例),其中觀察組(3例)和對照組(15例)因放棄治療或選擇手術(shù)等原因未能完成實驗。所有入選患者,均經(jīng)影像學(xué)明確證實存在腰椎間盤突出,且臨床上有腰部疼痛和相應(yīng)神經(jīng)反射區(qū)域的放射痛。所有患者均給予臥床休息、脫水、消炎鎮(zhèn)痛等常規(guī)保守治療。觀察組接受糾正“骨錯縫”的馮氏脊柱手法。對照組則接受由同一醫(yī)生施予模擬馮氏手法的脊柱安慰手法。觀察如下指標(biāo)：①對治療前后(1D、20D)觀察組和對照組分別進行癥狀學(xué)評價(Oswestry腰及下肢功能障礙調(diào)查表即ODI指數(shù))、神經(jīng)根刺激體征(RS值)和結(jié)構(gòu)力學(xué)紊亂體征(PS值)等的量化評分。②用腰椎MRI檢查對治療前后兩組突出間盤形態(tài)的量化觀察。結(jié)果：兩組患者在20天治療后癥狀、0DI指數(shù)、RS值和PS值均有一定程度的改善.但觀察組治療后數(shù)值明顯優(yōu)于對照組ODI (t=-3.51, p=0.00**) RS (t=-2.89, p=0.02*);治療前后差值的比較中,觀察組明顯優(yōu)于對照組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,通過治療前后影像學(xué)對比,突出髓核”形態(tài)及結(jié)構(gòu)指標(biāo)變化無統(tǒng)計學(xué)意義。結(jié)論：馮氏脊柱手法對腰椎間盤突出癥緩解癥狀具有肯定的促進作用。但患者癥狀改變與“突出髓核”形態(tài)及結(jié)構(gòu)學(xué)變化并無顯著相關(guān)性,從而進一步證明,保守治療的重點應(yīng)從突出髓核轉(zhuǎn)移到恢復(fù)脊柱功能和建立代償平衡。
[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.

【學(xué)位授予單位】：中國中醫(yī)科學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R244.1

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