本文選題：補(bǔ)腎壯筋湯 + 腰椎小關(guān)節(jié)松解術(shù)��； 參考：《湖北中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的比較腰椎小關(guān)節(jié)松解與補(bǔ)腎壯筋湯配合腰椎小關(guān)節(jié)松解治療脊神經(jīng)后支源性下腰痛的療效差異,以探討補(bǔ)腎壯筋湯配合腰椎小關(guān)節(jié)松解治療的優(yōu)越性,為選擇最合適的脊神經(jīng)后支源性下腰痛治療方案提供理論依據(jù);同時(shí)對(duì)腰椎小關(guān)節(jié)松解的操作過(guò)程進(jìn)行回顧,總結(jié)腰椎小關(guān)節(jié)松解的操作技巧。方法收集湖北省中醫(yī)院骨科住院部2014年5月至2015年10月經(jīng)同一組骨科醫(yī)師收治的腰痛患者,符合病例診斷標(biāo)準(zhǔn)的脊神經(jīng)后支源性下腰痛患者有65例,隨訪成功的患者有50例:其中行腰椎小關(guān)節(jié)松解、超短波及配合鍛煉腰背部肌肉治療的患者有25例(稱(chēng)為對(duì)照組);行腰椎小關(guān)節(jié)松解、口服中草藥辯證方、超短波及配合鍛煉腰背部肌肉共同治療的患者有25例(稱(chēng)為治療組),對(duì)這兩組共50名病人進(jìn)行回顧性分析。用統(tǒng)計(jì)學(xué)方法對(duì)兩組患者在住院治療前、后分別填寫(xiě)的JOA評(píng)分表,進(jìn)行的VAS評(píng)分,和治療后3個(gè)月隨訪所獲得的分值進(jìn)行計(jì)算,分析經(jīng)不同治療后的療效區(qū)別;同時(shí)通過(guò)回顧50例腰椎小關(guān)節(jié)松解的操作過(guò)程,體會(huì)和歸納總結(jié)該松解手法的操作技巧。結(jié)果兩組患者在年齡和性別方面有比較意義,治療前二者疼痛和功能障礙評(píng)分,經(jīng)統(tǒng)計(jì)學(xué)計(jì)算,均有P0.05,無(wú)顯著差別,有可比性;在治療2周后兩組分別與其治療前比較VAS評(píng)分明顯下降、JOA評(píng)分明顯上升,提示了采取腰椎小關(guān)節(jié)松解、超短波及鍛煉腰背肌和較對(duì)照組加用經(jīng)中醫(yī)辯證加減的補(bǔ)腎壯筋湯兩種方式在治療脊神經(jīng)后支源性下腰痛時(shí),均可以明顯減輕患者疼痛和改善功能活動(dòng);所有病人3個(gè)月后隨訪發(fā)現(xiàn),與治療前相比VAS評(píng)分均減少、JOA評(píng)分均提高,同時(shí)還發(fā)現(xiàn)加用經(jīng)中醫(yī)辯證加減的補(bǔ)腎壯筋湯組的患者VAS評(píng)分相比于對(duì)照組減少的多一些,JOA評(píng)分在生理功能、疼痛、健康自評(píng)、活力、社會(huì)功能等5個(gè)項(xiàng)目得分均高于對(duì)照組。結(jié)論單純運(yùn)用腰椎小關(guān)節(jié)松解配合理療及鍛煉腰背肌和在運(yùn)用對(duì)照組治療的同時(shí)加以口服經(jīng)中醫(yī)辯證加減的補(bǔ)腎壯筋湯兩種治療方式均可在近期內(nèi)明顯改善脊神經(jīng)后支源性下腰痛患者的疼痛、功能活動(dòng)及生活質(zhì)量,但治療組疼痛程度較對(duì)照組減輕的多。同時(shí)運(yùn)用補(bǔ)腎壯筋湯配合腰椎小關(guān)節(jié)松解治療脊神經(jīng)后支源性下腰痛對(duì)患者遠(yuǎn)期(治療后3個(gè)月)的疼痛緩解和功能、生活質(zhì)量等方面均優(yōu)于對(duì)照組。通過(guò)觀察、體會(huì)、總結(jié)腰椎小關(guān)節(jié)松解手法操作技巧,從而指導(dǎo)臨床操作。腰椎小關(guān)節(jié)松解手法具有操作精準(zhǔn)、簡(jiǎn)潔,微創(chuàng),康復(fù)快,耗時(shí)短,低費(fèi)用,副作用小等優(yōu)點(diǎn),值得推廣應(yīng)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.
【學(xué)位授予單位】：湖北中醫(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)】：R274.9

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