袁仕国，邹宇聪，陈超，张志伟，李义凯*

（1.海南省中医院骨伤科，海南海口570203；2.南方医科大学中医药学院中西医结合外科教研室，广东广州510515）

·针推经络·

推拿治疗中老年退行性腰椎侧凸的疗效及与侧凸程度的关系

袁仕国1，2，邹宇聪2，陈超2，张志伟1，李义凯2*

（1.海南省中医院骨伤科，海南海口570203；2.南方医科大学中医药学院中西医结合外科教研室，广东广州510515）

目的分析退行性腰椎侧凸的传统推拿疗效及其与侧凸方向、Cobb角、顶椎位置等的关系。方法中老年DLS患者按侧凸方向、Cobb角、顶椎位置分组，采用相同推拿治疗。分析性别、年龄、腰痛时间及治疗前后疼痛视觉模拟评分（VAS）、汉化Oswestry功能障碍指数（ODI）等差异，及其与Cobb角、侧凸方向和顶椎位置的关系。结果共纳入76例患者，Cobb角（18.30±4.11）°，10°～20°组56例，＞20°组20例；左侧凸44例，右侧凸32例；顶椎位置中，上腰椎31例，下腰椎45例。治疗前后Cobb角差异均无统计学意义（t=1.88，P=0.06），VAS、ODI治疗后均减小（t=24.64、19.37，P＜0.01）。Cobb角与腰痛时间具有相关性（r=0.52，P＜0.01），Cobb角、侧凸方向、顶椎位置与VAS、ODI无明显相关性。结论推拿治疗DLS可缓解疼痛、改善功能，但不能改善Cobb角，侧凸方向、Cobb角、顶椎位置与疗效无关，疼痛时间越长则相应侧凸程度越大。

退行性腰椎侧凸；推拿；疼痛视觉模拟评分；汉化Oswestry功能障碍指数；Cobb角

〔Abstract〕Objective To investigate the efficacy of degenerative lumbar scoliosis and its relationships with scoliosis derection，Cobb's angle，apical vertebral.M ethods The middle-aged and elderly patients with DLS were divided into groups according to scoliosis derection，Cobb's angle，apical vertebral.The gender，age，lumbago time were analyzed.Relationships between location and direction of the apex of curvature，coronal Cobb's angle and VAS，ODI were also analyzed statistically.Results Seventy-six cases were included.The average Cobb's angle was 18.30°±4.11°with 56 cases，10°～20°group with 56 cases，and＞20°group with 20 cases.There were 44 cases with apex of curves on the left side，32 cases on the right side，31 cases in superior lumbar and 45 cases in inferior lumbar.The Cobb's angle was not statistically significant（t=1.88，P=0.06），VAS and ODI were decreased after treatment（t=24.64，19.37，P＜0.01）.Cobb's angle was correlated postively with onset time of pain（r=0.52，P＜0.01），but location and direction of the apex of curvature，coronal Cobb's angle had not significant correlation with VAS and ODI.Conclusion Pain and dysfunction could be released by treatment ofmanipulation，but Cobb's angle can not be improved.Location and direction of the apex of curvature，coronal Cobb's angle had not correlation with efficacy.The greater onset time of pain was with the bigger Cobb's angle.

〔Keywords〕degenerative lumbar scoliosis，manipulation，visual analogue scale，Chinese Oswestry disability index，Cobb's angle

中老年人群退行性腰椎侧凸（degenerative lumbar scoliosis，DLS）发病率高［1］，其被认为是椎间盘、椎间关节、骨质疏松、椎体压缩性骨折等非对称性的退变导致的结果［2-3］，常见的症状是腰痛、腿痛、间歇性跛行等［4］。大部分均采取保守治疗，而传统推拿在治疗腰痛治疗方面发挥了很好的疗效［5-7］。……