潘宣竹 吕立江 陈家正 李景虎

[摘要] 目的 观察仰卧牵抖法联合针灸治疗老年腰椎间盘突出症的疗效。 方法 将2019年1月～2020年1月在浙江中医药大学附属第三医院推拿科就诊的60例老年腰椎间盘突出症患者用数字表法随机分为观察组和对照组，每组各30例。对照组予常规推拿手法联合针灸治疗，观察组予仰卧牵抖法联合针灸治疗，分析两组患者治疗后的疗效及两组患者治疗前后改良腰椎Oswestry功能障碍指数（ODI评分）、视觉模拟评分（VAS）及安全性。 结果 观察组总有效率为96.67%，明显高于对照组的83.33%（P<0.05）;观察组治疗前后ODI评分分别为18.0（13.5， 25.5）分，7.0（1.0，15.0）分;前后VAS评分分别为6.0（5.0，7.0）分，3.0（1.0，5.0）分。对照组治疗前后ODI评分分别为20.0（14.5，27.0）分，12.0（6.5，18.5）分;前后VAS评分分别为7.0（5.5，7.0）分、4.0（3.0，6.0）分。治疗后两组ODI与VAS评分均低于治疗前（P<0.05），且观察组评分下降幅度较对照组更为显著（P<0.05）。治疗过程中两组患者均未出现不良事件。 结论 仰卧牵抖法联合针灸治疗老年腰椎间盘突出症可有效改善腰椎功能状况，缓解疼痛，值得临床推广应用。

[关键词] 老年腰椎间盘突出症;仰卧牵抖法;推拿手法;针灸;疗效观察

[中图分类号] R274          [文献标识码] B          [文章編号] 1673-9701（2020）34-0137-04

[Abstract] Objective To observe the efficacy of shaking in the supine position combined with acupuncture in the treatment of senile lumbar disc herniation. Methods A total of 60 elderly patients with lumbar disc herniation admitted to the Third Affiliated Hospital of Zhejiang Chinese Medical University from January 2019 to January 2020 were randomly divided into the observation group and the control group by numerical table method， with 30 patients in each group. The control group received conventional massage combined with acupuncture， and the observation group received shaking in the supine position combined with acupuncture. The therapeutic effect of the two groups after treatment and the improved lumbar Oswestry disability index（ODI score） and visual analogue scale（VAS） before and after treatment were observed and analyzed. Results The total effective rate was 96.67% in the observation group， which was significantly higher than 83.33% in the control group（P<0.05）. Before and after treatment， the ODI score of the observation group was 18.0（13.5， 25.5） points and 7.0（1.0， 15.0） points， respectively; the VAS score of the observation group was 6.0（5.0， 7.0） points and 3.0（1.0， 5.0） points respectively; the ODI score of the control group was 20.0（14.5， 27.0） points and 12.0（6.5， 18.5） points， respectively; the VAS score of the control group was 7.0（5.5， 7.0） points and 4.0（3.0， 6.0） points， respectively. After treatment， the ODI and VAS scores of the two groups were lower than those before treatment（P<0.05）， and the score decline of the observation group was more significant than that of the control group（P<0.05）. No adverse events occurred in the two groups during the treatment. Conclusion Shaking in the supine position combined with acupuncture in the treatment of senile lumbar disc herniation is effective to improve the function of the lumbar spine， relieve pain， and is worthy of clinical application.

[Key words] Senile lumbar disc herniation; Shaking in the supine position; Manipulation of the massage; Acupuncture; Clinical observation

腰椎间盘突出症是推拿科的常见疾病，随着年龄的增长腰椎间盘逐渐发生退变，在各种外力作用下导致纤维环破裂，髓核从破裂处突出压迫或刺激神经根引起一系列综合征。临床研究发现[1]，60岁以上的腰椎间盘突出症患者大多伴有骨质疏松或其他基础性疾病，且椎间盘退变严重，椎间隙变窄[2]。患者病程较长，症状复杂，难以耐受手术和大强度的治疗方法[3]。临床上常用的非甾体类消炎镇痛药只能缓解疼痛，不能从根本上解决椎间盘退变和神经根受压的问题。在老年腰椎间盘突出症的保守治疗方法中，推拿联合针灸的疗效得到了广大认可[4]，但考虑推拿手法的临床有效性和安全性，吕立江教授针对老年腰椎间盘突出症的特点，结合腰椎解剖学及腰椎三维力学特征，在传统牵抖手法的基础上创立了仰卧牵抖法[5]，临床疗效显著，可有效改善腰椎间盘突出症患者的症状[6]。……