薛俐娴

[摘要] 目的 探討揿针留针候气联合核心肌力训练治疗气滞血瘀型腰椎间盘突出症（LDH）的疗效及安全性。 方法 将2019年3～10月入我院骨伤科门诊就诊的60例气滞血瘀型LDH患者随机分为观察组和对照组，每组30例。对照组接受常规腰椎牵引治疗，观察组接受揿针留针候气联合核心肌力训练治疗，比较两组患者治疗前后日本骨科协会（JOA）评分、视觉模拟评分法（VAS）评分、炎性因子（IL-6、TNF-α、NO）水平和不良反应发生情况。 结果 治疗3周后两组JOA评分均较治疗前升高（P<0.05），且观察组升高更明显（P<0.05）。治疗后两组VAS评分较治疗前下降（P<0.05），观察组评分低于对照组（P<0.05）。治疗后观察组IL-6、TNF-α、NO水平均低于治疗前（P<0.05），且低于同期对照组（P<0.05）。治疗期间两组均未见严重不良反应。 结论 揿针留针候气联合核心肌力训练治疗气滞血瘀型腰椎间盘突出症疗效显著，安全性高。

[关键词] 气滞血瘀;腰椎间盘突出症;揿针;留针候气;核心肌力训练

[中图分类号] R246.9          [文献标识码] B          [文章编号] 1673-9701（2020）17-0096-05

An evaluation of the efficacy of press-needle and prolonged needling for acu-esthesia combined with core muscle strength training against lumbar disc herniation

XUE Lixian

Department of Orthopedics and Traumatology， Yancheng Hospital of Traditional Chinese Medicine in Jiangsu Province， Yancheng   224000， China

[Abstract] Objective To explore the efficacy and safety of press-needle and prolonged needling for acu-esthesia combined with core muscle strength training against lumbar disc herniation（LDH） of qi stagnation and blood stasis type. Methods The 60 LDH patients of qi stagnation and blood stasis type admitted to and treated in the orthopedic clinic of our hospital from March to October 2019 were randomly divided into the observation group and the control group， with 30 patients in each group. The control group received conventional lumbar traction treatment， while the observation group received the treatment of press-needle and prolonged needling for acu-esthesia combined with core muscle strength training. The Japanese orthopedic association（JOA） scores， visual analogue scale（VAS） scores， levels of inflammatory factors（IL-6， TNF-α， NO） and adverse reactions（ADRs） before and after treatment were compared between the two groups. Results After 3 week of treatment， the JOA scores in both groups were higher than those before treatment（P<0.05）， and the increase in the observation group was more obvious（P<0.05）. After treatment， the VAS scores of the two groups decreased when compared with those before treatment（P<0.05）， and the scores of the observation group were lower than those of the control group（P<0.05）. After treatment， the levels of IL-6， TNF-α and NO in the observation group were all lower than those before treatment（P<0.05）， and lower than those in the control group at the same time（P<0.05）. No serious ADR was found in either group during treatment. Conclusion Press-needle and prolonged needling for acu-esthesia combined with core muscle strength training has significant efficacy and sound safety in the treatment of LDH of qi stagnation and blood stasis type.

[Key words] Qi stagnation and blood stasis; Lumbar disc herniation; Press-needle; Prolonged needling for acu-esthesia; Core muscle strength training

腰椎间盘突出症（Lumbar disc herniation，LDH）是骨科常见病，是因腰椎间盘退行性改变或外伤致纤维环破裂、髓核突出进而压迫脊神经或脊髓所引发的一系列症状及体征，近年来其发病有年轻化趋势[1]。患者常有反复腰腿痛发作并朝坐骨神经放射等表现，可致活动受限，影响身体健康[2-3]。中医学认为，腰椎间盘突出症属“腰痛病”、“痹症”范畴，病因主要与外感和内伤有关，风、寒、湿、热等外感诸邪，劳役、跌扑闪挫均可引发腰痛[4]。因气血问题所致腰痛通常体现在两个方面：因外力损伤、不当乏力或跌打损伤致腰椎受损后可造成局部血瘀塞阻筋脉，气无所致、血失其养，进而导致气滞血瘀，不通、不荣则痛;因积劳、年龄增长或长期不良坐立姿势所致劳损造成气血亏虚，气不能推动血运行，最终致气滞血瘀而引发腰痛。作为一种中医辅助治疗技术，揿针疗法缓解疼痛效果显著，可有效缓解LDH急性期患者的疼痛症状[5]。……