针刺治疗腰椎间盘突出症疗效观察

Efficacy observation of acupuncture in treating lumbar disc herniation

关键词:  腰椎间盘突出症  针刺治疗  远道取穴  腰大肌  腰多裂肌

Key words:  lumbar disc herniation  acupuncture therapy  distant point selection  psoas major muscle  lumbar multifidus muscle

摘要:

[目的] 观察针刺双侧带脉配合远道取穴治疗腰椎间盘突出症（LDH）患者腰大肌（PS）与腰多裂肌（MF）横截面面积（CSA）变化情况，评价其疗效。[方法] 研究选取2021年4月—2024年4月自贡市中医医院的110例确诊为LDH患者进行临床研究，采用随机数字表法将患者分为治疗组54例，进行针刺双侧带脉配合远道取穴针刺治疗；对照组56例，采用单纯针刺双侧带脉治疗。采用倾向性评分匹配法进行匹配，最终两组各48例患者。分别在匹配前后对两组患者基本资料进行比较。比较两组患者治疗前后PS与MF的CSA、矢状位参数。对符合正态分布且满足方差齐性的重复测量疗效指标进行分析。采用单因素重复测量方差分析方法，判断治疗6周对LDH患者PS与MF的疼痛视觉模拟评分（VAS）及矢状位参数影响。比较治疗前及治疗期间患者的VAS、功能障碍指数问卷表（ODI）评分。分层交互检验作用分析治疗前后PS与MF的CSA变化及VAS、ODI评分之间的关系。对两组患者进行疗效有效性评价。以对照组患者为参照，对治疗组不良事件进行Log-binomial模型回归分析。[结果] 治疗6周后，两组患者PS、MF的CSA及矢状位参数比较，差异具有统计学意义（P<0.05）。两组患者PS与MF的CSA及矢状位参数在时间效应方面比较，差异有统计学意义（P<0.05）。两组患者PS与MF的CSA及腰椎前凸角（LL）、骶骨倾斜角（SS）在组间效应、交互效应方面比较，差异有统计学意义（P<0.05）。治疗6周后，两组患者VAS、ODI评分比较，差异具有统计学意义（P<0.05）。治疗前后PS与MF的CSA变化与VAS、ODI评分具有相关性。治疗组的治疗有效性高于对照组，差异具有统计学意义（P<0.05）。对照组患者不良事件发生率为10.42%，治疗组患者不良事件发生率为4.17%，差异无统计学意义（P>0.05）。[结论] 针刺双侧带脉配合远道取穴针刺能够显著改善LDH患者PS与MF的CSA，提高患者腰椎稳定性，减轻患者痛苦。

Abstract:

[Objective] To observe the changes in the cross-sectional area（CSA） of the psoas major（PS） and lumbar multifidus（MF） muscles in patients with lumbar disc herniation（LDH） treated with acupuncture at bilateral Daimai（Belt Vessel） combined with distant point selection，and to evaluate its efficacy. [Methods] Total of 110 patients diagnosed with LDH at Zigong Hospital of Traditional Chinese Medicine from April 2021 to April 2024 were selected for this clinical study. Patients were randomly divided into a treatment group（n=54） receiving acupuncture at bilateral Daimai combined with distant point selection，and a control group（n=56） receiving acupuncture at bilateral Daimai alone. After propensity score matching，each group consisted of 48 patients. Basic characteristics were compared between the two groups before and after matching. The CSA and sagittal parameters of the PS and MF muscles before and after treatment were compared between the two groups. Repeated measures efficacy indicators conforming to normal distribution and homogeneity of variance were analyzed. One-way repeated measures analysis of variance（ANOVA） was used to determine the effect of 6 weeks of treatment on the CSA and sagittal parameters of the PS and MF muscles in LDH patients. The Visual Analogue Scale（VAS） and Oswestry Disability Index（ODI） scores were compared before and during treatment. Hierarchical interaction analysis was performed to examine the relationship between changes in PS and MF muscle CSA and VAS and ODI scores before and after treatment. The therapeutic effectiveness of the two groups was evaluated. With the control group as reference，a Log-binomial model regression analysis was conducted on adverse events in the treatment group. [Results] After 6 weeks of treatment，the differences in PS and MF muscle CSA and sagittal parameters between the two groups were statistically significant（P<0.05）. Significant differences were observed in the time effect of PS and MF muscle CSA and sagittal parameters between the two groups（P<0.05）. Significant differences were also found in the between-group effects and interaction effects for PS and MF muscle CSA，lumbar lordosis（LL），and sacral slope（SS）（P<0.05）. After 6 weeks of treatment，the differences in VAS and ODI scores between the two groups were statistically significant（P<0.05）. Changes in PS and MF muscle CSA before and after treatment were correlated with VAS and ODI scores. The treatment effectiveness of the treatment group was significantly higher than that of the control group（P<0.05）. The incidence of adverse events was 10.42% in the control group and 4.17% in the treatment group，with no statistically significant difference between the two groups（P>0.05）. [Conclusion] Acupuncture at bilateral Daimai combined with distant point selection can significantly improve the CSA of the PS and MF muscles in LDH patients，enhance lumbar stability，and alleviate pain.