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[1]王志強(qiáng),林順,朱宇,等.口服益氣活血方為主保炎治療脫出和游離型腰椎間盤突出癥[J].中醫(yī)正骨,2024,36(08):69-72.
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口服益氣活血方為主保炎治療脫出和游離型腰椎間盤突出癥()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期數(shù):
2024年08期
頁碼:
69-72
欄目:
臨床報(bào)道
出版日期:
2024-08-20

文章信息/Info

作者:
王志強(qiáng)林順朱宇俞鵬飛楊柳姜宏劉錦濤李曉春
南京中醫(yī)藥大學(xué)附屬蘇州市中醫(yī)醫(yī)院,江蘇 蘇州 215009
關(guān)鍵詞:
椎間盤移位 腰椎 重吸收 益氣活血方 炎癥保留
摘要:
目的:探討以口服益氣活血方為主保炎治療脫出和游離型腰椎間盤突出癥(lumbar disc herniation,LDH)的臨床療效。方法:2019年1月至2023年1月收治64例LDH患者。男34例,女30例; 年齡20~58歲,中位數(shù)37歲; 中醫(yī)辨證均為血瘀證; 脫出型43例,游離型21例; 牛眼征Ⅰ型25例、Ⅱ型17例、Ⅲ型22例。均采用口服益氣活血方治療,每日1劑,水煎服,早晚飯后分2次服用,4周為1個療程。急性期要求患者絕對臥床休息,同時口服鹽酸乙哌立松片,每次50 mg,每天3次。疼痛無法緩解時,口服鹽酸曲馬多片,每次50 mg。治療期間所有患者均不應(yīng)用非甾體抗炎藥和糖皮質(zhì)激素。選擇日本骨科學(xué)會(Japanese Orthopedic Association,JOA)腰痛評分、腰痛視覺模擬量表(visual analogue scale,VAS)評分、突出物體積、突出物吸收率(吸收率≥30%視為發(fā)生重吸收、吸收率≥50%視為發(fā)生明顯重吸收)作為療效指標(biāo)進(jìn)行療效評價(jià)。結(jié)果:64例患者均按規(guī)定方案完成治療,均未使用非甾體抗炎藥和糖皮質(zhì)激素,治療時間4~16周,中位數(shù)10周。治療開始后6個月,61例患者癥狀明顯緩解,3例患者癥狀緩解不明顯。治療開始后6個月,本組患者JOA腰痛評分較治療前提高[(10.73±2.76)分,(24.11±3.00)分,t=9.230,P=0.017],腰痛VAS評分較治療前降低[(7.30±1.09)分,(2.38±0.92)分,t=15.880,P=0.024],椎間盤突出物體積較治療前減小[(2 194.30±745.71)mm3、(1 083.94±721.58)mm3,t=8.564,P=0.000)]。49例患者(76.56%)發(fā)生重吸收,其中牛眼征Ⅰ型19例、Ⅱ型14例、Ⅲ型16例; 39例患者(60.94%)發(fā)生明顯重吸收,其中牛眼征Ⅰ型18例、Ⅱ型11例、Ⅲ型10例。牛眼征Ⅰ型患者突出物吸收率(61.99±31.66)%,Ⅱ型患者突出物吸收率(62.11±32.85)%,Ⅲ型患者突出物吸收率(39.89±32.01)%。治療后癥狀明顯緩解的61例患者中48例發(fā)生了重吸收,13例未發(fā)生重吸收; 癥狀緩解不明顯的3例患者中1例發(fā)生了明顯重吸收,給予地塞米松、甘露醇對癥治療后癥狀緩解,另外2例最終采用手術(shù)治療。結(jié)論:以口服益氣活血方為主保炎治療脫出和游離型LDH療效確切,保留炎癥有利于突出椎間盤組織的重吸收。

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備注/Memo:
基金項(xiàng)目:國家自然科學(xué)基金項(xiàng)目(82374220,82074467); 江蘇省中醫(yī)藥科技發(fā)展項(xiàng)目(MS2022080); 第三批江蘇省中醫(yī)藥領(lǐng)軍人才項(xiàng)目(蘇中醫(yī)科教〔2023〕17號); 江蘇省科教能力提升工程:江蘇省醫(yī)學(xué)重點(diǎn)學(xué)科和醫(yī)學(xué)重點(diǎn)實(shí)驗(yàn)室建設(shè)項(xiàng)目(蘇衛(wèi)科教〔2022〕9號); 蘇州市2022年度第二十九批科技發(fā)展計(jì)劃(市重點(diǎn)實(shí)驗(yàn)室新建)項(xiàng)目(SZS2022019); 蘇州市科技發(fā)展計(jì)劃項(xiàng)目(SKYD2023151,SKYD2023152); 蘇州市“科教興衛(wèi)”青年科技項(xiàng)目(KJXW2021047)
更新日期/Last Update: 1900-01-01