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冲击波对不同类型腰椎间盘突出症的干预研究

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目的 探究冲击波(ESW)对不同类型腰椎间盘突出症(LDH)的干预情况.方法 选取2020年2月-2023年2月在云南中医药大学第三附属医院、云南中医药大学第一附属医院、曲靖市中医医院和宣汉县人民医院4家医院骨伤科收治的LDH患者3 454例.根据患者椎间盘突出的不同类型进行分组,分为中央型组1 231例、旁中央型组1 081例、旁侧型组1 142例,所有患者均接受ESW治疗和功能锻炼指导.比较3组患者治疗前、治疗后2 d、治疗后6 d、治疗结束后的疼痛视觉模拟量表(VAS)评分、日本骨科协会评估(JOA)评分,以及治疗前、治疗结束后炎症指标(IL-6、TNF-α),综合评估ESW对3组患者的干预效果.结果 在一般资料方面,3组患者性别、年龄、病程、节段等比较,差异无统计学意义(P>0.05).在VAS评分方面,3组患者在治疗后2、6 d及治疗结束后,均较治疗前明显下降(P<0.05);在治疗后2 d,3组患者组间比较,中央型组明显低于旁中央型组、旁侧型组(P<0.05);在治疗后6 d及治疗结束后3组患者组间比较,差异无统计学意义(P>0.05).在JOA评分方面,3组患者在治疗后2、6 d及治疗结束后,均较治疗前明显上升(P<0.05);在治疗后2 d,3组患者组间比较,中央型组明显高于旁中央型组、旁侧型组(P<0.05);在治疗后6 d及治疗结束后,3组患者组间比较,差异无统计学意义(P>0.05).炎症指标IL-6、TNF-α,与治疗前比较,3组患者治疗结束后IL-6、TNF-α含量均明显下降(P<0.05);治疗结束后,3组患者组间比较,中央型组IL-6、TNF-α含量明显低于旁中央型组、旁侧型组(P<0.05).结论 ESW对中央型、旁中央型、旁侧型等3种类型LDH均有缓解疼痛、恢复腰椎功能、降低炎症因子等作用,且对中央型LDH表现最为优异,在临床工作中,对于中央型LDH,ESW治疗值得优先推荐.
Effect of Extracorporeal Shock Wave Therapy on Different Types of Lumbar Disc Herniation
Objective To explore the effect of extracorporeal shock wave(ESW)therapy on different types of lumbar disc herniation(LDH).Methods A total of 3,454 patients with LDH admitted to the Department of Orthopedics and Traumatology of the Third Affiliated Hospital of Yunnan University of Traditional Chinese Medicine,the First Affiliated Hospital of Yunnan University of Traditional Chinese Medicine,Qujing Hospital of Traditional Chinese Medicine,Xuanhan County People's Hospital from February 2020 to February 2023 were selected.According to the different types of LDH,the patients were divided into the central disc hernia-tion group(1,231 cases),the paracentral disc herniation group(1,081 cases)and the lateral disc herniation group(1,142 cases).All patients received ESW therapy and functional exercise guidance.The visual analogue scale(VAS)and Japanese Orthopaedic Associ-ation(JOA)scores were compared among the three groups before treatment,on the 2nd and 6th day of treatment,and at the end of treatment.The inflammatory markers(IL-6,TNF-α)were evaluated before and after treatment,and the intervention effects of ESW in the three groups were comprehensively evaluated.Results There was no significant difference in gender,age,course of disease and stage among the three groups(P>0.05).The VAS score of the three groups after 2 and 6 days of treatment and at the end of the treatment period were all significantly lower than those before treatment(P<0.05).After 2 days of treatment,the central disc hernia-tion group had significantly lower score than the paracentral disc herniation group and the lateral disc herniation group,and the dif-ferences were statistically significant P<0.05).However,there was no significant difference among the three groups after 6 days of treatment and at the end of the treatment period(P>0.05).In terms of JOA score,all the three groups showed a significantly higher score after 2 days,6 days,and at the end of the treatment period,than those before treatment and the differences were statistically significant(P<0.05).After 2 days of treatment,the central disc herniation group had significantly higher score than the paracentral disc herniation group and the lateral disc herniation group,and the differences were statistically significant(P<0.05).There was no significant differences among the three groups after 6 days of treatment and at the end of treatment period(P>0.05).In terms of inflammatory markers(IL-6,TNF-α),the level of IL-6 and TNF-α in the three groups after treatment were significantly lower than those before treatment,and the differences were statistically significant(P<0.05);after treatment,the level of IL-6 and TNF-α in the central disc herniation group were significantly lower than those in the paracentral disc herniation group and the lateral disc hernia-tion group,and the differences was statistically significant(P<0.05).Conclusion ESW therapy can relieve pain,restore lumbar function and reduce inflammatory markers in three types of LDH,which are central disc herniation type,paracentral disc herniation type and lateral disc herniation type.It has the most remarkable effect for central LDH.In clinical work,ESW therapy is recommend-ed as a priority for central LDH.

extracorporeal shock wavelumbar disc herniationdifferent typesphysical therapyintervention study

向刚刚、陈建琨、黎太友、许帅、高启龙

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宣汉县人民医院,四川 宣汉 636150

云南中医药大学第三附属医院,云南 昆明 650051

曲靖市中医医院,云南 曲靖 655000

云南中医药大学第一附属医院,云南 昆明 650000

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冲击波 腰椎间盘突出症 不同类型 物理治疗 干预研究

云南省中医(骨伤)临床医学中心建设项目

20210701

2024

康复学报
福建中医药大学

康复学报

CSTPCD
影响因子:0.545
ISSN:2096-0328
年,卷(期):2024.34(1)
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