【摘要】 目的:通过对腰椎间盘突出症患者保守治疗前后MRI指标和临床表现变化的分析,探讨手法治疗腰椎间盘突出症的机制。方法:自2007年6月至12月,收集70例腰椎间盘突出症患者的临床资料,男40例,女30例;年龄21～56岁,平均39岁。对保守治疗前后进行症状体征(包括直腿抬高角度、视觉疼痛量表VAS值、JOA值)量化评分,对腰椎MRI进行量化测量(包括突出物绝对值D,突出物与神经根管夹角AN值),对两次测量指标结果进行自身配对检验和相关性检验。结果:治疗前后直腿抬高角度SLR(t=12.72705,P<0.0001)、视觉疼痛量表VAS值(t=-23.8799,P<0.0001)、JOA值(t=20.68767,P<0.0001)差异有统计学意义。治疗前后的突出物与神经根管夹角AN值(P>0.05)、突出物绝对值D值(P>0.05)差异无统计学意义。将治疗前后的D值变化与JOA评分差值间进行相关性分析(r=0.00397,P=0.9739>0.05),两者无显著相关性;AN值改变与JOA评分差值间进行相关性分析(r=0.00568,P=0.9628>0.05),两者亦无显著相关性。结论:腰椎间盘突出症手法治疗后,复查MRI发现突出髓核的形状和大小并没有显著变化,与临床症状的改善不平行相关。更多还原

【Abstract】 Objective:To study the correlation between the MRI and some symptom scores of the patients with lumbar disc herniation(LDH),such as VAS(visual analogue scale),JOA(Japanese orthopedic association scale),and SLR(straight leg raising test) before and after manipulative therapy.Methods:From June to December in 2007,70 patients with LDH were selected in the study.Among the patients,40 patients were male and 30 patients were female,ranging in age from 21 to 56 years(averaged 39 years).MRI was used to measure the size and position of the protruded nucleus pulposus(size of disc protrution,the angle between nerve root canal and disc protrution).Correlation study was conducted between the MRI and VAS,JOA,and SLR before and after therapy.The correlation between the changes of MRI and that of the quantified clinical indexes of LDH patients was also analyzed.Results:There were significant differences before and after therapy in some quantified indexes for the clinical manifestation of the patients,such as VAS,JOA,and SLR.There were no significant changes in the shape and size of protrude nucleus pulposus after 20 days’ therapy by CT or MR recheck.Correlation study between the quantified indexes of clinical manifestation(JOA) and MRI before and after the treatment showed that there was no significant correlation.Conclusion:The study proves again that the shape and size of protrude nucleus pulposus has no paralleled relation with the patient’s clinical manifestation,which is demonstrated by the recheck of MRI after a successful spinal manipulative treatment in the study.更多还原