【摘要】 目的 ：探讨整腰三步九法结合理疗对退行性腰椎滑脱症（degenerative lumbar spondylolisthesis,DLS）患者的临床疗效及安全性。方法：自2021年1月至2021年12月，纳入72例确诊为DLS的患者，分为整腰三步九法组与骨盆牵引组，每组36例。整腰三步九法组男15例，女21例；年龄54～66(59.07±5.69)岁；病程14～26(20.35±5.66)年；采用整腰三步九法结合低频理疗治疗，每周治疗3次，疗程为4周；骨盆牵引组男12例，女24例；年龄54～66(59.69±5.59)岁；病程13～26(19.74±5.80)年；采用骨盆牵引结合低频理疗治疗。疗效评估采用视觉模拟评分（visual analogur scale,VAS）、Oswestry功能障碍指数（Oswestry disability index,ODI）、日本骨科学会（Japanese Orthopeadic Association,JOA）评分、健康调查简表SF-36在治疗前、治疗2、4周后及治疗结束后8周随访时进行测评，以及对椎旁肌肉的影像学参数在治疗前、治疗完成时进行测评。结果：所有72例患者获得8周随访。治疗结束后8周随访，整腰三步九法组腰痛VAS由治疗前的（6.25±1.23）分下降至（1.25±0.65）分，差异有统计学意义（P<0.05）,ODI由治疗前的（57.17±7.13）%下降至（19.89±5.66）%，差异有统计学意义（P<0.05）,JOA评分和SF-36评分分别由治疗前的（15.46±3.20）分和（35.25±9.28）分提升至（23.75±2.10）分和（62.31±13.03）分，差异有统计学意义（P<0.05）；整腰三步九法组各指标的改善均优于骨盆牵引组（P<0.05），但影像学参数变化不明显（P>0.05）。两组患者的不良反应发生率差异无统计学意义（P>0.05），且未发生严重不良反应事件。结论：整腰三步九法结合理疗治疗DLS疗效肯定，能显著缓解疼痛症状，提升躯体功能，改善患者的生活质量，其效果优于骨盆牵引结合理疗的治疗方法，且安全性较高。但对椎旁肌肉的改善不明显。更多还原

【Abstract】 Objective To explore the clinical efficacy and safety of the "Three-Step Nine-Method Lumbar Correction" combined with physical therapy in the treatment of patients with degenerative lumbar spondylolisthesis(DLS).Methods From January 2021 to December 2021,72 patients diagnosed with DLS were enrolled and divided into the Three-Step Nine-Method Lumbar Correction group and the pelvic traction group,with 36 cases in each group.In the Three-Step NineMethod Lumbar Correction group,there were 15 males and 21 females;aged 54 to 66 years old,with an average of(59.07±5.69) years old;the course of disease was 14 to 26 years old,with an average of(20.35±5.66) years old.They were treated with the Three-Step Nine-Method Lumbar Correction combined with low-frequency physical therapy,3 times a week,for a 4-week course.In the pelvic traction group,there were 12 males and 24 females;aged 54 to 66 years old,with an average of(59.69±5.59) years old;the course of disease was 13 to 26 years old,with an average of(19.74±5.80) years old.They were treated with pelvic traction combined with low-frequency physical therapy.Efficacy evaluation was conducted using the visual analogue scale(VAS),Oswestry disability index(ODI),Japanese Orthopaedic Association(JOA) score,and Short Form36 Health Survey(SF-36) before treatment,after 2 and 4 weeks of treatment,and at the 8-week follow-up after the end of treatment.In addition,imaging parameters of paravertebral muscles were evaluated before treatment and at the completion of treatment.Results All 72 patients completed the follow-up for 8 weeks.At the 8-week follow-up after the end of treatment,in the Three-Step Nine-Method Lumbar Correction group,the VAS score for low back pain decreased from(6.25±1.23)points before treatment to(1.25±0.65) points,with a statistically significant difference(P<0.05);the ODI decreased from(57.17±7.13)% before treatment to(19.89±5.66)%,with a statistically significant difference(P<0.05);the JOA score and SF-36 score increased from(15.46±3.20) points and(35.25±9.28) points before treatment to(23.75±2.10) points and(62.31±13.03) points,respectively,with statistically significant differences(P<0.05).The improvement of each index in the Three-Step Nine-Method Lumbar Correction group was better than that in the pelvic traction group(P<0.05),but the change in imaging parameters was not significant(P>0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05),and no serious adverse events occurred.Conclusion The Three-Step NineMethod Lumbar Correction combined with physical therapy has a definite efficacy in the treatment of DLS.It can significantly relieve pain symptoms,improve physical function and patients’ quality of life.Its effect is better than that of pelvic traction combined with physical therapy,and it has high safety.However,its improvement on paravertebral muscles is not obvious.更多还原