【作者】 黄庆生；

【导师】 陈国龄；

【作者基本信息】 福建中医学院 ， 中医骨伤科学， 2007， 硕士

【摘要】 目的：通过临床前瞻性研究，来判定腰椎间盘突出症推拿疗效的影响因素并对其进行分析研究，从中找出可能的原因并提出可能的预防措施，为临床在推拿治疗腰椎间盘突出症时提高疗效提供依据。方法：收集2005年11月—2007年02月推拿治疗80例腰椎间盘突出症患者。本组平均年龄40.9岁（20—60岁）。其中男48例，女32例，男女比例1.5：1。腰椎间盘突出间隙：L_3-412例，L_4-535例，L₅—S₁ 33例。腰椎间盘突出类型按CT分型：膨出型：20例，突出型：26例，脱出型：23例，游离型：11例。统计患者病程、临床表现、突出类型、神经根是否受压、侧隐窝是否狭窄、性别、年龄、突出间隙、突出大小等因素，将这9个因素作为自变量，患者疗效作为应变量。先对其进行单因素分析，采用卡方检验或校正的卡方检验；以P＜0.05为差异有显著性。最后将单因素分析证实有显著性的自变量带入二分类Logistic回归模型进行多因素分析。所有数据处理由SPSS12.0统计软件完成。结果：10天为一个疗程，治疗两个疗程。采用改良的Macnab标准进行疗效评估。单因素分析结果表明，病程、临床表现、突出类型、神经根是否受压、侧隐窝是否狭窄与腰椎间盘突出症预后有显著性意义。进一步多因素Logistic回归分析表明病程、临床表现、突出类型是影响推拿疗效的独立危险因素。其中突出类型是最重要的影响因素。（1）病程越长疗效越差（P＜0.05）；（2）JOA评分对疗效影响显著（P＜0.05），评分越低即临床表现越严重疗效就越差。（3）腰椎间盘突出类型对推拿疗效有重要的影响，突出类型的疗效优劣程度依次为：膨出型、突出型、脱出型、游离型。结论：病程、临床表现、突出类型是影响推拿治疗腰椎间盘突出症疗效的独立危险因素。故膨出型、突出型是推拿首选的适应症；脱出型为次选；游离型为不选。病程长、临床表现严重者应当增加治疗疗程。更多还原

【Abstract】 Objectives: To analyze prognostic relative factors affecting the tuina treatment outcomeof lumbar disc herniation so as to establish the theoretic basis for a further improvement ofcurative effect.Methods: A total of 80 patients with lumbar disc herniation admitted from November2005 to February 2007 were collected.There were 48 males and 32 females.The sex ratio was1.5:1. Extruded position distributing:12 cases in the position of lumbar 3 to lumbar 4,35cases in the position of lumbar 4 to lumbar 5, 33 cases in the position of lumbar 5 to sacrum1.Type classified with CT distributing: 20 cases in the bulge type,26 cases in the protrusiontype,23 cases in the extrusion type, 11 cases in the sequestration type. All the clinicalparameters including age,sex,paroxysm process, clinical performance, type of herniation,whether nerve root is pressed or not, whether lateral recess is narrow or not, position ofherniation,and size of herniation were investigated as predictive risk factors. In order to findthe risk factors,the data was dealt with x~2 test and binary logistic, analysis (the parameters withP＜0.05).All of statistic was treated with SPSS 12.0.Results: 10 days was a course of treatment.All the patients were treated 2 course.We useimproved macnabs’ criterion to value curative effect. Univariate analysis demonstrated thatmany factors were significantly correlated with the curative outcome of lumbar discherniation,such as paroxysm process,clinical performance,type of herniation, whether nerveroot is pressed or not,and whether lateral recess is narrow or not.The binary logistic analysisshowed that paroxysm process, clinical performance, and type of herniation were thesignificant independent predictors.Conclusion: Paroxysm process, clinical performance, and type of herniation were thesignificant independent predictors of curative outcome of lumbar disc herniation.So bulge type LDH and protrusion type are the first choice of tuna treatment.The patient of extrusiontype LDH can be treated by tuna. The sequestration type LDH is forbidden to use tuina. Forthe patient of Long paroxysm process or serious clinical performance we must increase thecourse of tuna treatment.更多还原