摘要
Objective:To observe the analgesic effect and therapeutic mechanism of the dragon-tiger fight needling method in treating lumbar disc herniation(LDH).Methods:A total of 100 patients with LDH were selected and randomly divided into an observation group and a control group,with 50 patients in each group.Both groups received the same basic treatment of Western medicine.The observation group received additional acupuncture treatment using the dragon-tiger fight needling method,administered once every other day for a consecutive month.Before and after treatment,the serum levels of bradykinin(BK),soluble tumor necrosis factor type 1 receptor(sTNF-R1),α1-acid glycoprotein(α1-AGP),phospholipase A2(PLA2),methionine enkephalin(M-ENK),β-endorphin(β-EP),and 6-keto prostaglandin E1α(6-keto-PGE1α)were measured in both groups.Additionally,the sensory conduction velocities(SCV)of the sural nerve and superficial peroneal nerve,as well as the biomechanical indicators of lumbar muscles(including the lumbar flexion-extension ratio and peak torque and average power in the lumbar extension position)were assessed.The Oswestry disability index(ODI)was evaluated,and traditional Chinese medicine(TCM)symptoms were scored for patients in both groups.After treatment,the clinical efficacy of the two groups was compared.Results:After treatment,the serum levels ofα1-AGP and PLA2 in both groups decreased compared to their respective pre-treatment levels(P<0.05),and the levels in the observation group were lower than those in the control group(P<0.05).The serum levels of sTNF-R1 in both groups increased compared to their respective pre-treatment levels(P<0.05),and the levels in the observation group were higher than those in the control group(P<0.05).The serum levels of 6-keto-PGE1αand BK in both groups decreased significantly compared to their respective pre-treatment levels(P<0.05),and the levels in the observation group were lower than those in the control group(P<0.05).The serum levels of M-ENK andβ-EP in both groups increased compared to their respective pre-treatment levels(P<0.05),and the levels in the observation group were higher than those in the control group(P<0.05).The lumbar flexion-extension ratio in both groups decreased compared to their respective pre-treatment level(P<0.05),and the ratio in the observation group was lower than that in the control group(P<0.05).The peak torque and average power in the lumbar extension position increased in both groups compared to their respective pre-treatment levels(P<0.05),and both values in the observation group were higher than those in the control group(P<0.05).The SCV of the superficial peroneal nerve and sural nerve in both groups increased compared to their respective pre-treatment levels(P<0.05),and the values in the observation group were higher than those in the control group(P<0.05).The ODI and TCM symptom scores in both groups decreased(P<0.05),and the scores in the observation group were lower than those in the control group(P<0.05).Conclusion:Based on Western medicine treatment,acupuncture treatment using the dragon-tiger fight needling method for LDH patients can inhibit inflammatory markers,regulate pain mediator levels,alleviate pain,improve the biomechanical and electromyographic indicators of lumbar extensor muscles,and thus enhance lumbar function and clinical efficacy.
目的:观察龙虎交战针刺法治疗腰椎间盘突出症(LDH)的镇痛效应及疗效机制。方法:选择LDH患者100例,根据随机数字表法分为观察组和对照组,每组50例。两组均接受相同的西医基础治疗;观察组加用龙虎交战手法针刺治疗,隔日治疗1次,连续治疗1个月。治疗前后检测两组患者血清缓激肽(BK)、可溶性肿瘤坏死因子1型受体(sTNF-R1)、α1-酸性糖蛋白(α1-AGP)、磷脂酶A2(PLA2)、甲硫氨酸脑啡肽(M-ENK)、β内啡肽(β-EP)及6-酮前列腺素E1α(6-keto-PGE1α)水平,检测两组腓肠神经及腓浅神经的感觉传导速度(SCV)以及患者腰背肌生物力学指标(包括腰背屈伸比、腰背伸状态下峰力矩和平均功率),进行Oswestry功能障碍指数(ODI)评价及中医症状评分。治疗后比较两组临床疗效。结果:治疗后,两组患者血清α1-AGP及PLA2含量较本组治疗前降低(P<0.05),观察组含量低于对照组(P<0.05);两组患者血清sTNF-R1含量较治疗前升高(P<0.05),观察组含量高于对照组(P<0.05);两组患者血清6-keto-PGE1α及BK含量较治疗前明显降低(P<0.05),观察组含量低于对照组(P<0.05);两组血清M-ENK及β-EP含量较治疗前升高(P<0.05),观察组含量高于对照组(P<0.05);两组患者腰背屈伸比均较本组治疗前降低(P<0.05),观察组低于对照组(P<0.05);两组患者腰背伸状态下峰力矩及平均功率均较治疗前升高(P<0.05),观察组两项值均高于对照组(P<0.05);两组腓浅神经及腓肠神经SCV较治疗前升高(P<0.05),观察组两项值高于对照组(P<0.05);两组ODI及中医症状评分均降低(P<0.05),观察评分低于对照组(P<0.05)。结论:在西医基础治疗基础上加用龙虎交战手法针刺治疗LDH患者可抑制炎症指标,调节疼痛介质水平,缓解疼痛,改善腰背伸肌群生物力学及肌电图指标,提升腰椎功能及临床疗效。
基金
安徽省卫生健康软科学研究项目,No.AHWJ2020a029。
