摘要
目的 探讨磁共振成像(Magnetic resonance imaging, MRI)参数与气滞血瘀型腰椎间盘突出症(Lumbar disc herniation, LDH)患者椎间盘退变程度的相关性并观察中药膏摩在其中的辅助作用。方法 选取2023年1月—2024年12月在安徽中医药大学第二附属医院就诊的气滞血瘀型LDH患者150例作为研究对象,根据椎间盘退变程度分为轻度退变组(47例)、中度退变组(72例)、重度退变组(31例),对比其MRI参数。根据SAS 9.4软件生成的随机化序列将所有患者分为对照组和研究组,每组各75例。对照组采用牵引疗法治疗,研究组在其基础上实施中药膏摩干预,比较两组患者临床疗效,治疗前后中医证候积分、腰椎功能[日本骨科协会评分(Japanese orthopaedic association, JOA)]及腰椎疼痛[视觉模拟量表(Visuell analog skala, VAS)]、MRI参数。结果 治疗前轻度退变组、中度退变组、重度退变组患者JOA评分、VAS评分及MRI参数比较,差异有统计学意义(P<0.05)。进一步采用Spearman相关性分析发现,NP区T2值与椎间盘退变程度、VAS评分呈负相关(r=-0.712、-0.369),与JOA评分呈正相关(r=0.361);AF区T2值与椎间盘退变程度、VAS评分呈负相关(r=-0.600、-0.320),与JOA评分呈正相关(r=0.349),差异有统计学意义(P<0.05)。治疗后研究组临床总有效率98.67%(74/75)高于对照组89.33%(67/75),差异有统计学意义(P<0.05)。治疗后两组患者腰部刺痛、腰部板硬积分较治疗前降低,差异有统计学意义(P<0.05);且研究组中医证候积分明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者JOA评分较治疗前升高,VAS评分较治疗前降低,差异有统计学意义(P<0.05);且研究组JOA评分高于对照组,VAS评分低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者NP区T2值、AF区T2值较治疗前降低,差异有统计学意义(P<0.05);且研究组NP区T2值、AF区T2值均低于对照组,差异有统计学意义(P<0.05)。结论 MRI参数与气滞血瘀型LDH患者椎间盘退变程度密切相关,进一步实施中药膏摩可以促进临床疗效,降低中医证候积分,改善腰椎功能。
Objective To explore the correlation between magnetic resonance imaging(MRI)parameters and the degree of disc degeneration in patients with lumbar disc herniation(LDH)of qi stagnation and blood stasis type,and to observe the auxiliary effect of traditional Chinese medicine(TCM)ointment massage therein.Methods A total of 150 LDH patients of qi stagnation and blood stasis type treated at the Second Affiliated Hospital of Anhui University of Chinese Medicine from January 2023 to December 2024 were selected as the research subjects and divided into a mild degeneration group(47 cases),a moderate degeneration group(72 cases),and a severe degeneration group(31 cases)according to the degree of disc degeneration,with MRI parameters compared.All patients were divided into a control group and a study group according to the randomized sequence generated by SAS 9. 4 software,with 75 cases in each group. Both groups received traction therapy,and the study group additionally received TCM ointment massage intervention. After treatment,the clinical efficacy was compared between the two groups,as well as the following aspects before and after treatment:TCM syndrome score,lumbar function[Japanese Orthopaedic Association(JOA)],lumbar pain[visuell analog skala(VAS)],and MRI pa rameters. Results Before treatment,there were statistically significant differences in the JOA scores and VAS scores in the three groups compared by MRI parameters(P < 0. 05). It was further found by Spearman correlation that T2 value in the nucleus pulposus(NP)region was negatively correlated with the degree of disc degeneration and VAS score(r = - 0. 712, - 0. 369),and positively correlated with JOA score(r = 0. 361). T2 value in the annulus fibrous(AF)area was negatively correlated with the degree of disc degeneration and VAS score(r = - 0. 600,- 0. 320),and positively correlated with JOA score(r = 0. 349)(P < 0. 05). After treatment,the total clinical effective rate of the study group was 98. 67%(74 / 75), which was higher than the control group(89. 33% 67 / 75)(P < 0. 05). The scores of lumbar stabbing pain and lumbar stiffness were decreased in both groups(P < 0. 05),with the above TCM syndrome scores being significantly lower in the study group(P < 0. 05). The JOA scores were increased in both groups,and the VAS scores were decreased(P < 0. 05), with the above changes being more significant in the study group(P < 0. 05). T2 values in the NP and AF regions were de creased in both groups(P < 0. 05),with the values being significantly lower in the study group(P < 0. 05). Conclusion MRI parameters are closely related to the degree of disc degeneration in LDH patients of qi stagnation and blood stasis types. Further implementation of TCM ointment massage can promote clinical efficacy and reduce the TCM syndrome score, improving lumbar spine function.
作者
张亚平
朱俊琛
侯倩雯
叶子璇
王怀泽
ZHANG Ya-ping;ZHU Jun-chen;HOU Qian-wen;YE Zi-xuan;WANG Huai-ze(The Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine,Hefei Anhui 230061)
出处
《世界中西医结合杂志》
2025年第10期2042-2047,共6页
World Journal of Integrated Traditional and Western Medicine
基金
安徽省中医药传承创新科研项目(2022CCZC02)
长三角名中医工作室(詹红生工作室)(皖中医药发展秘(2023)16号)
安徽“十四五”省级中医优势特色专科(皖中医药服务秘[2021]71号)。
关键词
磁共振成像
气滞血瘀型
腰椎间盘突出
椎间盘退变
中药膏摩
Magnetic Resonance Imaging
Qi Stagnation and Blood Stasis Type
Lumbar Disc Herniation
Degree of Disc Degeneration
Traditional Chinese Medicine Ointment Massage
