腰椎多方位快速牵引与腰椎纵向牵引临床疗效的对比研究

关键词：临床疗效  牵引  腰椎间盘突出症  疼痛  物理治疗

Keywords:treatment outcome  traction  lumbar disc herniation  pain  physical therapy

摘要：

      目的：本研究的目的是通过与腰椎纵向牵引比较，评价多方位快速牵引的临床疗效。 方法：本研究为前瞻性随机对照研究。120例确诊为腰椎间盘突出症的患者被随机分为2组，分别进行多方位快速牵引和纵向牵引的治疗，在治疗前、治疗后4周和1年后进行活动能力（RMDQ）、疼痛程度（VAS）和直腿抬高试验（SLR angle）检查。RMDQ提高超过3分，VAS提高超过20分，就被认为临床有效。 结果：多方位快速牵引和纵向牵引均可使腰椎间盘突出症患者的RMDQ，VAS和SLR angle评分产生明显的改善(均有P<0.05)，两种方法的改善效果相似(P>0.05)，但前者对活动能力（RMDQ）的改善更明显(P<0.05)。临床疗效与患者的年龄、病程有关，但与突出大小、突出节段和类型的关系不大。所有的患者在治疗1年后症状都没有恶化。 结论：多方位快速牵引可更好的改善患者症状，且疗程短、见效快，是治疗腰椎间盘突出症的一种良好的保守疗法。

Abstract:

      Abstract Objective: To evaluate the clinical effectiveness of multi-directional mechanical traction (MT) for the treatment of patients with lumbar disc herniation (LDH) compared with longitudinal traction (LT) as control. Method: This prospective, single-blind, randomized clinical trial was performed in Qi Lu Hospital, Shandong University from January 2008 to December 2008. One hundred and twenty outpatients with LDH were randomly divided into MT group or LT group. MT group was treated with computer-controlled multi-directional mechanical traction. LT group was treated with longitudinal traction. Roland Morris Low Back Pain and Disability Questionnaire (RMDQ), visual analogue scale (VAS), and straight leg raising (SLR) angle were measured for every patient pre-, 4 weeks post-, and 1 year post-treatment. Result: The results of clinical observations showed significant improvements in RMDQ, VAS, and SLR angle assessments (all P<0.05) in both groups 4 weeks post- and 1 year post-treatment compared with pre-treatment. Score of RMDQ in MT group was significantly lower than that in LT group(P<0.05), however, there was no significant difference between two groups in VAS score and SLR angle (P>0.05). The differences in improvement ratios between two groups were not significant (all P>0.05). The clinical outcomes were negatively correlated with patient's age and disease duration. Conclusion: The effect of MT is equivalent and probably superior to that of LT in improving the symptoms and clinical findings of patients with LDH.