基于络病理论指导的补阳还五汤加味对腰椎间盘突出症术后康复的影响

赵萃; 毕锋莉; 崔静

doi:10.13422/j.cnki.syfjx.20192332

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基于络病理论指导的补阳还五汤加味对腰椎间盘突出症术后康复的影响

临床 | 更新时间：2021-02-09

- 基于络病理论指导的补阳还五汤加味对腰椎间盘突出症术后康复的影响
- Effect of Modified Buyang Huanwu Tang on Patients with Lumbar Disc Herniation After Percutaneous Foramen Endoscopy Based on Collateral Disease Theory
- 中国实验方剂学杂志 2020年26卷第8期页码：124-129
- 作者机构：
  
  滨州医学院　附属医院，山东滨州　 256603
- 作者简介：
  
  [第一作者]　赵萃，主治医师，从事中西医结合的康复临床工作，E-mail：zhaocuibz@163.com
  *崔静，主治医师，从事中西医结合的康复临床工作，E-mail：1320451574@qq.com
- 基金信息：
  
  山东省自然科学基金项目(2017SD0024)
- DOI：10.13422/j.cnki.syfjx.20192332
  中图分类号： R289; R24; R274; R274.9
- 收稿日期：2019-08-23，
  
  网络出版日期：2019-09-25，
  
  纸质出版日期：2020-04-20
- 稿件说明：
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赵萃, 毕锋莉, 崔静. 基于络病理论指导的补阳还五汤加味对腰椎间盘突出症术后康复的影响[J]. 中国实验方剂学杂志, 2020,26(8):124-129.

Cui ZHAO, Feng-li BI, Jing CUI. Effect of Modified Buyang Huanwu Tang on Patients with Lumbar Disc Herniation After Percutaneous Foramen Endoscopy Based on Collateral Disease Theory[J]. Chinese journal of experimental traditional medical formulae, 2020, 26(8): 124-129.
赵萃, 毕锋莉, 崔静. 基于络病理论指导的补阳还五汤加味对腰椎间盘突出症术后康复的影响[J]. 中国实验方剂学杂志, 2020,26(8):124-129. DOI： 10.13422/j.cnki.syfjx.20192332.

Cui ZHAO, Feng-li BI, Jing CUI. Effect of Modified Buyang Huanwu Tang on Patients with Lumbar Disc Herniation After Percutaneous Foramen Endoscopy Based on Collateral Disease Theory[J]. Chinese journal of experimental traditional medical formulae, 2020, 26(8): 124-129. DOI： 10.13422/j.cnki.syfjx.20192332.

摘要

目的：

评价基于络病理论指导的补阳还五汤加味对腰椎间盘突出症(LDH)经皮椎间孔镜(PELD)术后患者的康复效果及对炎症因子和致痛介质的影响。

方法：

将144例患者随机按数字表法分为对照组和观察组各72例。两组患者行PELD治疗，对照组术后给予脱水、抗炎等对症处理。观察组在对照组治疗的基础上给予补阳还五汤加味内服，1剂/d。两组疗程均连续治疗4周，随访12周。记录术前，术后3 d和1，4，16周的疼痛程度视觉模拟评分法(VAS)，记录术前，术后1，4和16周的Oswestry功能障碍指数(ODI)评分；记录术后16周内LDH术后综合征(FBSS)发生情况；进行治疗前后日本骨科协会评估(JOA)和气虚血瘀证评分；检测治疗前后前列腺素E

(PGE

)，血栓素B

(TXB

)，白细胞介素-1

(IL-1

)，肿瘤坏死因子-

(TNF-

)和5-羟色胺(5-HT)水平，采用改良Macnab进行疗效评价。

结果：

观察组在术后3 d和1，4，16周VAS评分均低于同期对照组(

0.01)；观察组在术后1，4和16周ODI评分均低于同期对照组(

0.01)；观察组FBSS发生率18.06%(13/72)，低于对照组的37.5%(27/72)(

＝6.784，

0.01)；观察组患者JOA总分及主观症状、客观体征、日常活动3个因子评分均高于对照组(

0.01)；治疗后观察组气虚血瘀证各症状评分及总分均低于对照组(

0.01)；治疗后观察组TNF-

，IL-1

，PGE

，TXB

，5-HT水平均低于对照组(

0.01)；经秩和检验分析，改良Macnab疗效，观察组优于对照组(

＝2.151，

0.05)。

结论：

基于络病理论下，采用补阳还五汤加味用于腰椎间盘突出症PELD术后患者，可减轻疼痛等症状，促进腰椎功能恢复，抑制炎症因子和致痛介质表达，减轻近期术后残余症状，降低FBSS发生率，促进了术后患者康复，提高了治疗效果。

Abstract

Objective:

To observe the clinical efficacy of modified Buyang Huanwu Tang on patients with lumbar disc herniation (LDH) after percutaneous foramen endoscopy by the collateral disease theory

and its effect on inflammatory factors and pain-inducing mediators.

Method:

One hundred and forty-four patients were randomly divided into control group (72 cases) and observation group (72 cases) by random number table. Both groups’ patients were treated with percutaneous endoscopic lumbar discectomy(PELD)

and symptomatic treatment dehydration and anti-inflammation were also given to those patients after the operation. Patients in observation group got modified Buyang Huanwu Tang

1 dose/day. The course of treatment was 4 weeks

and a 12-week fellow-up was recorded. Before the operation and at the 3

day

the 4

and 16

week after the operation

scores of visual analogue score of pain degree (VAS) were recorded. And before the operation and at the 1

and 16

week after the operation

scores of dysfunction index (ODI) of Oswestry were recorded. Failed back surgery syndrome of LDH was recorded during 16 weeks after the operation. And Japanese orthopaedic association (JOA) and Qi deficiency and blood stasis syndrome were scored. And the levels of prostaglandin E

(PGE

)

thromboxane B

(TXB

)

interleukin-1beta (IL-1beta)

tumor necrosis factor-alpha (TNF-alpha) and serotonin (5-HT) were all detected

and the effect was assessed by improved Macnab.

Result:

At the 1

day and the 1

and 16

week after treatment

scores of VAS were all lower than those in control group (

0.01). And at the 1

and 16

week after treatment

scores of ODI were lower than those in control group (

0.01). The rate of incidence was 18.06%(13/72)

which was lower than 37.5%(27/72) in control group (

=6.784

0.01). Scores of the total JOA and subjective symptoms

objective signs and daily activities were all higher than those in control group (

0.01). And scores of symptom scores and total scores of deficiency and blood stasis syndrome were all lower than those in control group (

0.01). After treatment

levels of TNF-

IL-1

PGE

TXB

and 5-HT were lower than those in control group (

0.01). According to the rank sum test

the effect of modified Macnab was better than that in control group (

=2.151

0.05).

Conclusion:

Based on Luobing theory

modified Buyang Huanwu Tang can alleviate pain and other symptoms

promote the recovery of lumbar vertebral function

inhibit the expressions of inflammatory factors and pain-causing mediators

alleviate the residual symptoms after recent operation

reduce the incidence of FBSS

promote the rehabilitation of patients after operation

and improve the efficacy.

关键词

Keywords

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