| In nowadays, with quicken pace of our lives and the changes of people's working style, the lumbar disc herniation spondylosis disease was increasing continuously. which has become a modern disease accompanied with the modern society. Prolapse of lumbar intervertebral disc is a common disease in the department of orthopaedics and traumatology, and it's also the most popular reason of lumbago, leg pain. It is commonly occurs in the group of young people, and Male suffer more than female, for the cause of the disease is related to work intensity. In recent years, it has been kept at a high incidence rate, and has brought bad painfulness for patients and side effects for the patients' daily work and life. As one of the most commonly diagnosed vertebrae diseases in orthopedics department in modern society, prolapse of lumbar intervertebral disc has been attached much importance in the medical field, and the clinical treatment research of it has also deepened continuously.In China, this treatment has been popularized in county hospitals. Some data show that the operation rate of prolapse of lumbar intervertebral disc in China is over 82.76% at present. According to some research data, what most of these patients need is expectant treatment, only about 5% of LDH patients have to take operations. Harry B. Skinner still believes that only about 10% of LDH patients need surgical treatment at last. So modern medicine is attaching more and more importance on conservative treatment. It mainly includes the followings,①simply resting on the bed;②manipulation maneuver;③medication, including western medicine for oral use and Chinese traditional categorical identificational (internal and external therapy of TCM syndrome differentiation) endotherapy and external therapy.④acupuncture and moxibustion, acupuncture adopted as main method;⑤lumbar spine traction by instruments;⑥physiotherapy;⑦exercises of lumbar and back muscles and the related rehabilitation;⑧combined therapy of the upper ways. Among the above, manipulation therapy is a widely used and reliable clinical remedy at present. The TCM manuever of fractures and wounds is the character of department of orthopaedics and traumatology. It has obvious advantages in the treatment of lumbar disc hemiation and usually take effect right at once, faster than medication. But sub-standards operations cause harmful results, which seriously affected the clinical application and spreading of the TCM manuever of fractures and wounds. Surgical treatment is usually used in the treatment of central type lumber disk hemiation, including minimally invasive and open surgery . Unnecessary details will not be mentioned here. Clinical studies show that the disease could be remitted or cured by expectant treatment. Therefore, the expectant treatment for LDH is used widely at clinic. Abroad scholars give latest summary of choosing remedy for LDH according to evidence-based medicine. They conclude that 6 weeks' expectant treatment should be given at first no matter what type the disease is. If the expectant treatment has no effect, consider surgical treatment.Chinese traditional bone therapeutics, as one of the effective way to cure prolapse of lumbar intervertebral disc, gained the certification of the entire medicine field. The advantages of manipulation are little pain, no injure, low costs, and high safety and certain effect, which can be characterized as "simple, convenient, effective and cheap".However, as the common Chinese traditional bone therapeutics itself, it divided into many different schools. Doctors in different hospitals treat the patients according to their own experiences, lacking of systematicness, normalization and rarely get the expected result, although they have different features and sometimes have certain curative effect. This is the main reason that modern medicine doubts about the effect of traditional bone therapeutics sometimes. What's more, many operations at clinical are not canonical, and Reports of iatrogenic injuries are of common occurrence. Therefore, to find a systemic, canonical, and effective remedy is more and more emphasized by the Medicine fields all over the world. This topic is to form a set of canonical remedy for the prolapse of lumbar intervertebral disc disease on the base of the former experiences and scientific research achievements.1. Three-times Pulling Manuever Standard ResearchSince December 2006 to December 2007, we selected 120 patients who correspond to the diagnostic criteria of prolapse of lumbar intervertebral disc in the hospital of traumatology of CACMS. Considering some cases may drop out, we selected 130 patients.Based on random contrast methods, patients were randomly divided into control group of lumbar traction and treatment group of TCM manuever of fractures and wounds according to their consulting order. 58 cases in treatment group and 60 cases in control group were in the statistics at last.The items such as general condition, symptoms and signs of two groups of patients were matched before treatment. Using Spssl3.0 for data analysis.1. Diagnostic programme1.1 Western medicine diagnostic criteriaAccording to the《clinical orthopaedics》, 2nd edition, published by press of People's healthy, 20041.2 Diagnostic criteria of traditional Chinese medicineAccording to the "Industry standards of TCM in China—the criteria of diagnosis and therapeutic effect of diseases and syndromes in traditional Chinese medicine" ,made by State Administration of Traditional Chinese Medicine, 1st, January, 1995.1.3 The diagnostic criteria of Prolapse of lumbar intervertebral disca. Low back trauma or chronic strain. Most of the patients had have histoty of chronic low back pain before onset of the disease.b. low back pain accompanied with leg pain, and the leg pain is serious than low back painc. Scoliosis, disappearance of lumbar physiology curve, limitation of lumber movement . pressure pain in paraspinal of lesion location, and radiation to lower limbs.d. involvement innervating areas of lower limbs hyperesthesia or dysesthesia.straight-leg raising test and augmentation test positive.e. X-ray: scoliosis, disppearance of lumbar lordosis, probably become narrowof intervertebral disc,and corresponding edge has osteophyte hyperplasia.It can shows the location, size, degree of the intervertebral disc,and the relationship with nerve roots and dural sac.[Differential Diagnosis]To differentiate from similar diseases such as lumbar muscle strain , lumbar vertebral tumors, tuberculosis of lumber spine, and nerve entrapments syndrome(inflammation of superior clunial nerves and pyriformis syndrome) etc.1.4 Inclusive criteria:a.Patients who in accordance with the diagnostic criteria above;b.At the age of 20 to 50.c.course less than 10 years1.5 Exclusive criteriona. Patients who doesn't accord with the inclusive criteria;b. The size of the protrusion resulted from annulus fibrosus rupture is as 1/3as spinal canal, the protrusion of nucleus pulposus of central type lumbar disc herniation is comparatively big, free disc herniation of the lumbar spine or extreme lateral prolapse of intervertebral disc.c. Exclude non lumbar disc herniation.d. Suspected or definite tumor of the joint, parenchyma, or intraspinal canal;e. Patients of hematonosis with hemorrhagic tendency;f. Patients of osteoarticular tuberculosis, ostemyelitis, or senile osteoporosis;g. Patients of indefinite diagnosis of spinal injures accompany with spinal cord injures;h. Patients with serious heart, lung, or brain internal disease;i. Patients with serious swelling of lumbar soft tissue in acute phasej. Patients with serious skin disease on the location of manipulation;k. Pregnant women;l. Patients who don't want to accept the investigation.1.6 Criteria of cases doped outa. Seriously adverse reaction occur, and patients can not stick to the treatmentb. Patients who didn't finish 2/3 of the course of treatment;c. Serious complication occurred during the experiment process;d. Symptoms get worse, and need to take emergency measures;e. Curative effect can not be evaluated for patients take other treatmentthemselves;f. Patients who require to quit midway, make clear the reason, and record theevaluation indexes when they quit.1.7 Standard of the cases kicked outThe final diagnose does not accord with this disease.2. Treatment methods2.1 Experimental group: adopt Sun Shi manipulation for lumbar disc herniation, 3 times a week, 20min each time, and the period of treatment was 3 weeks.2.2 Control group: Decubitus pelvic traction with the Japan ORTHOTRAC/OL-2000 computer cuntroled extension table, 30min each time, trailing load depends on the weight and the tolerance of the patients, commonly is half of the patient's body weight with proper adjustments, 5 times a week, and the period of treatment was 3 weeks.3. Results3.1 Analysis to the effect of manipulation therapy of prolapse of lumbar intervertebral diskTCM maneuver of fractures and wounds on tendon trauma can be characterized as adroitly guiding action according to circumstances, lightness and softness, integrated of manipulation and drugs. His view of diagnoses and treatment is extractive and original. Based on old manipulation treatment and combined with different manipulations of different schools, Pro. Zhangjun summarized TCM maneuver of fractures and wounds for LDH according to his own clinical experiences. The manipulations can be divided into examine manipulation, tendon-regulating manipulation, three-wrenching manipulation. Finding shows a positive curative effect of Sun's manipulation treatment for lumbar intervertebral disk. Among the 58 cases of experimental group, 18 were clinical controlled, 12 were clinical obviously improved, and 18 were clinical improved, 10 were clinical ineffective, and total effective rate is 82.76%. In the 60 cases of control group, 6 were clinical controlled, 6 were clinical obviously improved, and 22 were clinical improved, 26 were clinical ineffective, and total effective rate is 57.67%. At the end of the treatment period of 2 groups, the statistic results of treatment effect of experimental group compared with control group shows: P<0.01. The differences between this two groups is significant, and it proves the curative effect of the manipulation group is obviously better than the control group. 3.2 Analysis of the symptoms and signs of the lumbar intervertebral disk before and after the manipulation therapyAt the end of the treatment period of 2 groups, the statistical comparison of remarks of symptoms and signs before and after the manipulation therapy shows: P<0.01. It suggests that Sun's manipulation therapy can improve the symptoms and signs of this disease effectively. Compared with control group, symptoms and signs before and after the therapy has better effect, P<0.001.Comparison of flank pain remarks before and after manipulation shows: P<0.001. It suggests that the pain has obviously released after manipulation. Comparison of flank pain remarks between tow groups shows, P<0.01. Comparison between onset time and disappear time shows P<0.001. It suggests that curative effect, onset time and disappear time of flank pain of the manipulation group is obviously better than the control group. Comparison of Straight-leg raising test between tow groups shows P<0.001. It suggests that the effect of manipulation to improve positive Straight-leg raising test is better than distraction. The disappear time of positive Straight-leg raising test of manipulation group is obviously short than distraction group. Comparison of radiate leg pain remarks before and after manipulation shows: P<0.001., which suggests that pain has obviously released after manipulation. Comparison of radiate leg pain remarks between tow groups shows, P<0.001. Comparison between onset time and disappear time shows P<0.001. It suggests that curative effect, onset time and disappear time of radiate leg pain of the manipulation group is obviously better than the control group. Manipulation therapy is superior than the extension therapy in many aspects, such as vertebra thorn nearby tenderness,tenderness radiation,lumbar restricted in moving. While, the curative effect of manipulation therapy does not so obvious on curing sensory disturbance, muscle force abnormality, and tendinous reflect weakenness, when compared with the extension therapy.3.3 Analysis of the lumbar muscle tension state before and after the manipulation treatment for the lumbar intervertebral disk diseaseAfter compared the muscle tension parameter of lumbar vertebrae tender spot, which was measured by soft tissue tension meter before and after the manipulation therapy, we got a result that P<0.001. It proves the manipulation therapy has a good effect on improving the lumbar soft tissue tension state. Compared muscle tension parameter of the control group with extraction therapy before and after the manipulation therapy, we got a result that P<0.001, which is also evident on improving the lumbar soft tissue tension state. When comparing the muscle tension parameter on the lumbar tender area between two groups, P<0.001, which shows that the manipulation therapy has a better curative effect than the extension therapy.3.4 Analysis of lumbar active radius before and after the Sun's manipulation treatment for the lumbar intervertebral disk diseaseAccording to the instrument of measuring cervical range of motion measuring, when compared the active angle of flexion and extension,bilateral rotation,lateral bending, P<0.001, it shows that the manipulation therapy used in the experimental group does have a very effective result in improving lumbar active radius. In the data of the control group, when comparing the active angle of flexion and extension,bilateral rotation,lateral bending, P<0.001, it shows the extension therapy used in the control group does also have a very effective result in improving lumbar active radius. Comparing integral value of flexion and extension,lateral bending before and after treatment in this two different methods, P<0.001, which shows the manipulation therapy has a better effection than the extension therapy.2. mechanical researchThe core theory of this standard manipulation therapy is "touching by your hands, comprehension in your mind, hands action following the mind, ideas coming up from the hands". After the standardized research of TCM manipulation for lubar intervertebral disc protrusion, we realized mechanical research is required to make manipulation easily to learn and widely application. Based on the experience of the application of transducer technology in spinal biomechanics, recording the changes of patients' condition before and after manipulation therapy and analyzing the power, angle, direction in the course of manipulation, and benting and extending, rotation, and force of patients' vertebral column, we get large amount of data. To summary, analyze and abstract them, we get the mechanical standard manipulation. There are two important aspects of manipulation mechanical research. First is "touching by your hands, comprehension in your mind". It means that after manipulate examination, doctor could have got the information of the pain threshold and the condition of muscle tone of the patient. The second one is "hands action following the mind, ideas coming up from the hands". That means based on above manipulate examination, doctors can make clear the power and the time of manipulation. Our mechanical research faithfully represented the clinical experiences srandard manipulation, and made this academic experience widely applied. Comparison through this Mechanical research database, discover the differentiations of standard manipulation, so that to better develop it. And it's also the way to shorten the distance of becoming a talent of TMC. And avoid from the same appearance and different essence.1. Measure for Pain Threshold and muscle tonusWe measured the pain threshold and muscle tonus of a patient with soft tissue tension meter when teacher Sun was performing the manipulation therapy, recordedthe data of manipulation therapy of TCM and the patient's condition.2. Measure for gentle twisting and Three-times Pulling Manuever(TPM)Therapy for lumber prolapsed vertebral disc is tendon-soothing maneuver and rotation maneuver. Tendon-soothing maneuver is mainly based on rolling maneuver, which can make the tension muscles released and promote the blood circulation to achieve the purpose of dredging veins and arteries. We measured the pressure and the action time when teacher Sun was performing the tendon-soothing maneuver therapy with the instrument of testing force of point pressing measuring, and measured the bulk and action time of TPM with the instrument of testing force of TPM measuring.ConclusionOur research have the conclusion that the standard manipulation therapy do have a very effective curative on aspects of curing the waist leg pain, activity sings and symptoms, and it's better than the lumbar traction therapy. It's also helpful for wiping out the waist abnormal stress, recovering the normal lumbar vertebrae joint anatomy sequence,releasing the high-strengthened muscles to make the abnormal muscle tonus normalized, obstructing malignant stimulus, which is really helpful for the recovery of lumbar blood-supplication. |
PDF Full Text Request