Observation Of Clinical Curative Effect Of Combined Cervical-lumbar-abdominal Manipulation In The Treatment Of Lumbar Disc Herniation

Objective:The study is to observe the clinical curative effect and explore the possible mechanism with combined cervical-lumbar-abdominal manipulation in the treatment of lumbar disc herniation,which can provide a new way for lumbar disc herniation.Methods:Using randomized controlled trial,105 patients with lumbar disc herniation in accordance with the standards of inclusion and exclusion were randomly assigned to three groups by SPSS 23.0: traditional massage group(control group A),combined lumbar-abdominal manipulation group(control group B),combined cervical-lumbar-abdominal manipulation group(observation group C).All of groups were treated for 3 courses,once a day,5 times as a course.There was a two-day rest after each course.The visual analogue scale(VAS)score,oswestry disability index(ODI)score,Japanese orthopaedic association(JOA)score and the Medical Outcomes Study 36-item short form health survey(SF-36)score were compared before and after the treatment.After the treatment,the efficacy evaluation was conducted according to “Diagnostic and Therapeutic Standard of TCM Diseases”combining with the improvement rate of JOA.The VAS score,ODI score,JOA score and SF-36 score of patients who were followed up 1 months after the treatment were compared with those before the treatment.The data were analyzed by SPSS 23.0.Results:1.Baseline comparison There were no statistical differences in age,gender,disease duration,body mass index,responsible lumbar disc,VAS score,ODI score,JOA score and SF-36 score among three groups before the treatment(P>0.05),therefore three groups were comparable.2.Observation indexes comparison(1)Comparison of indicators after the treatment Within the group,compared with before the treatment the VAS score and ODI score of three groups were reduced after the treatment;the JOA score and SF-36 score were increased.There were highly statistical differences(P<0.01).Compared among groups,the VAS score,ODI score,JOA score and SF-36 score after the treatment showed that there were statistical differences(P<0.05).Among them,observation group C was lower than control group A in the VAS score and ODI score and higher than group A in the JOA score and SF-36 score.The differences between group C and group A were highly statistically significant(P<0.01).There were no statistical differences between observation group C and control group B in the VAS score,ODI score,JOA score and SF-36 score(P>0.05).Control group B was lower than control group A in the VAS score and ODI score and higher than group A in the JOA score and SF-36 score.There were statistical differences between group B and group A(P<0.05).(2)Comparison of follow-up indexes 1 months after the treatment Within the group,compared with before the treatment,the VAS score and ODI score of the three groups were reduced 1 months after the end of treatment and the JOA score and SF-36 score were both increased.There were highly statistical differences(P<0.01).Compared among groups,the VAS score,ODI score,JOA score and SF-36 score showed that there were all highly statistical differences(P<0.01).Among them,observation group C was lower than control group A in the VAS score and ODI score and higher than control group A in the JOA score and SF-36 score.There were highly statistical differences between group C and group A(P<0.01).Observation group C was lower than control group B in the VAS score and ODI score and higher than control group B in the JOA score and SF-36 score.There were statistical differences between group C and group B(P<0.05).Control group B was lower than control group A in the VAS score and ODI score and higher than group A in the JOA score and SF-36 score.There were statistical differences between group B and group A(P<0.05).3.Evaluation of clinical curative effect he total effective rate of control group A was 66.67%;control group B was87.88%;observation group C was 93.94%.There were highly statistical differences in total effective rates of three groups(P<0.01).Among them,there were no statistical differences between group C and group B(P>0.05).There were highly statistical differences between group C and group A(P<0.01).There were statistical differences between group B and group A(P<0.05).Conclusions:1.Combined cervical-lumbar-abdominal manipulation,combined lumbar-abdominal manipulation and traditional massage can all reduce the pain intensity of patients with lumbar disc herniation and improve lumbar spine dysfunction and quality of life to varying degrees,which have certain stable clinical effect.2.In the short-term curative effect,combined cervical-lumbar-abdominal manipulation has the same efficacy as combined lumbar-abdominal manipulation in alleviating pain,ameliorating lumbar vertebra dysfunction and comprehensive condition and improving quality of life.And both are superior to traditional massage.In terms of the stability of the efficacy,combined cervical-lumbar-abdominal manipulation is superior to the others in alleviating pain,ameliorating lumbar vertebra dysfunction and comprehensive condition and improving quality of life.Combined lumbar-abdominal manipulation is better than traditional massage.3.In terms of total effectiveness,combined cervical-lumbar-abdominal manipulation is equivalent to combined lumbar-abdominal manipulation and both are superior to traditional massage.4.“Treating cervical vertebra,lumber vertebra and abdomen at the same time”as a new way in the treatment of lumbar disc herniation is worth further exploration and research.