| Objective:This study aims to analyze the clinical efficacy of Shentong Zhuyu Decoction in the treatment of residual pain after pereutaneous endoscopic lumbar discectomy for lumbar disc herniation with Qi stagnation and blood stasis,to analyze the causes of pain,to observe the superiority of Shentong Zhuyu Decoction over the conventional treatment of Western medicine,to investigate its effects on plasma pain mediators and inflammatory factors,and to deeply explore its mechanism of action for clinical treatment.It provides a better scheme,and provides a new method with reference significance and practical application value for TCM treatment of patients who suffer from residual pain after pereutaneous endoscopic lumbar discectomy.Method:Objective To select 56 patients with lumbar disc herniation who had residual pain after treatment with pereutaneous endoscopic lumbar discectomy from September 2017 to October 2019 in Department of Orthopedics of Jiangxi Integrated Hospital of Traditional Chinese and Western Medicine.The patients who met the screening conditions of diagnosis and exclusion were randomly divided into experimental group and control group.On the basis of routine postoperative lumbar functional exercise and treatment,The experimental group was treatedwith Shentong Zhuyu Decoction oral decoction,one dose daily,divided into morning and evening.Every week for a course of treatment,a total of four courses of treatment.The control group was treated with conventional western medicine orally(celecoxib,eperisone,Mecobalamin tablets)for 4 weeks.All patients who participated in this study were followed up for 12 weeks from the beginning of the trial to observe the overall therapeutic effect of the two groups,including the SF-MPQ score,J0 A score,plasma beta-EP content before treatment,1 week,4 weeks and 12 weeks after treatment,and the changes of plasma inflammatory factors(IL-6,TNF-a)levels before treatment and 4 weeks and 12 weeks after treatment.The data of the two groups before and after treatment were collected for statistical analysis and comparison,and finally a comprehensive evaluation of the two treatment regimens was obtained.Result:1.General data comparison: There was no significant difference in general data(age,sex,course of disease,operative segment,pain location,etc.)between the patients in this study by statistical analysis(P>0.05).It indicated that the differences in age,gender,surgical segment,pain location and other aspects of patients were not enough to have an important impact on the test results.2.Comparison of clinical efficacy: Through statistical analysis and comparison,the effective rate and marked efficiency of the treatment effect in the experimental group were higher than those in the control group,and the difference was statistically significant(P<0.05).The results showed that after treatment with Shentong Zhuyu Decoction in the experimental group,patients’ pain improved significantly,lower limb and lumbar activities improved,and their previous work and daily life were basically restored.3.SF-MPQ comparison: During the follow-up period from pre-treatment to 12 weeks after treatment,the SF-MPQ scores of both groups showed a linear decline after treatment,with the greatest decline in the period from pre-treatment to 1 week after treatment,and then gradually flat.There was no significant difference in SF-MPQ between the two groups before treatment.However(P>0.05),the SF-MPQ score of the test group was lower than that of the control group at 1week after treatment(P<0.05),and the scores of the test group were lower at 4 weeks after treatment and 12 weeks after treatment(P<0.01),with significant difference.This indicates that Shentong Zhuyu Decoction has a long-lasting and excellent therapeutic effect on pain relief in patients with LDH after percutaneous transforaminal endoscopy.4.JOA score comparison: after different treatment methods,both groups can improve the JOA score,indicating that both treatment methods can improve the degree of lumbar functional recovery of patients.There was no significant difference in JOA score between the two groups before treatment,which was comparable(P>0.05).The JOA score of the test group was significantly higher than that of the control group at 1,4,and 12 weeks after treatment,and the difference was statistically significant(P<0.05).The effect of the test group on lumbar functional rehabilitation was better than that of the control group.This indicated that the patients in the experimental group had significant improvement in pain,gait,daily life and other aspects after treatment with Shentong Zhuyu Decoction,and achieved better recovery of lumbar function.5.Plasma beta-EP level and comparison: The plasma beta-EP level in both groups showed an upward trend during the treatment period,but decreased during the follow-up period,in which the control group had a greater decline,and the plasma beta-EP level was lower at 12 weeks after treatment than at 4 weeks after treatment.The plasmalevel of beta-EP remained high in the treatment group from follow-up to 12 weeks after treatment and was significantly higher than that at4 weeks after treatment.In comparison between the two groups,the plasma beta-EP level of Shentong Zhuyu Decoction was higher than that of the control group at 1 week,4 weeks and 12 weeks after treatment,and the difference was statistically significant(P<0.01).Based on the understanding that higher plasma level of beta-EP can produce better analgesic effect,it can be concluded that the analgesic effect of Shentong Zhuyu Decoction is significantly better than that of the control group.6.Comparison of plasma levels of inflammatory factors(IL-6,TNF-a): After treatment,the levels of plasma inflammatory factors(IL-6,TNF-a)in both groups were reduced,and the difference was statistically significant before and after treatment(P<0.05).The expression of IL-6 and TNF-a in the serum of the experimental group was lower than that in the plasma of the control group at 4 weeks and12 weeks after treatment,and the difference was statistically significant(P<0.01),indicating that the body pain was relieved.Yutang can better inhibit the proinflammatory factors IL-6and TNF-a,reduce the stimulation of chemical factors on nerve roots,and more effectively relieve nerve root pain in patients.Conclusion:For patients with residual pain after pereutaneous endoscopic lumbar discectomy for lumbar disc herniation with Qi stagnation and blood stasis,the treatment effect of Shentong Zhuyu Decoction oral decoction is better than that of Western medicine,with better pain relief effect and better clinical effective rate,so that patients can get faster recovery of lumbar function.It is suggested to be widely used in clinical application and further in-depth study. |
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