| Objective: 1.The efficacy and safety of tendon regulating manipulation in the treatment of acute lumbar disc herniation in Tianchi Department of Traumatology were solved through a large sample multicenter randomized controlled trial,providing evidence-based medical evidence for manipulation in the treatment of acute lumbar disc herniation.2.the biomechanical mechanism of manual therapy was analyzed by three-dimensional dynamic capture system,and the changes of lower limb biomechanical parameters after manual therapy were quantitatively analyzed.Methods:Study 1: This clinical study is based on the construction project of Jilin provincial clinical medical center for bone and trauma of traditional Chinese medicine(Project No: 20180623048).With the Affiliated Hospital of Changchun University of traditional Chinese medicine as the technical guidance unit,240 patients with acute lumbar disc herniation are planned to be recruited in four sub centers in Jilin Province.They are allocated according to the ratio of 1:1between the experimental group and the control group through the central random method.In the basic treatment(bed rest,wearing waist circumference,health education)The experimental group was treated with two steps and ten methods combined with basic treatment,and the control group was treated with celecoxib capsules combined with basic treatment.The outcome indicators of waist and leg VAS score,disability index ODI,quality of life score SF-36,depression(SDS)and anxiety scale(SAS)were used.Finally,203 patients were included in the statistical analysis,and the efficacy and safety of Tianchi Shangke tendon regulating manipulation in the treatment of acute lumbar disc herniation were discussed.Study 2: Based on Study 1,the quantitative changes of lower limb biomechanical parameters after manipulation intervention were further discussed.The kinematic data before and after the intervention of tendon regulating manipulation in acute lumbar disc herniation of Tianchi traumatology school were collected through dynamic capture system,threedimensional force measuring platform and plantar pressure system.The obtained data were imported into the biomechanical analysis software Bob for modeling.Through the simulation calculation of Bob software,the quantitative changes of temporal and spatial parameters,motion parameters and plantar pressure of Tianchi traumatology school manipulation intervention on lumbar disc herniation were obtained,and the biomechanical mechanism of lower limb gait balance after manipulation intervention was discussed.Results:Study 1:1.There were no significant differences in gender,age,height,weight,body mass index BMI,course of disease,waist VAS score,leg VAS score,disability function index scale ODI,quality of life scale SF-36,depression SDS scale,anxiety SAS scale between the two groups(all P>0.05),and the baseline was comparable.2.Main outcome measures: comparison of lumbar VAS score: the lumbar VAS score of the two groups decreased over time.There was no significant difference in the improvement of lumbar VAS score between the experimental group B and the control group A on the first day,the third day and the fifth day of the treatment cycle(P>0.05),but as time went on,the lumbar VAS score of the two groups decreased on the seventh day,the ninth day,the eleventh day,the fourteenth day of the treatment cycle,and the first month,the third month,the fifth day of the follow-up There was significant difference in the improvement of lumbar VAS score between the two groups at the 6th month(P<0.05).The VAS scores of the legs of the two groups were compared: the VAS scores of the legs of the two groups were improved with the passage of time,and there was no significant difference between the experimental group B and the control group A in the improvement of the VAS scores of the legs of the two groups on the first day and the third day of the treatment cycle(P>0.05),but with the passage of time,the VAS scores of the legs of the two groups were improved on the fifth day,the seventh day,the ninth day,the eleventh day,the fourteenth day of the treatment week,and the first month,the third month,the third month,the fourth day of the follow-up There was significant difference in the improvement of lumbar VAS score between the two groups at the 6th month(P<0.05).3.Secondary efficacy index: Comparison of ODI score of disability function index between the two groups: there was a significant difference in ODI score of disability function index between experimental group B and control group A on the 7th and 14 th day of intervention and at the 1st,3rd and 6th month of follow-up(P<0.05).Comparison of SF-36 scores of quality of life between the two groups: there was no significant difference in SF-36 scores of quality of life between the experimental group B and the control group A within 7days before the intervention(P>0.05),but there was significant difference in SF-36 scores of quality of life between the two groups on the 14 th day of the intervention and at the first,third and sixth months of follow-up(P<0.05).Comparison of SDS scores between the two groups:there was no significant difference in SDS scores between experimental group B and control group A within 7 days before intervention(P>0.05),but there was significant difference in SDS scores between the two groups on the 7th day of intervention and at the 1st,3rd and 6th month of follow-up(P<0.05).Comparison of SAS scores of anxiety between the two groups: there were significant differences in SAS scores of depression between experimental group B and control group A on the 7th and 14 th day of intervention and at the 1st,3rd and 6th month of follow-up(P<0.05).Study 2:1.After manual therapy,compared with before treatment,it was found that the patient’s step length,pace and frequency increased,the proportion of support phase increased,the proportion of swing phase decreased,and the time ratio of support phase to swing phase generally tended to be normal(6:4).The difference was statistically significant before and after treatment(p<0.05).2.Compared with before treatment,the maximum range of motion and maximum flexion angle of the hip joint sagittal plane in patients with acute LDH increased,the maximum range of motion and maximum flexion angle of the knee joint sagittal plane increased,and the maximum range of motion and maximum plantar flexion angle of the ankle joint sagittal plane increased.The difference was statistically significant before and after treatment(p<0.05).3.Before treatment,the peak plantar pressure of the affected foot was less than that of the healthy foot.The maximum pressure peak appeared in the heel medial,followed by the lateral heel(HL)and the second metatarsal(M2).The areas with smaller average plantar pressure peak were mainly distributed in the first toe(T1)and the fifth metatarsal(M5).After treatment,the peak value of the affected foot plantar area increased compared with that before,and was relatively equal to the peak value of the pressure of the healthy foot plantar area,and the balance of the force points of both feet was good.The difference was statistically significant before and after treatment(p<0.05).Conclusion:1.The tendon regulating manipulation of Tianchi traumatology department can effectively improve the symptoms and signs of patients with acute lumbar disc herniation,relieve the pain in the waist and legs,improve disability and dysfunction,improve the quality of life,and actively improve anxiety and depression.In terms of vas evaluation of the waist and legs,the medium and long-term efficacy of the two-step ten method in relieving pain in the waist and legs of patients was better than that of the western medicine celecoxib control group;In terms of disability evaluation,the short,medium and long-term efficacy of the two-step ten method in improving the degree of disability function of patients is much better than that of the western medicine celecoxib control group;In terms of quality of life evaluation,the two-step ten method was superior to the control group in improving the quality of life and promoting the physical and mental health of patients in the medium and long term;In terms of depression and anxiety evaluation,the two-step ten method has a positive effect on improving the psychological state and mood of patients with acute lumbar disc herniation,and the short,medium and long-term curative effect is significantly better than that of the drug group.There was no obvious adverse event related to the two-step ten method in the treatment of acute lumbar disc herniation,and the treatment was safe and effective.2.Through the three-dimensional gait analysis system to evaluate the kinematic parameters of patients with acute LDH before and after the treatment of the two-step ten method,we found that after the treatment of the two-step ten method,the patient’s step length,step speed and step frequency increased,the proportion of the support phase increased,the proportion of the swing phase decreased,and the proportion of the support phase and the swing phase tended to be normal,which could effectively improve the spatiotemporal parameters of the patient’s lower limb biomechanics;The range of motion of hip joint,knee joint and ankle joint were increased,which effectively improved the range of motion of patients’ lower limb joints;The plantar pressure of the affected foot increased compared with that before treatment,and the bilateral plantar pressure was more balanced.From the perspective of biomechanical quantification,it is explained that the two-step ten method can effectively improve the gait coordination,balance stability and symmetry of patients,and reduce the gait variability. |
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