中西医协作阶梯式治疗腰椎间盘突出症的意义与展望
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摘要
腰椎间盘突出症引起的下腰痛是导致生理残疾的主要因素之一,中西医协作在治疗腰椎间盘突出症过程中可以发挥其各自的优势,有助于降低社会和家庭负担。结合目前国际上对于腰椎间盘突出症手术指征的界定,我们将腰椎间盘突出症分为保守治疗期、手术干预期、术后康复期3个阶段。本文从中西医协作角度出发,探索腰椎间盘突出症阶梯式治疗的意义、现状及未来的发展前景。
Low back pain caused by lumbar disc herniation is one of the main factors leading to physical disability.In the treatment of lumbar disc herniation, the collaboration of traditional Chinese medicine and Western medicine have their respective advantages, helping to reduce the burden of society and family. Based on the international surgical indications for lumbar disc herniation, we divided lumbar disc herniation into 3 stages, including conservative treatment stage, surgical intervention stage and postoperative rehabilitation stage. From the perspective of collaboration of traditional Chinese medicine and Western medicine, we discussed the significance, status and future prospects of stepwise therapy for lumbar disc herniation.
Low back pain caused by lumbar disc herniation is one of the main factors leading to physical disability.In the treatment of lumbar disc herniation, the collaboration of traditional Chinese medicine and Western medicine have their respective advantages, helping to reduce the burden of society and family. Based on the international surgical indications for lumbar disc herniation, we divided lumbar disc herniation into 3 stages, including conservative treatment stage, surgical intervention stage and postoperative rehabilitation stage. From the perspective of collaboration of traditional Chinese medicine and Western medicine, we discussed the significance, status and future prospects of stepwise therapy for lumbar disc herniation.
引文
[1]MACPHERSON H.NICE for some interventions,but not so NICE for others:questionable guidance on acupuncture for osteoarthritis and low-back pain[J].JAltern Complement Med,2017,23:247-248.
[2]URITS I,BURSHTEIN A,SHARMA M,TESTA L,GOLD P A,ORHURHU V,et al.Low back pain,a comprehensive review:pathophysiology,diagnosis,and treatment[J/OL].Curr Pain Headache Rep,2019,23:23.doi:10.1007/s11916-019-0757-1.
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[6]国家中医药管理局.中医病证诊断疗效标准[M].北京:中国医药科技出版社,2012:214.
[7]GIBSON J N,WADDELL G.Surgical interventions for lumbar disc prolapse:updated cochrane review[J].Spine(Phila Pa 1976),2007,32:1735-1747.
[8]莫伟,许金海,叶洁,邬学群,马俊明,杨龙,等.腰椎间盘突出症中医治疗方法的研究进展[J].中国中医急症,2016,25:474-476.
[9]FARDON D F,WILLIAMS A L,DOHRING E J,MURTAGH F R,GABRIEL ROTHMAN S L,SZE G K.Lumbar disc nomenclature:version 2.0:recommendations of the combined task forces of the North American Spine Society,the American Society of Spine Radiology and the American Society of Neuroradiology[J].Spine J,2014,14:2525-2545.
[10]GOO B,KIM S J,KIM E J,NAM D,LEE H J,KIM JS,et al.Clinical research on the efficacy and safety of Bosinji for low back pain with radiculopathy caused by herniated intervertebral disc of the lumbar spine:a protocol for a multicenter,randomized,controlled equivalence trial[J/OL].Medicine(Baltimore),2018,97:e13684.doi:10.1097/MD.0000000000013684.
[11]ZHONG Y,HUANG Y L,HU Y M,ZHU L R,ZHAOY S.Puerarin alleviate radicular pain from lumbar disc herniation by inhibiting ERK-dependent spinal microglia activation[J].Neuropeptides,2018,72:30-37.
[12]张喜林,沈国权.短杠杆微调手法治疗复杂性腰椎间盘突出症32例小结[J].甘肃中医,2006,19:3-4.
[13]龚金德,奚桂芳,潘小平,李其松,吴文豹,虞建邦.推拿镇痛与内啡肽的关系[J].上海中医药杂志,1982(4):22-23.
[14]JIANG S,ZHANG H,FANG M,ZHANG Y,LU N,ZHUQ,et al.Analgesic effects of Chinese Tuina massage in a rat model of pain[J].Exp Ther Med,2016,11:1367-1374.
[15]LONG Y.Treatment of protrusion of the lumbar intervertebral disc by TCM massage[J].J Tradit Chin Med,2002,22:126-127.
[16]CHERKIN D C,SHERMAN K J,DEYO R A,SHEKELLE P G.A review of the evidence for the effectiveness,safety,and cost of acupuncture,massage therapy,and spinal manipulation for back pain[J].Ann Intern Med,2003,138:898-906.
[17]SECA S,PATRíCIO M,KIRCH S,FRANCONIG,CABRITA A S,GRETEN H J.Effectiveness of acupuncture on pain,functional disability,and quality of life in rheumatoid arthritis of the hand:results of a double-blind randomized clinical trial[J].J Altern Complement Med,2019,25:86-97.
[18]KIM S A,LEE B H,BAE J H,KIM K J,STEFFENSENS C,RYU Y H,et al.Peripheral afferent mechanisms underlying acupuncture inhibition of cocaine behavioral effects in rats[J/OL].PLoS One,2013,8:e81018.doi:10.1371/journal.pone.0081018.
[19]SUTER M R,BERTA T,GAO Y J,DECOSTERD I,JIR R.Large A-fiber activity is required for microglial proliferation and p38 MAPK activation in the spinal cord:different effects of resiniferatoxin and bupivacaine on spinal microglial changes after spared nerve injury[J/OL].Mol Pain,2009,5:53.doi:10.1186/1744-8069-5-53.
[20]LIANG Y D,LI Y,ZHAO J,WANG X Y,ZHU H Z,CHEN X H.Study of acupuncture for low back pain in recent 20 years:a bibliometric analysis via CiteSpace[J].J Pain Res,2017,10:951-964.
[21]KREINER D S,HWANG S W,EASA J E,RESNICK DK,BAISDEN J L,BESS S,et al;North American Spine Society.An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy[J].Spine J,2014,14:180-191.
[22]李具宝,熊启良,屈尚可,亓峰,张磊,王琦,等.近10年针灸治疗腰椎间盘突出症选穴规律的探讨[J].中国针灸,2013,33:668-672.
[23]QIN Z,LIU X,WU J,ZHAI Y,LIU Z.Effectiveness of acupuncture for treating sciatica:a systematic review and meta-analysis[J/OL].Evid Based Complement Alternat Med,2015,2015:425108.doi:10.1155/2015/425108.
[24]WEGNER I,WIDYAHENING I S,VAN TULDER M W,BLOMBERG S E,DE VET H C,BR豊FORT G,et al.Traction for low-back pain with or without sciatica[J/OL].Cochrane Database Syst Rev,2013(8):CD003010.doi:10.1002/14651858.CD003010.pub5.
[25]OAKLEY P A,HARRISON D E.Lumbar extension traction alleviates symptoms and facilitates healing of disc herniation/sequestration in 6-weeks,following failed treatment from three previous chiropractors:a CBP?case report with an 8 year follow-up[J].J Phys Ther Sci,2017,29:2051-2057.
[26]TOK C H,KAUR S,GANGI A.Symptomatic spinal epidural lipomatosis after a single local epidural steroid injection[J].Cardiovasc Intervent Radiol,2011,34(Suppl 2):S250-S255.
[27]MARCIA S,BELLINI M,HIRSCH J A,CHANDRA R V,PIRAS E,MARRAS M,et al.Efficacy of an ethyl alcohol gel in symptomatic disc herniation[J].Eur J Radiol,2018,109:101-107.
[28]KIM S K,LEE S C,PARK S W,KIM E S.Complications of lumbar disc herniations following trans-sacral epiduroscopic lumbar decompression:a single-center,retrospective study[J/OL].J Orthop Surg Res,2017,12:187.doi:10.1186/s13018-017-0691-z.
[29]RAMPERSAUD Y R,GRAY R,LEWIS S J,MASSICOTTE E M,FEHLINGS M G.Cost-utility analysis of posterior minimally invasive fusion compared with conventional open fusion for lumbar spondylolisthesis[J].SAS J,2011,5:29-35.
[30]何蔚,何海龙,许国华,范纯泉,张桦,蒋玉权,等.单侧椎板减压椎弓根螺钉固定椎间融合术治疗腰椎间盘突出症[J].第二军医大学学报,2009,30:537-540.HE W,HE H L,XU G H,FAN C Q,ZHANG H,JIANGY Q,et al.Unilateral vertebral plate decompression,interbody fusion and pedicle screw fixation in treatment of lumbar disc herniation[J].Acad J Sec Mil Med Univ,2009,30:537-540.
[31]MEHREN C,MAYER H M,ZANDANELL C,SIEPE CJ,KORGE A.The oblique anterolateral approach to the lumbar spine provides access to the lumbar spine with few early complications[J].Clin Orthop Relat Res,2016,474:2020-2027.
[32]PARK H Y,KIM Y H,HA K Y,KIM S I,MIN H K,OHI S,et al.Minimally invasive lateral lumbar interbody fusion for clinical adjacent segment pathology:a comparative study with conventional posterior lumbar interbody fusion[J/OL].Clin Spine Surg,2019.doi:10.1097/BSD.0000000000000787.
[33]ALVI M A,KEREZOUDIS P,WAHOOD W,GOYALA,BYDON M.Operative approaches for lumbar disc herniation:a systematic review and multiple treatment meta-analysis of conventional and minimally invasive surgeries[J/OL].World Neurosurg,2018,114:391-407.e2.doi:10.1016/j.wneu.2018.02.156.
[34]李同明,王新,方凡夫,顾伟,李柏.核心区肌群功能性训练预防新兵下背痛和提高核心肌功能效果观察[J].第二军医大学学报,2018,39:538-542.LI T M,WANG X,FANG F F,GU W,LI B.Functional training of core muscles preventing low back pain and improving core muscle function of recruits:an observational study[J].Acad J Sec Mil Med Univ,2018,39:538-542.
[35]QIN L,CHOY W,LEUNG K,LEUNG P C,AU S,HUNG W,et al.Beneficial effects of regular Tai Chi exercise on musculoskeletal system[J].J Bone Miner Metab,2005,23:186-190.
[36]HAYASHI K,IKEMOTO T,UENO T,ARAI Y C,SHIMO K,NISHIHARA M,et al.Regional differences of repeatability on visual analogue scale with experimental mechanical pain stimuli[J].Neurosci Lett,2015,585:67-71.
[37]WHITEHOUSE S,STEPHENSON J,SINCLAIR V,GREGORY J,TAMBE A,VERMA R,et al.A validation of the Oswestry spinal risk index[J].Eur Spine J,2016,25:247-251.
[38]WEI X,YI H,WU B,QI M,LIU X,CHEN Z,et al.A valid cross-culturally adapted simplified Chinese version of the Quebec back pain disability scale[J].J Clin Epidemiol,2012,65:1321-1328.
[39]YI H,JI X,WEI X,CHEN Z,WANG X,ZHU X,et al.Reliability and validity of simplified Chinese version of Roland-Morris questionnaire in evaluating rural and urban patients with low back pain[J/OL].PLoS One,2012,7:e30807.doi:10.1371/journal.pone.0030807.
[40]WEI X,CHEN Z,BAI Y,ZHU X,WU D,LIU X,et al.Validation of the simplified Chinese version of the functional rating index for patients with low back pain[J].Spine(Phila Pa 1976),2012,37:1602-1608.
[2]URITS I,BURSHTEIN A,SHARMA M,TESTA L,GOLD P A,ORHURHU V,et al.Low back pain,a comprehensive review:pathophysiology,diagnosis,and treatment[J/OL].Curr Pain Headache Rep,2019,23:23.doi:10.1007/s11916-019-0757-1.
[3]GBD 2017 Disease and Injury Incidence and Prevalence Collaborators.Global,regional,and national incidence,prevalence,and years lived with disability for 354diseases and injuries for 195 countries and territories,1990.2017:a systematic analysis for the Global Burden of Disease Study 2017[J].Lancet,2018,392:1789-1858.
[4]SELVA-SEVILLA C,FERRARA P,GERóNIMOPARDOM.Cost-utility analysis for recurrent lumbar disc herniation:conservative treatment versus discectomy versus discectomy with fusion[J/OL].Clin Spine Surg,2019.doi:10.1097/BSD.0000000000000797.
[5]陈孝平,汪建平.外科学[M].8版.北京:人民卫生出版社,2013:753.
[6]国家中医药管理局.中医病证诊断疗效标准[M].北京:中国医药科技出版社,2012:214.
[7]GIBSON J N,WADDELL G.Surgical interventions for lumbar disc prolapse:updated cochrane review[J].Spine(Phila Pa 1976),2007,32:1735-1747.
[8]莫伟,许金海,叶洁,邬学群,马俊明,杨龙,等.腰椎间盘突出症中医治疗方法的研究进展[J].中国中医急症,2016,25:474-476.
[9]FARDON D F,WILLIAMS A L,DOHRING E J,MURTAGH F R,GABRIEL ROTHMAN S L,SZE G K.Lumbar disc nomenclature:version 2.0:recommendations of the combined task forces of the North American Spine Society,the American Society of Spine Radiology and the American Society of Neuroradiology[J].Spine J,2014,14:2525-2545.
[10]GOO B,KIM S J,KIM E J,NAM D,LEE H J,KIM JS,et al.Clinical research on the efficacy and safety of Bosinji for low back pain with radiculopathy caused by herniated intervertebral disc of the lumbar spine:a protocol for a multicenter,randomized,controlled equivalence trial[J/OL].Medicine(Baltimore),2018,97:e13684.doi:10.1097/MD.0000000000013684.
[11]ZHONG Y,HUANG Y L,HU Y M,ZHU L R,ZHAOY S.Puerarin alleviate radicular pain from lumbar disc herniation by inhibiting ERK-dependent spinal microglia activation[J].Neuropeptides,2018,72:30-37.
[12]张喜林,沈国权.短杠杆微调手法治疗复杂性腰椎间盘突出症32例小结[J].甘肃中医,2006,19:3-4.
[13]龚金德,奚桂芳,潘小平,李其松,吴文豹,虞建邦.推拿镇痛与内啡肽的关系[J].上海中医药杂志,1982(4):22-23.
[14]JIANG S,ZHANG H,FANG M,ZHANG Y,LU N,ZHUQ,et al.Analgesic effects of Chinese Tuina massage in a rat model of pain[J].Exp Ther Med,2016,11:1367-1374.
[15]LONG Y.Treatment of protrusion of the lumbar intervertebral disc by TCM massage[J].J Tradit Chin Med,2002,22:126-127.
[16]CHERKIN D C,SHERMAN K J,DEYO R A,SHEKELLE P G.A review of the evidence for the effectiveness,safety,and cost of acupuncture,massage therapy,and spinal manipulation for back pain[J].Ann Intern Med,2003,138:898-906.
[17]SECA S,PATRíCIO M,KIRCH S,FRANCONIG,CABRITA A S,GRETEN H J.Effectiveness of acupuncture on pain,functional disability,and quality of life in rheumatoid arthritis of the hand:results of a double-blind randomized clinical trial[J].J Altern Complement Med,2019,25:86-97.
[18]KIM S A,LEE B H,BAE J H,KIM K J,STEFFENSENS C,RYU Y H,et al.Peripheral afferent mechanisms underlying acupuncture inhibition of cocaine behavioral effects in rats[J/OL].PLoS One,2013,8:e81018.doi:10.1371/journal.pone.0081018.
[19]SUTER M R,BERTA T,GAO Y J,DECOSTERD I,JIR R.Large A-fiber activity is required for microglial proliferation and p38 MAPK activation in the spinal cord:different effects of resiniferatoxin and bupivacaine on spinal microglial changes after spared nerve injury[J/OL].Mol Pain,2009,5:53.doi:10.1186/1744-8069-5-53.
[20]LIANG Y D,LI Y,ZHAO J,WANG X Y,ZHU H Z,CHEN X H.Study of acupuncture for low back pain in recent 20 years:a bibliometric analysis via CiteSpace[J].J Pain Res,2017,10:951-964.
[21]KREINER D S,HWANG S W,EASA J E,RESNICK DK,BAISDEN J L,BESS S,et al;North American Spine Society.An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy[J].Spine J,2014,14:180-191.
[22]李具宝,熊启良,屈尚可,亓峰,张磊,王琦,等.近10年针灸治疗腰椎间盘突出症选穴规律的探讨[J].中国针灸,2013,33:668-672.
[23]QIN Z,LIU X,WU J,ZHAI Y,LIU Z.Effectiveness of acupuncture for treating sciatica:a systematic review and meta-analysis[J/OL].Evid Based Complement Alternat Med,2015,2015:425108.doi:10.1155/2015/425108.
[24]WEGNER I,WIDYAHENING I S,VAN TULDER M W,BLOMBERG S E,DE VET H C,BR豊FORT G,et al.Traction for low-back pain with or without sciatica[J/OL].Cochrane Database Syst Rev,2013(8):CD003010.doi:10.1002/14651858.CD003010.pub5.
[25]OAKLEY P A,HARRISON D E.Lumbar extension traction alleviates symptoms and facilitates healing of disc herniation/sequestration in 6-weeks,following failed treatment from three previous chiropractors:a CBP?case report with an 8 year follow-up[J].J Phys Ther Sci,2017,29:2051-2057.
[26]TOK C H,KAUR S,GANGI A.Symptomatic spinal epidural lipomatosis after a single local epidural steroid injection[J].Cardiovasc Intervent Radiol,2011,34(Suppl 2):S250-S255.
[27]MARCIA S,BELLINI M,HIRSCH J A,CHANDRA R V,PIRAS E,MARRAS M,et al.Efficacy of an ethyl alcohol gel in symptomatic disc herniation[J].Eur J Radiol,2018,109:101-107.
[28]KIM S K,LEE S C,PARK S W,KIM E S.Complications of lumbar disc herniations following trans-sacral epiduroscopic lumbar decompression:a single-center,retrospective study[J/OL].J Orthop Surg Res,2017,12:187.doi:10.1186/s13018-017-0691-z.
[29]RAMPERSAUD Y R,GRAY R,LEWIS S J,MASSICOTTE E M,FEHLINGS M G.Cost-utility analysis of posterior minimally invasive fusion compared with conventional open fusion for lumbar spondylolisthesis[J].SAS J,2011,5:29-35.
[30]何蔚,何海龙,许国华,范纯泉,张桦,蒋玉权,等.单侧椎板减压椎弓根螺钉固定椎间融合术治疗腰椎间盘突出症[J].第二军医大学学报,2009,30:537-540.HE W,HE H L,XU G H,FAN C Q,ZHANG H,JIANGY Q,et al.Unilateral vertebral plate decompression,interbody fusion and pedicle screw fixation in treatment of lumbar disc herniation[J].Acad J Sec Mil Med Univ,2009,30:537-540.
[31]MEHREN C,MAYER H M,ZANDANELL C,SIEPE CJ,KORGE A.The oblique anterolateral approach to the lumbar spine provides access to the lumbar spine with few early complications[J].Clin Orthop Relat Res,2016,474:2020-2027.
[32]PARK H Y,KIM Y H,HA K Y,KIM S I,MIN H K,OHI S,et al.Minimally invasive lateral lumbar interbody fusion for clinical adjacent segment pathology:a comparative study with conventional posterior lumbar interbody fusion[J/OL].Clin Spine Surg,2019.doi:10.1097/BSD.0000000000000787.
[33]ALVI M A,KEREZOUDIS P,WAHOOD W,GOYALA,BYDON M.Operative approaches for lumbar disc herniation:a systematic review and multiple treatment meta-analysis of conventional and minimally invasive surgeries[J/OL].World Neurosurg,2018,114:391-407.e2.doi:10.1016/j.wneu.2018.02.156.
[34]李同明,王新,方凡夫,顾伟,李柏.核心区肌群功能性训练预防新兵下背痛和提高核心肌功能效果观察[J].第二军医大学学报,2018,39:538-542.LI T M,WANG X,FANG F F,GU W,LI B.Functional training of core muscles preventing low back pain and improving core muscle function of recruits:an observational study[J].Acad J Sec Mil Med Univ,2018,39:538-542.
[35]QIN L,CHOY W,LEUNG K,LEUNG P C,AU S,HUNG W,et al.Beneficial effects of regular Tai Chi exercise on musculoskeletal system[J].J Bone Miner Metab,2005,23:186-190.
[36]HAYASHI K,IKEMOTO T,UENO T,ARAI Y C,SHIMO K,NISHIHARA M,et al.Regional differences of repeatability on visual analogue scale with experimental mechanical pain stimuli[J].Neurosci Lett,2015,585:67-71.
[37]WHITEHOUSE S,STEPHENSON J,SINCLAIR V,GREGORY J,TAMBE A,VERMA R,et al.A validation of the Oswestry spinal risk index[J].Eur Spine J,2016,25:247-251.
[38]WEI X,YI H,WU B,QI M,LIU X,CHEN Z,et al.A valid cross-culturally adapted simplified Chinese version of the Quebec back pain disability scale[J].J Clin Epidemiol,2012,65:1321-1328.
[39]YI H,JI X,WEI X,CHEN Z,WANG X,ZHU X,et al.Reliability and validity of simplified Chinese version of Roland-Morris questionnaire in evaluating rural and urban patients with low back pain[J/OL].PLoS One,2012,7:e30807.doi:10.1371/journal.pone.0030807.
[40]WEI X,CHEN Z,BAI Y,ZHU X,WU D,LIU X,et al.Validation of the simplified Chinese version of the functional rating index for patients with low back pain[J].Spine(Phila Pa 1976),2012,37:1602-1608.
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