[1]吉璐宏 严浩 谷艳超 周唯 吴浙栋 汪松林 朱凌△.超声引导小针刀联合通督活血汤治疗肾虚血瘀型腰椎管狭窄症的临床研究[J].中国中医骨伤科杂志,2025,33(07):35-41.[doi:10.20085/j.cnki.issn1005-0205.250707 ]
　JI Luhong YAN Hao GU Yanchao ZHOU Wei WU Zhedong WANG SonglinZHU Ling.Clinical Study of Ultrasound-Guided Small Needle-Knife Combined with Tongdu Huoxue Decoction in the Treatment of Lumbar Spinal Stenosis of Kidney Deficiency and Blood Stasis Type[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2025,33(07):35-41.[doi:10.20085/j.cnki.issn1005-0205.250707 ]
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超声引导小针刀联合通督活血汤治疗肾虚血瘀型腰椎管狭窄症的临床研究()

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第33卷
期数:
2025年07期
页码:
35-41
栏目:
临床研究
出版日期:
2025-07-15

文章信息/Info

Title:
Clinical Study of Ultrasound-Guided Small Needle-Knife Combined with Tongdu Huoxue Decoction in the Treatment of Lumbar Spinal Stenosis of Kidney Deficiency and Blood Stasis Type
文章编号:
1005-0205(2025)07-0035-07
作者:
吉璐宏1 严浩1 谷艳超1 周唯1 吴浙栋1 汪松林1 朱凌1△
1武汉中西医结合骨科医院(武汉体育学院附属医院)(武汉,430079)
Author(s):
JI Luhong1 YAN Hao1 GU Yanchao1 ZHOU Wei1 WU Zhedong1 WANG Songlin1ZHU Ling1△
1Wuhan Orthopaedics Hospital of Integrated Traditional Chinese and Western Medicine(Affiliated Hospital of Wuhan Sports University),Wuhan 430079,China.
关键词:
超声引导小针刀;  通督活血汤;  腰椎管狭窄症;  肾虚血瘀型;  黄韧带肥厚
Keywords:
ultrasound-guided small needle-knife;  Tongdu Huoxue decoction;  lumbar spinal stenosis;  kidney deficiency and blood stasis type;  ligamentum flavum hypertrophy
分类号:
R681.5
DOI:
10.20085/j.cnki.issn1005-0205.250707
文献标志码:
A
摘要:
目的:探讨超声引导小针刀联合通督活血汤治疗肾虚血瘀型腰椎管狭窄症患者的临床疗效及其对血清炎症因子变化的影响。方法:将60例肾虚血瘀型腰椎管狭窄症患者随机分为观察组和对照组(各30例),观察组采用超声引导小针刀松解腰椎黄韧带联合内服通督活血汤,对照组采用超声引导小针刀松解腰椎后方韧带复合体(棘上韧带、棘间韧带、关节突关节韧带、横突间韧带)联合内服通督活血汤。治疗前及治疗后4周时,采用视觉模拟量表(VAS)评分、日本骨科协会(JOA)评分、Oswestry功能障碍指数(ODI)评分评估疗效,采用6 min平路步行实验观察间歇性跛行距离,采用尼龙绳实验观察皮肤感觉障碍情况,检测血清白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、前列腺素E2(PGE2)水平变化,治疗后3个月及6个月随访总体有效率及复发率,观察不良反应及并发症发生情况。治疗前两组患者性别、年龄、病程等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。结果:两组患者均成功随访,与治疗前相比,两组患者治疗后4周VAS评分和ODI评分显著降低,JOA评分显著升高,间歇性跛行距离及皮肤感觉障碍情况均显著改善,血清IL-1β、TNF-α、PGE2水平均较治疗前显著降低,差异有统计学意义(P<0.01)。与对照组相比,观察组治疗后4周VAS评分、JOA评分、ODI评分,间歇性跛行距离,皮肤感觉障碍情况差异有统计学意义(P<0.05),血清IL-1β、TNF-α、PGE2水平差异无统计学意义(P>0.05)。治疗后3个月及6个月时随访,观察组总体有效率高于对照组,复发率低于对照组,差异有统计学意义(P<0.05)。结论:超声引导小针刀联合通督活血汤可缓解肾虚血瘀型腰椎管狭窄症患者的临床症状,抑制炎症因子及相关介质的表达,安全性好,有效率高,远期疗效可靠,且超声引导小针刀直接松解黄韧带在减轻疼痛、改善腰椎功能、提升步行能力、缓解麻木等方面更具优势。
Abstract:
Objective:To investigate the clinical efficacy of ultrasound-guided small needle-knife combined with Tongdu Huoxue decoction in the treatment of lumbar spinal stenosis of kidney deficiency and blood stasis type and its effect on serum inflammatory factors.Methods:A total of 60 patients with lumbar spinal stenosis of kidney deficiency and blood stasis type were randomly divided into observation group(30 cases)and control group(30 cases).The observation group was treated with ultrasound-guided small needle-knife release of lumbar ligamentum flavum combined with oral administr- ation of Tongdu Huoxue decoction.The control group was treated with ultrasound-guided small needle-knife release of lumbar posterior ligament complex(supraspinal ligament,interspinous ligament,facet joint ligament,intertransverse process ligament)combined with oral administration of Tongdu Huoxue decoction.Before treatment and 4 weeks after treatment,visual analogue scale(VAS),Japanese orthopaedic association(JOA)and Oswestry disability index(ODI)scores were used to evaluate the efficacy,6 min level walking test was used to observe the distance of intermittent claudication,nylon rope test was used to observe the skin sensory disturbance,and changes in serum interleukin-1β(IL-1β),tumor necrosis facter-α(TNF-α)and prostaglandin E2(PGE2)levels were detected.The overall effective rate and recurrence rate were followed up 3 and 6 months after treatment.Adverse reactions and complications were observed.There was no significant difference in gender,age,disease duration,and preoperative general data between the two groups(P>0.05).Results:Both groups were successfully followed up.Compared with those before treatment,VAS and ODI scores of the two groups were significantly decreased,JOA scores were significantly increased,the intermittent claudication distance and skin sensory disturbance were significantly improved,and the serum levels of IL-1β,TNF-α,and PGE2 were significantly decreased after 4 weeks of treatment in the two groups(P<0.01).Compared with the control group,there were significant differences in VAS,JOA,ODI scores,intermittent claudication distance,and skin sensory disturbance 4 weeks after treatment in the observation group(P<0.05),and there was no significant difference in serum IL-1β,TNF-α,and PGE2 levels between the two groups(P>0.05).After 3 months and 6 months of follow-up,the overall effective rate of the observation group was higher than that of the control group,and the recurrence rate was lower than that of the control group,and the differences were statistically significant(P<0.05).Conclusion:Ultrasound-guided small needle-knife combined with Tongdu Huoxue decoction can effectively relieve the clinical symptoms of lumbar spinal stenosis of kidney deficiency and blood stasis type,inhibit the expression of inflammatory factors and related mediators,with good safety,high efficiency and reliable long-term efficacy.And ultrasound-guided small needle-knife directly releasing the ligament flavum has more advantages in reducing pain,improving lumbar function,improving walking ability and relieving numbness.

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备注/Memo

备注/Memo:
基金项目:武汉体育学院附属医院科研计划资助项目(WTFY202310)
湖北省中医药管理局中医药科研项目(ZY2025L127)
△通信作者 E-mail:54167657@qq.com
更新日期/Last Update: 2025-07-15