| 摘要: |
| [目的] 探究身痛逐瘀汤联合针刀对腰椎间盘突出症（LDH）患者脊柱-骨盆矢状位参数及腰椎功能的影响。[方法] 回顾性选择2022年3月—2025年3月于淮安市中医院收治的180例LDH患者为研究对象。依据是否服用身痛逐瘀汤分为对照组和研究组，通过倾向性评分匹配法调整基线数据差异。分析2组患者间的中医症状评分、疗效及不良反应。采用广义估计方程（GEE）分析治疗方法对脊柱-骨盆矢状位参数的影响，构建双重差分（DID）模型分析腰椎ROM参数及评分变化特征，分层分析患者腰椎功能未恢复发生风险。[结果] 治疗后，两组腰腿刺痛、腰部板硬、腰腿麻木、转侧不利、昼轻夜重中医症状评分均明显下降，且研究组治疗后中医症状评分均低于对照组（P<0.05）；研究组临床疗效的总有效率明显高于对照组临床疗效的总有效率（P<0.05）；研究组不良事件发生率明显低于对照组（P<0.05）。GEE结果显示，研究组骶骨倾斜角（SS）、腰椎前凸角（LL）升幅更大，骨盆倾斜角（PT）、矢状面垂直轴（SVA）、胸椎后凸角（TK）降幅更大，明显优于对照组（P<0.05）。DID单模型结果表明，研究组前屈、后伸、侧屈、旋转水平及日本骨科协会（JOA）评分较对照组分别多升高7.078 °、4.512 °、3.799 °、4.874 °、3.382分，视觉模拟（VAS）评分较对照组多降低0.553分（P<0.05）；DID全模型结果表明，研究组干预后前屈、后伸、侧屈、旋转水平及JOA评分升高幅度较对照组分别多出7.078 °、4.512 °、3.969 °、5.048 °、3.398分，VAS评分较对照组低出0.593分（P<0.001）。进一步分层分析结果显示，在各年龄、身体质量指数（BMI）≤24.60 kg/m2、病程、PT>14.28 °、SS≤33.30 °、LL≤45.63 °、SVA≤-15.42 mm、TK≤22.40 °分层水平中，研究组患者腰椎功能未恢复的风险均小于对照组（P<0.05）。[结论] 身痛逐瘀汤联合针刀治疗LDH，可改善中医症状、提升疗效、降低不良反应，优化脊柱-骨盆矢状位参数，促进腰椎功能恢复，尤其对年轻、病程短、BMI适中患者效果更明显，为临床治疗提供有效方案。 |
| 关键词: 脊柱-骨盆参数 身痛逐瘀汤 针刀 腰椎间盘突出症 腰椎功能 |
| DOI：10.11656/j.issn.1672-1519.2026.09.05 |
| 分类号:R274.9 |
| 基金项目: |
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| Impact of Shentong Zhuyu Decoction combined with acupotomy on lumbar function in patients with lumbar disc herniation based on spinal-pelvic sagittal parameters |
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YU Dapeng1, ZHAO Xu1, BAI Yang1, CHU Hui2
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1.Department of Orthopedics, Huai'an Hospital of Traditional Chinese Medicine, Huai'an, 223000, China;2.Department of Surgery, Huai'an Fourth People's Hospital, Huai'an 223000, China
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| Abstract: |
| [Objective] To explore the effects of Shentong Zhuyu Decoction combined with acupotomy therapy on the spinal- pelvic sagittal parameters and lumbar function of patients with lumbar disc herniation（LDH）. [Methods] A retrospective selection was made of 180 patients with LDH who were admitted to Huai'an Hospital of Traditional Chinese Medicine from March 2022 to March 2025 as the research subjects. These patients were divided into the control group and the study group based on whether they took Shentong Zhuyu Decoction. The baseline data differences were adjusted through the propensity score matching method. The Chinese symptom scores，therapeutic effects，and adverse reactions of the two groups of patients were analyzed. The generalized estimating equation （GEE）was used to analyze the influence of treatment methods on the sagittal spinal-pelvic parameters. The Difference-in-Differences （DID）model was constructed to analyze the characteristics of changes in lumbar ROM parameters and scores. Stratified analysis was conducted on the risk of non -recovery of lumbar spine function in patients. [Results] After the treatment，the scores of traditional Chinese medicine symptoms such as waist and leg stabbing pain，stiff waist，numbness in waist and legs，difficulty in turning over，and mild during the day and severe at night，in both groups，decreased significantly. Moreover，the scores of traditional Chinese medicine symptoms in the study group after treatment were lower than those in the control group（P<0.05）；the total effective rate of clinical efficacy in the study group was significantly higher than that in the control group（P<0.05）. The incidence of adverse events in the research group was significantly lower than that in the control group（P<0.05）. The GEE results showed that the increase in the sacral slope（SS）and lumbar lordosis angle（LL）in the study group was greater，while the decrease in the pelvic inclination angle（PT）， sagittal vertical axis（SVA），and thoracic kyphosis angle（TK）was greater in the study group compared to the control group（P<0.05）. The results of the DID single model indicated that the study group had a higher increase in flexion，extension，lateral flexion，rotational level，and Japanese Orthopedic Association（JOA）score compared to the control group by 7.078°，4.512°，3.799°，4.874°，and 3.382 points respectively，and a lower visual analogue scale（VAS）score by 0.553 points（P<0.05）；the results of the DID full model indicated that the increase in the study group’s flexion，extension，lateral flexion，rotational level，and JOA score was greater than that of the control group by 7.078°，4.512°，3.969°，5.048°，and 3.398 points respectively，and the VAS score was lower by 0.593 points（P< 0.001）. Further stratified analysis results showed that in each age group，body mass index（BMI）≤24.60 kg/m2，disease duration，PT> 14.28°，SS≤33.30°，LL≤45.63°，SVA≤-15.42 mm，TK≤22.40° stratified levels，the risk of lumbar function not recovering in the study group was less than that in the control group（P<0.05）. [Conclusion] Shentong Zhuyu Decoction combined with acupotomy can improve TCM symptoms，enhance efficacy，reduce adverse reactions，optimize spinal-pelvic sagittal parameters，and promote lumbar function recovery in LDH patients，particularly showing more significant effects in younger patients with shorter disease duration and moderate BMI，providing an effective clinical treatment option. |
| Key words: spinal-pelvic parameters Shentong Zhuyu Decoction acupotomy lumbar disc herniation lumbar function |
