Tesio L, Luccarelli G, Fornari M
Department of Orthopaedics, Ospedale San Raffaele, Milan, Italy.
Arch Phys Med Rehabil. 1989 Nov;70(12):831-4.
In Lind's auto-traction (LAT) for lumbago-sciatica, the patient provides traction force by pulling with the arms on a specially designed table, which also allows painless mobilization of the lumbar spine and passive traction. Two studies reported that one to 15 one-hour sessions on successive days might be sufficient to relieve pain in 25% to 90% of cases with verified lumbar disc herniation. Unfortunately, the technique imposes tiring manual efforts on the therapist and requires that the patient be transported by ambulance and confined to bed for a long time. These inconveniences were removed in a new version of the treatment proposed by Natchev. The effectiveness of Natchev's auto-traction (NAT) was evaluated in an open prospective trial on 77 patient with chronic lumbago-sciatica refractory to previous therapies, and herniation of one or more lumbar discs verified by computed tomography (CT) or myelography. Thirty-six of the 77 patients (47%) responded to the treatment in three to ten (median = 5) half-hour sessions. Pain intensity dropped to 27% (median) of the pretreatment intensity. Six months after treatment, 28 of the 36 responders were stable; only four had undergone surgery. By contrast, 20 of the 41 nonresponders had been operated on. The severity of either the radiologic or the neurologic picture was not predictive of the outcome. NAT was as effective as LAT: thus, due to its greater convenience it appears to be suitable as a routine approach in lumbar disc herniation and as a screening technique before surgery.
在用于腰腿痛-坐骨神经痛的林德自动牵引（LAT）中，患者通过在特制的桌子上用手臂牵拉来提供牵引力，该桌子还能使腰椎无痛活动并进行被动牵引。两项研究报告称，连续数日进行1至15次1小时的治疗，可能足以缓解25%至90%经证实为腰椎间盘突出症患者的疼痛。不幸的是，该技术给治疗师带来了费力的体力劳动，并且要求患者用救护车运送并长时间卧床。纳切夫提出的新版本治疗方法消除了这些不便之处。在一项开放性前瞻性试验中，对77例对先前治疗无效的慢性腰腿痛-坐骨神经痛患者以及经计算机断层扫描（CT）或脊髓造影证实有一个或多个腰椎间盘突出的患者，评估了纳切夫自动牵引（NAT）的有效性。77例患者中有36例（47%）在进行3至10次（中位数 = 5次）半小时的治疗后有反应。疼痛强度降至治疗前强度的27%（中位数）。治疗6个月后，36例有反应的患者中有28例病情稳定；只有4例接受了手术。相比之下，41例无反应的患者中有20例接受了手术。影像学或神经学表现的严重程度并不能预测治疗结果。NAT与LAT效果相同：因此，由于其更大的便利性，它似乎适合作为腰椎间盘突出症的常规治疗方法以及手术前的筛查技术。
