Oka Hiroyuki, Matsudaira Ko, Takano Yuichi, Kasuya Daichi, Niiya Masaki, Tonosu Juichi, Fukushima Masayoshi, Oshima Yasushi, Fujii Tomoko, Tanaka Sakae, Inanami Hirohiko
Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, Faculty of Medicine, University of Tokyo, Hongo 7-3-1, Bunkyo, Tokyo, 113-8655, Japan.
Department of Orthopedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan.
BMC Complement Altern Med. 2018 Jan 19;18(1):19. doi: 10.1186/s12906-018-2087-y.
Although the efficiency of conservative management for lumbar spinal stenosis (LSS) has been examined, different conservative management approaches have not been compared. We have performed the first comparative trial of three types of conservative management (medication with acetaminophen, exercise, and acupuncture) in Japanese patients with LSS.
Patients with L5 root radiculopathy associated with LSS who visited our hospital for surgical treatment were enrolled between December 2011 and January 2014. In this open-label study, patients were assigned to three treatment groups (medication, exercise, acupuncture) according to the visit time. The primary outcomes were Zurich claudication questionnaire (ZCQ) scores before and after 4 weeks of treatment. Least square mean analysis was used to assess the following dependent variables in the treatment groups: changes in symptom severity and physical function scores of the ZCQ and the ZCQ score of patient's satisfaction after treatment.
Thirty-eight, 40, and 41 patients were allocated to the medication, exercise, and acupuncture groups, respectively. No patient underwent surgical treatment during the study period. The symptom severity scores of the ZCQ improved significantly after treatment in the medication (p = 0.048), exercise (p = 0.003), and acupuncture (p = 0.04) groups. The physical function score improved significantly in the acupuncture group (p = 0.045) but not in the medication (p = 0.20) and exercise (p = 0.29) groups. The mean reduction in the ZCQ score for physical function was significantly greater for acupuncture than for exercise. The mean ZCQ score for treatment satisfaction was significantly greater for acupuncture than for medication.
Acupuncture was significantly more effective than physical exercise according to the physical function score of the ZCQ and than medication according to the satisfaction score. The present study provides new important information that will aid decision making in LSS treatment.
This study was registered with the UMIN Clinical Trials Registry ( UMIN000006957 ).
虽然已经对腰椎管狭窄症（LSS）保守治疗的疗效进行了研究，但不同的保守治疗方法尚未进行比较。我们在日本LSS患者中开展了三种保守治疗方法（对乙酰氨基酚药物治疗、运动疗法和针灸疗法）的首次对比试验。
2011年12月至2014年1月期间，纳入因L5神经根型病变伴LSS前来我院接受手术治疗的患者。在这项开放标签研究中，根据就诊时间将患者分为三个治疗组（药物治疗组、运动治疗组、针灸治疗组）。主要结局指标为治疗4周前后的苏黎世跛行问卷（ZCQ）评分。采用最小二乘均值分析评估治疗组中以下因变量：ZCQ症状严重程度和身体功能评分的变化以及治疗后患者满意度的ZCQ评分。
分别有38例、40例和41例患者被分配至药物治疗组、运动治疗组和针灸治疗组。研究期间无患者接受手术治疗。药物治疗组（p = 0.048）、运动治疗组（p = 0.003）和针灸治疗组（p = 0.04）治疗后ZCQ症状严重程度评分均显著改善。针灸治疗组身体功能评分显著改善（p = 0.045），而药物治疗组（p = 0.20）和运动治疗组（p = 0.29）未显著改善。针灸治疗组身体功能的ZCQ评分平均降低幅度显著大于运动治疗组。针灸治疗组治疗满意度的平均ZCQ评分显著高于药物治疗组。
根据ZCQ身体功能评分，针灸疗法比体育锻炼显著更有效；根据满意度评分，针灸疗法比药物治疗显著更有效。本研究提供了有助于LSS治疗决策的重要新信息。
本研究已在UMIN临床试验注册中心注册（UMIN000006957）。
