Dai Feng, Dai Yu Xiang, Jiang Hong, Yu Peng Fei, Liu Jin Tao
Department of Orthopedics, Suzhou TCM Hospital affiliated to Nanjing University of Traditional Chinese Medicine, Suzhou, 215009, Jiangsu Province, China.
BMC Musculoskelet Disord. 2020 Oct 19;21(1):690. doi: 10.1186/s12891-020-03723-2.
BACKGROUND: Lumbar disc herniation (LDH) is mainly caused by annular fiber disruption with a discrete leakage of nucleus pulposus pressing on a nerve, resulting in back pain and radiating pain. Most patients with LDH can be treated conservatively, but there are many different conservative treatments. Furthermore, most previous studies did not evaluate the long-term efficacy of these treatments and the prognosis. Therefore, an effective and safe therapeutic strategy is lacking for patients with LDH. In this study, we evaluated Xiao Sui Hua He decoction (XSHHD) in the treatment of LDH. METHODS: This was a rigorous prospective observational 3-year follow-up study. We recruited 69 participants with ruptured lumbar disc herniation (RLDH) between February 2014 and February 2016. Patients took XSHHD orally twice a day for 6 months. The primary outcome measurements were visual analogue scale (VAS) pain score, Oswestry disability index (ODI) and straight leg raising test (SLRT). The secondary outcome measurements was nucleus pulposus protrusion volume on magnetic resonance imaging (MRI). Clinical outcomes were measured at baseline (Visit 1), and at 3, 6, 12, and 36 months (Visit 2, 3, 4, and 5, respectively).. RESULTS: Sixty-three patients were followed-up for 3 years after treatment. SLRT and ODI after non-surgical treatment improved significantly compared with baseline (P < .001). There were no statistically significant differences at 6 months vs 36 months for SLRT and ODI. VAS scores (leg, back) after 3 years of treatment were statistically significantly different compared with baseline (P < .001; Z = - 6.93, - 6.637). The baseline protrusion volume was 2018.61 ± 601.16 mm, and the volume decreased significantly to 996.51 ± 387.42 mm3 at 36 months (t = 12.863; P < .001). The volume of protrusion resorption rate (VPRR) at 36 months was 47.24 ± 23.99%, with significant resorption in 23 cases, partial resorption in 23 cases, no resorption in 15 cases, and increased volume in 2 cases. CONCLUSIONS: This study showed that non-surgical treatment with XSHHD was effective, and the study clarified the natural outcomes in LDH.
背景：腰椎间盘突出症（LDH）主要由纤维环破裂，髓核离散性漏出并压迫神经引起，导致腰痛和放射性疼痛。大多数腰椎间盘突出症患者可以采用保守治疗，但保守治疗方法繁多。此外，以往大多数研究未评估这些治疗方法的长期疗效及预后。因此，目前缺乏针对腰椎间盘突出症患者的有效且安全的治疗策略。在本研究中，我们评估了消髓化核汤（XSHHD）治疗腰椎间盘突出症的效果。 方法：这是一项严格的前瞻性观察性3年随访研究。我们在2014年2月至2016年2月期间招募了69例破裂型腰椎间盘突出症（RLDH）患者。患者每天口服消髓化核汤两次，持续6个月。主要观察指标为视觉模拟评分法（VAS）疼痛评分、Oswestry功能障碍指数（ODI）和直腿抬高试验（SLRT）。次要观察指标为磁共振成像（MRI）上的髓核突出体积。在基线（第1次就诊）以及3、6、12和36个月（分别为第2、3、4和5次就诊）时测量临床结局。 结果：63例患者在治疗后接受了3年随访。非手术治疗后的SLRT和ODI与基线相比有显著改善（P <.001）。SLRT和ODI在6个月与36个月时无统计学显著差异。治疗3年后的VAS评分（腿部、背部）与基线相比有统计学显著差异（P <.001；Z = - 6.93，- 6.637）。基线突出体积为2018.61±601.16mm³，在36个月时体积显著减小至996.51±387.42mm³（t = 12.863；P <.001）。36个月时的突出吸收体积率（VPRR）为47.24±23.99%，其中23例显著吸收，23例部分吸收，15例无吸收，2例体积增大。 结论：本研究表明，消髓化核汤非手术治疗有效，且本研究阐明了腰椎间盘突出症的自然转归。
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