Qin Xiaokuan, Sun Kai, Xu Weiguo, Gao Jinghua, Jiang Hong, Chen Wei, Zhang Ling, Li Zhenhua, Li Wuyin, Yuan Puwei, Yang Kexin, Tong Peijian, Zhong Yuanming, Zhu Xiaofeng, Wan Xiaoming, He Chengjian, Wang Yanguo, Xu Xilin, Huang Yong, Zhang Zhihai, Huang Yifei, Guo Wei, Cao Junling, Feng Tianxiao, Wang Xu, Yin Yuhui, Wang Hao, Sun Chuanrui, Xiao Xiangyu, Wei Xu, Zhu Liguo
Department of Spine II, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Department of Orthopaedics, Tianjin Hospital, Tianjin, China.
J Evid Based Med. 2024 Mar;17(1):187-206. doi: 10.1111/jebm.12598. Epub 2024 Mar 19.
Lumbar disc herniation (LDH), as one of the most common causes of lower back pain, imposes a heavy economic burden on patients and society. Conservative management is the first-line choice for the majority of LDH patients. Traditional Chinese medicine (TCM) is an important part of conservative treatment and has attracted more and more international attention.
Evidence-based guideline.
We formed a guideline panel of multidisciplinary experts. The clinical questions were identified on the basis of a systematic literature search and a consensus meeting. We searched the literature for direct evidence on the management of LDH and assessed its certainty-generated recommendations using the grading of recommendations, assessment, development, and evaluation (GRADE) approach.
The guideline panel made 20 recommendations, which covered the use of Shentong Zhuyu decoction, Shenzhuo decoction, Simiao San decoction, Duhuo Jisheng decoction, Yaobitong capsule, Yaotongning capsule, Osteoking, manual therapy, needle knife, manual acupuncture, electroacupuncture, Chinese exercise techniques (Tai Chi, Baduanjin, or Yijinjing), and integrative medicine, such as combined non-steroidal anti-inflammatory drugs, neural nutrition, and traction. Recommendations were either strong or weak, or in the form of ungraded consensus-based statement.
This is the first LDH treatment guideline for TCM and integrative medicine with a systematic search, synthesis of evidence, and using the GRADE method to rate the quality of evidence. We hope these recommendations can help support healthcare workers caring for LDH patients.
腰椎间盘突出症（LDH）是下腰痛最常见的病因之一，给患者和社会带来了沉重的经济负担。保守治疗是大多数LDH患者的一线选择。中医是保守治疗的重要组成部分，已引起越来越多的国际关注。
循证指南。
我们组建了一个多学科专家指南小组。临床问题是在系统的文献检索和共识会议的基础上确定的。我们检索了关于LDH治疗的直接证据，并使用推荐分级、评估、制定和评价（GRADE）方法评估其确定性以生成推荐意见。
指南小组提出了20条推荐意见，涵盖了身痛逐瘀汤、伸茁汤、四妙散、独活寄生汤、腰痹通胶囊、腰痛宁胶囊、骨通金贴、手法治疗、针刀、手工针刺、电针、中医运动技术（太极拳、八段锦或易筋经）以及中西医结合治疗，如联合使用非甾体抗炎药、神经营养药物和牵引治疗。推荐意见分为强推荐或弱推荐，或以基于共识的未分级陈述形式呈现。
这是首个针对中医和中西医结合治疗LDH的指南，采用了系统检索、证据综合，并使用GRADE方法对证据质量进行评级。我们希望这些推荐意见能够帮助医护人员照料LDH患者。
