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推拿疗法结合传统中医功法治疗症状性腰椎间盘突出症的临床疗效:一项多中心随机对照试验方案

Clinical efficacy of Tuina therapy combined with traditional Chinese exercises in the treatment of symptomatic lumbar disc herniation: a multicentre randomised controlled trial protocol.

作者信息

Fan Zhihong, Jia Shenghong, Zhou Xin, Li Chao, Shao Jiahao, Liu Xiaofeng, Liao Yitao, Xu Yenan, He Dandan, Wu Shixiang, Zhang Xian

机构信息

Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine, Wuxi, China.

Department of Spine, Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine, Wuxi, China.

出版信息

Front Neurol. 2025 Jan 24;16:1497933. doi: 10.3389/fneur.2025.1497933. eCollection 2025.

Abstract

BACKGROUND

Low back pain and lower extremity sensory and functional abnormalities are common symptoms of lumbar disc herniation (LDH), which can easily cause walking dysfunction and significantly impair the quality of life of patients. Tuina and traditional Chinese exercises (TCEs) are effective in relieving pain and restoring dysfunction, and both are often used in China as a combination of passive therapy and active exercise to ease symptoms in patients with LDH. However, the majority of current clinical trials on the treatment of LDH with Tuina or TCEs are single-centre clinical studies, and the quality of these studies is generally low. Furthermore, clear evidence of clinical efficacy as to whether Tuina combined with TCEs is superior to single TCEs for improving dysfunction and pain in patients with LDH is lacking.

METHODS/DESIGN: The design is a multicentre, assessor-blinded clinical randomised controlled trial. A total of 166 patients with LDH (aged 18-65 years) were recruited from four centres and randomly assigned at a 1:1 ratio to two groups: the TCE group and the Tuina combined with the TCE group. Each group received three treatments over the course of 1 week for a total of 4 weeks. The primary outcome indicator was the Oswestry Disability Index, whereas the secondary outcome indicators were the Short Form of Quality of Life Scale, the Short-Form McGill Pain Questionnaire Scale, and gait analysis. Assessments were made before the treatment, at the end of the treatment, and at the third and sixth months' follow-ups. Gait analysis was only used for comparison between the two groups before and after treatment, and did not involve follow-up. Adverse events occurring during the trial were faithfully recorded.

CONCLUSION

The results of this study are expected to provide a more effective research protocol for symptomatic LDH and an evidence-based rationale for the efficacy and safety of Tuina combined with TCEs in the treatment of symptomatic LDH.

CLINICAL TRIAL REGISTRATION

https://www.chictr.org.cn/showproj.html?proj=209956, identifier ChiCTR2300077361.

摘要

背景

腰背痛以及下肢感觉和功能异常是腰椎间盘突出症(LDH)的常见症状,极易导致行走功能障碍,严重损害患者生活质量。推拿和传统中医功法(TCEs)在缓解疼痛和恢复功能方面有效,在中国二者常作为被动治疗与主动锻炼的组合方式用于缓解LDH患者的症状。然而,目前大多数关于推拿或TCEs治疗LDH的临床试验为单中心临床研究,这些研究质量普遍较低。此外,缺乏明确证据表明推拿联合TCEs在改善LDH患者功能障碍和疼痛方面是否优于单纯TCEs。

方法/设计:本研究为多中心、评估者盲法的临床随机对照试验。从四个中心招募了总共166例LDH患者(年龄18 - 65岁),并按1:1比例随机分为两组:TCE组和推拿联合TCE组。每组在1周内接受3次治疗,共持续4周。主要结局指标为奥斯威斯残疾指数,次要结局指标为生活质量量表简表、简短麦吉尔疼痛问卷量表和步态分析。在治疗前、治疗结束时以及治疗后第3个月和第6个月随访时进行评估。步态分析仅用于两组治疗前后的比较,不涉及随访。如实记录试验期间发生的不良事件。

结论

本研究结果有望为有症状的LDH提供更有效的研究方案,并为推拿联合TCEs治疗有症状LDH的疗效和安全性提供循证依据。

临床试验注册

https://www.chictr.org.cn/showproj.html?proj=209956,标识符ChiCTR2300077361

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1a33/11802433/fe29bead601f/fneur-16-1497933-g001.jpg

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