腰椎牵引治疗椎间盘突出症所致神经根性疼痛:424名参与者的随机、开放标签、优效性对照试验

Lumbar Tractions in Radicular Pain Caused by Herniated Disc: Randomised, Open-Label, Superiority, and Controlled Trial on 424 Participants.

作者信息

Bernhard Elsa, Hittinger-Roux Ambre, Delaplace Helene, Pauvele Loïc, Charlot Isabelle, Geoffroy Marion, Kanagaratnam Lukshe, Eap Christophe, Mensa Christophe, Bolko Loïs, Salmon Jean-Hugues

机构信息

Department of Rheumatology, University of Reims Champagne-Ardenne (URCA), Reims University Hospital, 51100 Reims, France.

Department of Clinical Research and Public Health, University of Reims Champagne-Ardenne (URCA), University Hospital of Reims, 51100 Reims, France.

出版信息

J Clin Med. 2025 Jul 22;14(15):5192. doi: 10.3390/jcm14155192.

Abstract

: Radicular pain is a frequent pathology, and disc herniation is the commonest aetiology. A meta-analysis summarising international guidelines for radicular pain, published in 2021, showed that lumbar traction's place is still a topic of debate. In this study, our aim was to evaluate the effectiveness of lumbar tractions in treating radicular pain of discal origin in association with medical treatment versus medical treatment alone. We performed a randomised, controlled, interventional, prospective, superiority trial in Reims Hospital Rheumatology Unit. : We included participants with radicular pain and concordant disc herniation with ambulatory treatment failure. Participants were randomised into two groups: medical group (analgesics, anti-inflammatories treatments, at least two epidural injections); tractions group with this medical treatment associated with lumbar tractions. The primary outcome was the difference in the proportion of participants experiencing a minimum of 25% improvement in radicular pain at one month follow-up between the two groups. : We included 424 participants: 211 in the tractions group and 213 in the medical group. We analysed 388 participants (194 in each group). We collected demographic and clinical data, lumbar and radicular Numeric Pain Scale at baseline, one and three months. A statistical difference was found for the primary outcome: 120/194 participants (62%) in tractions group and 98/194 participants (51%) in medical group ( = 0.024). : To our knowledge, this is the first randomised and controlled study on this topic with these results. We can assert the superiority of lumbar tractions in association with medical treatment over medical treatment alone for radicular pain with concordant disc herniation.

摘要

神经根性疼痛是一种常见的病症,椎间盘突出是最常见的病因。2021年发表的一项总结神经根性疼痛国际指南的荟萃分析表明,腰椎牵引的地位仍是一个有争议的话题。在本研究中,我们的目的是评估腰椎牵引联合药物治疗与单纯药物治疗相比,在治疗椎间盘源性神经根性疼痛方面的有效性。我们在兰斯医院风湿病科进行了一项随机、对照、干预性、前瞻性、优效性试验。

我们纳入了有神经根性疼痛且伴有椎间盘突出且门诊治疗失败的参与者。参与者被随机分为两组:药物组(使用镇痛药、抗炎药治疗,至少进行两次硬膜外注射);牵引组,在这种药物治疗的基础上联合腰椎牵引。主要结局是两组在随访1个月时神经根性疼痛至少改善25%的参与者比例的差异。

我们纳入了424名参与者:牵引组211名,药物组213名。我们分析了388名参与者(每组194名)。我们收集了人口统计学和临床数据、基线、1个月和3个月时的腰椎和神经根数字疼痛量表。在主要结局方面发现了统计学差异:牵引组194名参与者中有120名(62%),药物组194名参与者中有98名(51%)(P = 0.024)。

据我们所知,这是关于该主题的第一项随机对照研究,得出了这些结果。我们可以断言,对于伴有椎间盘突出的神经根性疼痛,腰椎牵引联合药物治疗优于单纯药物治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9554/12347135/041964b0d07d/jcm-14-05192-g001.jpg

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