摘要
目的比较骨盆矢状位参数变化视角下三维与四维整脊牵引疗法治疗退变性腰椎滑脱症(DLS)的临床疗效。方法回顾性选取2022年6月至2024年6月陕西省核工业二一五医院收治的100例DLS患者,参考不同整脊牵引疗法分为三维组(常规治疗+三维牵引,n=50)与四维组(常规治疗+四维牵引,n=50)。比较两组患者治疗前、治疗完成时、治疗后3个月的疼痛程度[视觉模拟评分法(VAS)]评分、腰椎功能[日本矫形科学学会(JOA)]评分、腰曲弓顶距离、腰椎冠状面Cobb角、腰椎前凸指数,以及治疗完成时、治疗后3个月的椎体滑移复位率,治疗前、治疗完成时、治疗后3个月的腰骶-骨盆矢状位参数[腰椎前凸角(LL)、骶骨倾斜角(SS)],并于治疗后3个月评估两组患者的临床疗效。结果(1)较治疗前,两组患者治疗完成时、治疗后3个月VAS评分均更低,差异均有统计学意义(P<0.05);两组患者治疗完成时、治疗后3个月的VAS评分比较,差异均无统计学意义(P>0.05)。(2)较治疗前,两组患者治疗完成时、治疗后3个月JOA评分均更高,差异均有统计学意义(P<0.05);两组患者治疗完成时、治疗后3个月JOA评分比较,差异均无统计学意义(P>0.05)。(3)较治疗前,两组患者治疗完成时、治疗后3个月腰曲弓顶距离更高,腰椎冠状面Cobb角、腰椎前凸指数更低,差异均有统计学意义(P<0.05);较四维组,三维组患者治疗完成时腰曲弓顶距离更高[(17.59±3.64)mm vs.(15.62±3.07)mm],腰椎冠状面Cobb角[(6.19±1.17)°vs.(7.08±1.26)°]及腰椎前凸指数更低[(20.18±3.71)mm vs.(22.12±2.96)mm],差异均有统计学意义(P<0.05);治疗后3个月,两组患者腰曲弓顶距离、腰椎冠状面Cobb角及腰椎前凸指数比较,差异均无统计学意义(P>0.05)。(4)两组患者治疗完成时、治疗后3个月椎体滑移复位率差异均无统计学意义(P>0.05)。(5)较治疗前,两组患者治疗完成时、治疗后3个月LL、SS均更低,差异均有统计学意义(P<0.05);较四维组,三维组治疗完成时的LL[(40.96±4.31)°vs.(44.42±5.17)°]、SS[(30.11±4.08)°vs.(32.34±4.51)°]均更低,差异均有统计学意义(P<0.05);治疗后3个月,两组患者的LL、SS比较,差异均无统计学意义(P>0.05)。(6)两组患者治疗后3个月总有效率比较,差异无统计学意义(P>0.05)。结论DLS治疗中三维、四维牵引法均疗效良好,均可改善患者腰椎功能,缓解疼痛,但三维牵引对腰椎曲度、LL、SS改善更佳。
Objective To compare the clinical efficacy of three-dimensional(3D)and four-dimensional(4D)chiropractic traction therapy in the treatment of degenerative lumbar spondylolisthesis(DLS)from the perspective of changes in pelvic sagittal parameters.Methods A total of 100 patients with DLS admitted to NO.215 Hospital of Shaanxi Nuclear Industry from June 2022 to June 2024 were retrospectively selected and divided into 3D group(conventional treatment+3D traction,n=50)and 4D group(conventional treatment+4D traction,n=50)according to different chiropractic traction therapies.The pain[visual analogue scale(VAS)score],lumbar function[Japanese Orthopaedic Association(JOA)score],lumbar kyphosis apex distance,lumbar coronal Cobb angle,lumbar lordosis index before treatment,the completion of treatment and 3 months after treatment of the two groups were compared,vertebral slip reduction rate at the completion of treatment and 3 months after treatment,lumbar-sacral pelvic sagittal parameters[lumbar lordosis(LL),sacral slope(SS)]before treatment,the completion of treatment and 3 months after treatment were compared between the two groups.The clinical efficacy of the two groups was evaluated 3 months after treatment.Results(1)Compared with before treatment,the VAS scores of the two groups were lower than those at the completion of treatment and 3 months after treatment,and the differences were statistically significant(P<0.05).There were no statistically significant differences in VAS score between the two groups at the time of completion of treatment and 3 months after treatment(P>0.05).(2)Compared with before treatment,both groups had significantly higher JOA scores at the end of treatment and 3 months post-treatment(P<0.05).Compared with before treatment,the JOA scores of the two groups were higher at the completion of treatment and 3 months after treatment,and the differences were statistically significant(P<0.05).(3)Compared with before treatment,the distance of lumbar curvature arch top was higher,the Cobb angle of lumbar coronal plane and lumbar lordosis index were lower at the completion of treatment and 3 months after treatment in the two groups,and the differences were statistically significant(P<0.05).Compared with the 4D group,the 3D group had higher lumbar curvature arch distance[(17.59±3.64)mm vs.(15.62±3.07)mm],lower lumbar coronal Cobb angle[(6.19±1.17)°vs.(7.08±1.26)°]and lower lordosis index[(20.18±3.71)mm vs.(22.12±2.96)mm]at the end of treatment,and the differences were statistically significant(P<0.05);3 months after treatment,there were no statistically significant difference in lumbar kyphosis apex distance,lumbar coronal Cobb angle,and lordosis index between the two groups(P>0.05).(4)There was no statistically statistically significant difference in vertebral slip reduction rate between the two groups at the end of treatment and 3 months after treatment(P>0.05).(5)Compared with before treatment,the LL and SS of the two groups were lower at the completion of treatment and 3 months after treatment,and the differences were statistically significant(P<0.05).Compared with the 4D group,the 3D group had lower the LL[(40.96±4.31)°vs.(44.42±5.17)°]and SS[(30.11±4.08)°vs.(32.34±4.51)°]at the completion of treatment,and the differences were statistically significant(P<0.05).At 3 months after treatment,there were no statistically significant differences in LL and SS between the two groups(P>0.05).(6)There was no statistically significant difference in the total effective rate between the two groups 3 months post-treatment(P>0.05).Conclusion Both 3D and 4D traction methods are effective in the treatment of DLS,can improve lumbar function and relieve pain,but 3D traction is better for improving lumbar curvature,LL,and SS.
作者
费国策
潘建宏
王争刚
陈尚军
李宝明
张彬
FEI Guoce;PAN Jianhong;WANG Zhenggang(Department of Orthopedics,NO.215 Hospital of Shaanxi Nuclear Industry,Xianyang Shaanxi 712000,China;Department of Pediatric Orthopedics-Trauma Orthopedics,NO.215 Hospital of Shaanxi Nuclear Industry,Xianyang Shaanxi 712000,China;Department of Trauma Orthopedics,NO.215 Hospital of Shaanxi Nuclear Industry,Xianyang Shaanxi 712000,China)
出处
《临床和实验医学杂志》
2025年第14期1554-1558,共5页
Journal of Clinical and Experimental Medicine
基金
陕西省重点研发计划项目(编号:L2023-ZDYF-SF-033)。
关键词
疼痛
退变性腰椎滑脱症
三维牵引
四维牵引
腰骶-骨盆矢状位参数
Pain
Degenerative lumbar spondylolisthesis
Three-dimensional traction
Four-dimensional traction
Lumbosacral pelvic sagittal position parameters
作者简介
通信作者:王争刚,Email:2363956404@qq.com。
