Clinical Aplication And Research Of Combined Lumbar-abdominal Manipulation In The Treatment Of Lumbar Disc Herniation

Method:Research object:since2009Jan to2011Mar,75patients treated in department of neck,shoulder,lumbar and leg pain department of zhengzhou orthopaedics hospital, accord the diagnostic criteria inclusion criteria, subdivided randomly,25patients in each group。Research method:controlled group:conventional inter-venous medication and bed rest;treatment group1traditional manual treatment combined conventional inter-venous medication and bed rest;treatment group2:combined combined lumbar-abdominal manual therapy and conventional medication and bed rest.Observe index:1.clinical effect could be assessed by observing result of JOA score and relief rate, symptom assess, McGill pain questionare.VAS,PPI.2.Radiological research(x-ray lumbar vertebral cobb's angle and height of intervertebral space in lateral view),CT(intervertebral disc protrusion,posterior intervertebral protrusion angle),MRI(MRI transverse area of psoas major difference of bilateral parts in male and female)3.TXB2,IL-1β TNF-α,6-K-PGFlα4. electromyography:tibial and fibular conducting speed5.Abdominal tensity.Statistical method:statistical analysis performed by using SPSS19, t and X2test have been used for material analysis.Result:In the3groups, comparing JOA score and relief index of patients before and after treatment,in controlled group the patients received relief,but no statistical significance (p>0.05).In treatment group1and2, the results has statistical significance(p<0.05),after treatment,statistical significance exist between treatment group2and treatment group1,the JOA score and relief index in treatment group2are higher than treatment group1and controlled group.Clinical effect assessment of3groups:controlled group:25patients good:5fair:12bad:8,good rate20%total effective rate:68%.In treatment group1:25patients good:10fair:11bad:4,good rate40%, total effective rate:84%.In treatment group2:25patients good:17fair:7bad:1,good rate68%total effective rate:96%. Clinical effect in treatment group2are better than treatment group1and controlled group.Comparing the pain difference scores pre-treatment and post-treatment in these3groups: Mcgill total score, VAS, PPI score of the3group patients before and after treatment.No statistical significance between treatment group1and controlled group (p>0.05). Statistical significance exists between treatment group2and treatment group1and controlled group (p<0.05). significantly emotional improvement in treatment group2. Radiological research:x-ray lumbar vertebral cobb's angle,MRI transverse area of psoas major in these3groups has significant statistical difference (P<0.05).Biochemical analysis:TXB2,IL-1β,TNF-α amount after combined lumbar-abdominal manual therapies reduced evidently,6-K-PGFlα increased evidently than before treatment. Combined lumbar-abdominal manual therapy can improve biochemical index.Perhaps it is one of the main mechanisms.Electrophysiological research:tibial nerve and fibular nerve of related extremities conducting wave amplitude improves in observation group and treatment group1after treatment, no statistical significance (p>0.05).In treatment group2, tibial nerve and fibular nerve of related extremities conducting speed improves,and have statistical significance(p<0.05), combined lumbar-abdominal manual therapy in the treatment of lumbar intervertebral protrusion,can improve nerve conducting speed, is one of the mechanisms.Abdominal tensity research:in75patients,16"0" degree,22"1" degree,34"2" degree,3'3"degree,78.7%patients abdominal tensity increased.Conclusion:1.In this research, the clinical outcome observation of these3groups respectively, Combined lumbar-abdominal manual therapy group is obviously higher than other2groups in JOA score, the good and fair rate is68%, effective rate is96%. In pain difference scores, combined lumbar-abdominal manual therapy can relieve the pain of lumbar and leg in patients, but also can reduce the anxiety of patients strengthen the confidence,and promote their rehabilitation.2.Radiological analysis in these3groups of X ray,CT and MRI, statistical significance in lumbar vertebral cobb's angle,MRI transverse area of psoas major in combined lumbar-abdominal manual therapy group, and there is no statistical significance in analysis of intervertebral space, intervertebral disc protrusion object and posterior intervertebral protrusion angle.It proved that the combined lumbar-abdominal manual therapy can restore the lumbar vertebral balance and stable, and can not change the intervertebral disc protrusion status.3.Biochemical analysis result proved that combined lumbar-abdominal manual therapy can accelerate the blood circulation of patients, to promote metabolism, and to relieve the edema of nerve root.4.Electrophysiological research result proved that the combined lumbar-abdominal manual therapy can relieve the symptom of patients and restore the nerve conducting wave amplitude, and it maybe the mechanism.5.In this group, the abdominal tensity arc equal to the result by SLR,and abdominal tensity can be a effective supplement of intervertebral disc protrusion physical examination.