Manipulation Treatment For Lumbar Disc Herniation

English AbstractManipulation treatment for lumbar disc herniation-Evaluation of the effect based on literature research and clinical trialsLumbar disc herniation (Lumbar disc herniation, LDH), is a common disease, is the most common cause of low back pain. The disease has brought great suffering to patients and lead to his working ability, learning ability, decreased quality of life, and even disability. Clinical indications for non-surgical patients with LDH wide variety of conservative methods, traditional Chinese medicine also has unique perspectives and approaches, such as massage, taking herbs and prescription, topical creams traditional Chinese medicine, acupuncture, etc., have become a doctor, patients received a good way. However, many Chinese medicine approach, but also to bring some standardization of the drawbacks of the treatment. Application of scientific methods of modern medicine, Chinese medicine treatment of LDH objective evaluation of the program, tap a set of standardized, effective, economical and safe treatment in Chinese medicine for the treatment of this disease system, the establishment of standardized grass-roots promotion applications to The Chinese bone-setting academic standards for the establishment of a certain significance.This thesis follows the thinking of evidence-based medicine, from the perspective of philology, application evaluation methods, systems, analyze the past ten years Traditional Chinese Medicine in Treatment of randomized control trials of LDH, digging out a set of standardized, credible and effective LDH manual therapy program. And through epidemiological survey in the form of domestic specialists to carry out the demonstration program questionnaire to obtain professional recognition and advice. Finally, the optimization of the treatment program be re-used in clinical practice, through a multi-center, large sample, randomized controlled trials of efficacy and safety of further clinical validation, to obtain a clear effect of Chinese character and Chinese medicine treatment options, and to promote the use of grass-roots level.PartⅠResearch LiteratureA. Chinese medicine in recent years the treatment of lumbar disc herniation Quality Assessment of Randomized Controlled Trials1 Research MethodsExtensive collection, collation, analysis years of Chinese medicine treatment of lumbar disc herniation randomized control trials, quality assessment, in order to further tap the standardization of Chinese medicine treatment of the disease to prepare.2 results2.1 The situation of literature selectedIncluded in the 2000 to 2009, six months medical treatment of lumbar disc herniation randomized control trials of 392.2.2 The general literatureDocuments released last five years there is increasing trend. Nearly half of the literature on randomized controlled single-core or dual-core journals, only 8% of the studies mentioned Fund. Most of the studies did not mention the method of randomization, only two documents can be hidden random program. Taking into account the practices of Chinese medicine such as acupuncture, etc. in the special treatment, is mostly blind outcome measurements and statistical analysis based blind. Sample size estimation problem is that these documents exist in the absence of uniform, judging from the distribution of sample size, the average sample size was 170. About 1/3 of literature referred to the study exclusion criteria included standards or conditions, about 1/4 of the document explained the baseline comparability between groups. Excluding cases and loss of cases reported observation on the safety conditions, adverse reaction reports and deal with the situation, little.1/3 of the randomized controlled literature does not explain the source of diagnostic criteria, half of the diagnostic criteria derived from the theory of Chinese medicine with or national standards/industry standards. The single most frequently referenced book/standards promulgated by the State Administration of Traditional Chinese Medicine "TCM Lung Cancer"; is the most co-reference is issued by the State Administration of Traditional Chinese Medicine "TCM Lung Cancer," and Hu Gu "lumbar disc herniation." Reported in the literature of Chinese medicine treatment of lumbar disc herniation mainly concentrated in the 1 week to 4 weeks.Nearly 2/3 of the improvement in symptoms and signs according to the use of "excellent, good, and poor," "cured, markedly effective, effective, not cured," "cured, improved, invalid" and 4 or 3 indicators to judge its efficacy; about 1/5 of the literature using a visual analogue scale (VAS), a variety of scales assessed efficacy of the method; are few studies using more objective indicators, such as the analgesic effect onset time, under the somatosensory evoked potentials, nerve humoral factors to determine the effect of changes in circumstances.For the evaluation standard,1/3 of the literature does not explain the specific source; have around sixty percent of the study of the efficacy of standard or from one of the country/industry standards. Most of the or by reference to national/industry standards promulgated by the State Administration of Traditional Chinese Medicine "TCM Lung Cancer." Most are co-referenced standards are promulgated by the State Administration of Traditional Chinese Medicine "TCM Lung Cancer" and the JOA.1/10 studies reported follow-up cases were followed up from 2 months to 3 years, and most were used in follow-up time is 6 months, followed by 1 year, again in three months.Health Economics indicators are rarely mentioned in the literature section.B. Practices in recent years treatment of lumbar disc herniation in the treatment of Meta-analysis of literature1 Research MethodsComprehensive collection, analysis methods of Chinese medicine in recent years as the main interventions for lumbar disc herniation randomized controlled trial, on the other conservative treatment methods and compared the efficacy of Meta-analysis to high-quality literature from the perspective of Chinese medicine practice evaluation effectiveness of treatment of the disease.2 Results2.1 simply means the treatment group compared with the traction group Meta-Analysis Suggest a simple approach for lumbar disc herniation is more effective than simple traction.2.2 simply means the treatment group compared with the Chinese group Meta-AnalysisSuggest a simple approach for lumbar disc herniation is not better than traditional Chinese medicine.2.3 simply means the treatment group compared with the acupuncture group Meta-AnalysisSuggest a simple approach for lumbar disc herniation is not better than acupuncture.2.4 characteristics and traditional practices group practices Group Meta-analysis of comparative therapySuggest features used in lumbar disc herniation treated better than the traditional approach.2.5 Integrated approach with traditional Chinese medicine treatment group compared with the simple Meta-Analysis of Traditional Chinese MedicineTips integrated approach with traditional Chinese medicine treatment of lumbar disc herniation was better than traditional Chinese medicine.2.6 Integrated approach+acupuncture group compared with the simple Meta-analysis of acupunctureTips practices+Acupuncture and the treatment of lumbar disc herniation was better than acupuncture.3 ConclusionMeta-analysis according to the literature, show that a simple approach for lumbar disc herniation is more effective than simple traction; characteristics of manual therapy more effective than traditional methods, the characteristics mentioned in the literature methods are:oblique pulling, rotation, and chiropractic France; simple effect of manual therapy is not better than traditional Chinese medicine, but traditional Chinese medicine techniques and the efficacy of combined therapy better than traditional Chinese medicine; simple method of treatment efficacy is not better than acupuncture, but way better than the combined treatment with acupuncture simple acupuncture. But also noteworthy, according to "funnel plot" shows the results of the Meta analysis have certain "publication bias."PartⅡClinical EpidemiologyChinese Medicine Conservative Treatment of Lumbar Disc Herniation Current Status1 Research MethodsBased on literature research and expert experience, through the questionnaire in the form of Chinese medicine on the municipal common conservative treatment of lumbar disc herniation method to investigate practices of the characteristics of famous traditional Chinese treatment of the disease to investigate the degree of acceptance for the development of safe, effective, economic, and applicable Chinese medicine program of conservative treatment of lumbar disc herniation to provide reference information.2 ResultsThe survey results show that rolling method, compression method and the rolling method is most commonly used tendon technique (relaxation techniques), lateral position oblique pulling, pulling legs, waist and pull push push back shoulder is the most commonly used method treatment practices. Have senior professional titles of the respondents choose these types of practices was significantly higher than the proportion of intermediate grade and junior professional titles. Awareness of safety practices for the vast majority of respondents recognized at a reasonable standard to use under way, Chinese medicine treatment methods are safe. The older title of higher education the higher of the respondents given more to accept our standard practices of lumbar disc herniation treatment programs, and more willing to participate in training to master the law, is willing to promote the use of the law.PartⅢClinical trialsTreatment of lumbar disc herniation standard manipulation of multi-center, randomized controlled trial1 Research Methods A multicenter, randomized controlled trial, in the period of December 30,2008-December 21,2009 chosen for this study, the patient inclusion criteria 176 patients with lumbar disc herniation were divided into experimental group (standard manipulation group) and control group (traction therapy group) for three weeks during treatment and follow-up period Cancer. Final 169 patients completed 3 weeks of observation during the course of treatment, of which 143 patients completed 6 weeks of follow-up.2 Results2.1 The two groups efficacy Comparison in the end of the treatmentThe test group the total effective rate was 91.76%, control group was 86.90% effective. Theχ2 test between two groups was statistically significant, indicating the number of test group effective than the control group.2.2 The end of follow-up period compared two groups of recurrenceThe test group the recurrence rate was 6.85%, the recurrence rate was 12.86% in control group. Recurrence by theχ2 test groups showed no significant difference, yet the recurrence rate can not explain the experimental group than the control group.2.3 Comparison of JOA score improvement rate in both groupsTreatment, follow-up JOA score at the end of the two groups were both statistically significant difference, indicating the end of treatment, follow-up JOA score at the end of the test group were better than the control group.2.4 The effect of two trends in the various time pointsIn each observation point, two groups of "control", "markedly", "Invalid / recurrence" no significant difference between the number of "effective" number of statistically significant difference (P=0.026), explain the treatment group de facto " effective "number than the control group.2.5 The efficacy between two groups in the treatment period and follow-up indicators of improvementClinical indicators of two groups each week, no significant improvement in the situation.Treatment after two weeks of the JOA score / straight leg raising test angle and the week after treatment, no significant difference, RMD score/VAS score and the week after there was significant difference between the shows two weeks of the treatment group RMD after the score/VAS score than the control group.Treatment after three weeks RMD rating/straight leg raising test angle and two weeks after treatment no significant difference, JOA score/VAS score and two weeks later there was significant difference, indicating the treatment group After three weeks RMD rating/VAS score than the control group.Two follow-up period of the four indicators and the end of treatment showed significant difference, indicating the test group of four indicators of change in follow-up than the control group.3 Conclusion3.1 Compared with pelvic traction the lumbar standard manipulation is a safe, effective treatment superior in improving symptoms of lumbar disc herniation in patients with lowback pain, signs and activities of daily living have a significant effect, the total effective rate 91.76%, statistical tests show the effective rate superior traction therapy.3.2 Follow-up period of recurrence statistics, standard lumbar manual therapy group than the number of recurrent pelvic traction group, but from a statistical point of view can not explain the relapse rate between the two groups are different.3.3 On the treatment of the three other time-points and follow-up period of efficacy trends show that standard lumbar manual therapy control, markedly effective rate more than the number of pelvic traction group, recurrence is less than the number of pelvic traction group. Standard approach in the treatment of lumbar description of each phase of the superior efficacy of traction therapy, efficacy of a more stable, better controlled, but also shows pelvic traction than the standard approach to faster and more effectively improve the patients with lumbar disc herniation low back pain symptoms, signs and activities of daily living.3.4 Through the pain scale, life scale, function improvement Clinical evaluation of quantitative evaluation of various means of integrated applications, can be seen throughout the study the changes in these outcome measures differ. RMD and the VAS is more sensitive indicators of change, in the second week of treatment have been significantly different, but the change in VAS is more stable than the RMD; JOA involved in the evaluation of daily life, the contents of the third week of treatment has been changed, and stability to keep the follow-up period; straight leg raising angle is the most slowly changing the target, during treatment and can not show changes in the difference However, changes in the follow-up period was statistically significant.This shows that the JOA, RMD, VAS of three commonly used in the evaluation of lumbar disc herniation of the quantitative targets for treatment and follow-up evaluation of the credibility of the period is consistent, and straight leg raising angle measurement can be used as follow-up phase of the evaluation indicators.