| Research background and purpose:Lumbar disc herniation(LDH)is a common disease in the department of rehabilitation medicine,being common in herniation of L4/5 and L5/S1 more than 90%,and it has become younger in recent years.The main clinical manifestations of LDH are lumbocrural pain and lumbar motion dysfunction.Clinical studies have found that lumbocrural pain caused by LDH is closely related to nerve root inflammation and increased cytokines of blood circulation.Due to inflammatory stimulation of the pain,the declining fatigue resistance of paravertebral muscle group and the instability of lumbar motion segment lead to lumbar dysfunction,which could have an impact on people's daily life.However,routine rehabilitation treatment of LDH includes traction therapy,ultrashort wave electrotherapy,medium frequency electrotherapy,magnetotherapy and other physical methods at present.The treatment has a relatively long course and takes effect slowly.Meanwhile,it is difficult to maintain compliance for patients.Extracorporeal shock wave(ESW)therapy,as a new physiotherapy method,is gradually applied in skeletal musculoskeletal system disease.It has been noted that ESW have a biological effect on pain in osteoarthritis,showing excellent therapeutic effect.ESW has become the focus of domestic and foreign researchers.There are few studies on the application of ESW in the treatment of LDH,and the mechanism of action and long-term curative effect need to be further studied.Therefore,the purpose of this study is tantamount to observe the clinical efficacy of ESW based on conventional rehabilitation treatment for LDH patients in analgesia and improvement of lumbar function.At the same time,We preliminarily explore the possible mechanism of ESW in improving the clinical symptoms of LDH patients,so as to provide a reliable clinical basis and theoretical basis for the treatment of LDH by ESW.Materials and Methods:Adopting a randomized,controlled method,88 patients,according to the order of visit,matching the inclusion criteria,were randomly divided into the Treatment Group(TG)and the Contrast Group(CG),with 44 cases in each group.The treatment plan of the CG was conservative treatment,including acupuncture,massage,traction,magnetic therapy and medium frequency,each treatment lasted for 20 min,once a day,7 days for a course of treatment,the treatment course is 2 weeks in total.The treatment plan of the TG receives ESW treatment on day 1 and day 8 based on the treatment of the CG,with the parameters of 4 bar,6 Hz,and 2000 shock in total,a total of 2 weeks.Before and after the treatment,the VAS score,Lumbar mobility assessment,Lumbar endurance assessment,JOA score,ODI questionnaire and the concentration of serum TNF-?,IL-10 and VEGF-A were evaluated the efficacy.Follow-up visit was conducted after 3 months at the end of treatment,including VAS score and ODI questionnaire,in order to ascertain the long-term efficacy.Result:1.81 patients had completed the entire trial whereas 7 patients dropped out or eliminated.The data on gender,age and course of disease in the two groups was no significant differences(P > 0.05),suggesting comparability.2.The clinical curative effect: After treatment,the excellent curative effect of TG was 90.24%,and TG was 60.0%.The excellent curative effect of TG was higher than that in CG,indicating the significant differences in statistic(P < 0.05).At the same time,the total improvement rate of TG was 87.80%,and TG was 62.50%.The excellent curative effect of TG was higher than that in CG,indicating the significant differences in statistic(P < 0.05).3.Pain score: The VAS scores of patients in the TG before and after treatment were: 6.61 ± 0.83 and 1.15 ± 1.01,and the CG were 6.60 ± 0.84 and 2.15 ± 1.12.After treatment,the VAS scores of both groups were significantly lower than before treatment(P < 0.01),and the VAS score of TG was significant lower than that in CG,indicating the significant differences in statistic(P < 0.01).Also,the time of VAS scores less than 3 points was 8.46 ± 2.25 days in TG was significant lower than 8.46 ± 2.25 days in CG,indicating the significant difference in statistic(P < 0.01).4.Lumbar functional assessment: The lumbar mobility scores of patients in the TG before and after treatment were 12.85 ± 2.40 and 1.88 ± 2.51,and the CG were 12.83 ± 2.48 and 4.05 ± 2.41.After treatment,the lumbar mobility scores of both groups were significantly lower than before treatment(P < 0.01),and the lumbar mobility score of TG was significant lower than that in CG,indicating the significant differences in statistic(P < 0.01).The duration of lumbar endurance of patients in the TG before and after treatment were 11.39 ± 4.13 s and 34.17 ± 5.33 s,and the CG were 11.98 ± 4.31 s and 31.18 ± 6.30 s.After treatment,the duration of lumbar endurance of both groups were significantly higher than before treatment(P < 0.01),and the duration of lumbar endurance of TG was higher than that in CG,indicating the significant differences in statistic(P < 0.05).The JOA scores of patients in the TG before and after treatment were 15.73 ± 2.95 and 26.41 ± 2.35,and the CG were 15.78 ± 2.46 and 24.90 ± 2.34.After treatment,the JOA scores of both groups were significantly higher than before treatment(P < 0.01),and the JOA score of TG was significant higher than that in CG,indicating the significant differences in statistic(P < 0.01).The ODI scores of patients in the TG before and after treatment were 58.45 ± 9.48 and 6.80 ± 4.93,and the CG were 57.70 ± 8.57 and 10.46 ± 5.81.After treatment,the ODI scores of both groups were significantly lower than before treatment(P < 0.01),and the ODI score of TG was significant lower than that in CG,indicating the significant differences in statistic(P < 0.01).5.Serum cytokines concentration: The serum TNF-? concentrations of patients in the TG before and after treatment were 127.63 ± 22.41 pg/ml and 44.97 ± 17.77 pg/ml,and the CG were 127.97 ± 20.03 pg/ml and 58.96 ± 20.96 pg/ml.After treatment,the serum TNF-? concentrations of both groups were significantly lower than before treatment(P < 0.01),and the serum TNF-? concentration of TG was significant lower than that in CG,indicating the significant differences in statistic(P <0.01).The serum IL-10 concentrations of patients in the TG before and after treatment were 10.78 ± 3.69 pg/ml and 53.98 ± 12.30 pg/ml,and the CG were 11.05 ± 4.09 pg/ml and 47.14 ± 13.52 pg/ml.After treatment,the serum IL-10 concentrations of both groups were significantly higher than before treatment(P < 0.01),and the serum IL-10 concentration of TG was higher than that in CG,indicating the significant differences in statistic(P < 0.05).The serum VEGF-A concentrations of patients in the TG before and after treatment were 37.96 ± 11.02 pg/ml and 30.03 ± 6.98 pg/ml,and the CG were 37.39 ± 11.21 pg/ml and 31.63 ± 8.95 pg/ml.After treatment,the serum IL-10 concentrations of both groups were significantly lower than before treatment(P <0.01),and the serum VEGF-A concentration of TG was lower than that in CG,but there was no significant difference in statistic(P > 0.05).6.Follow-up visit: After 3 months,the VAS,ODI scores of TG,0.78 ± 0.96 and 3.74 ± 4.17,were separately higher than 1.50 ± 1.18 and 6.62 ± 5.85 in CG,indicating the significant differences in statistic(P < 0.05).Conclusion :1.ESW treatment can further relieve the lumbocrural pain symptoms of LDH patients and improve the lumbar function on the basis of conventional rehabilitation treatment,significantly shorten the time of rehabilitation treatment,and achieve well long-term efficacy.2.ESW treatment may improve chronic inflammatory condition by regulating serum IL-10,TNF-? and VEGF-A levels in LDH patients. |
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