椎间微分动力系统联合Tergumed对腰椎间盘突出症的疗效

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摘要目的〓观察对比椎间微分动力系统(intervertebral differential dynamics，IDD)联合Tergumed脊柱评估训练系统与IDD联合运动疗法治疗腰椎间盘突出症患者的疗效。方法〓选取2022年3月至2023年3月在解放军总医院第四医学中心符合入选标准和排除标准的腰椎间盘突出症(lumbar disc herniation，LDH)患者64例，按照随机数字表法分为试验组和对照组。试验组32例，男18例，女14例；年龄26~60岁，平均(50.21±5.53)岁；对照组32例，男19例，女13例；年龄29~59岁，平均(50.65±6.12)岁。两组均给予健康教育，对照组采用IDD联合运动疗法，每天1次，每周治疗5次，共接受4周治疗。试验组采用IDD联合Tergumed进行治疗，IDD治疗同对照组；Tergumed训练每周3次，共训练4周，12个单元。应用视觉模拟评分(visual analogue scale，VAS)评估患者的腰椎疼痛程度，应用Oswestry功能障碍指数(Oswestry disability index，ODI)评估功能障碍程度的变化，同时采用Tergumed评估两组患者腰椎生物力学数据——腰椎前屈、背伸活动度和最大肌力数值变化情况。分别于治疗前及治疗4周、16周时进行评估。结果〓治疗前两组患者VAS评分、ODI指数及腰椎前屈、背伸活动度和最大肌力值组间差异均无统计学意义(P＞0.05)；治疗4周、16周，两组VAS、ODI及各项生物力学数据均优于治疗前，差异有统计学意义(P＜0.05)；治疗16周，两组疼痛VAS评分降低值，差异无统计学意义(P＞0.05)，95%可信区间0.19(－0.07~1.03)下限大于预设的－1，达到非劣效检验标准；治疗4周，两组ODI及各项生物力学数据的变化值相比，差异无统计学意义(P＞0.05)；16周时，试验组前屈、背伸最大肌力值较治疗前的变化值均优于对照组(P＜0.05)。结论〓IDD联合Tergumed治疗LDH患者的临床疗效不劣于IDD联合常规运动疗法，可在节省人力的前提下，明显缓解疼痛，增加腰部肌力，改善腰椎功能，且安全可靠，值得临床推广。

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	樊晨
	石秀秀
	樊茹
	侯树勋
	李晓
	刘克敏

关键词 ：椎间微分动力系统, 腰椎间盘突出症, 脊柱评估训练系统, 非劣效

Abstract：Objective〓To observe and compare the efficacy of intervertebral differential dynamics (IDD) combined with proxomed tergumed (Tergumed) and IDD combined exercise therapy in the treatment of patients with lumbar disc herniation.Methods〓64 lumbar disc herniation (LDH) patients who met the inclusion and exclusion criteria at the Fourth Medical Center of the General Hospital of the Chinese People’s Liberation Army from March 2022 to March 2023 were randomly divided into a experiment group and a control group using a random number table method.There were 32 cases in the experimental group，including 18 males and 14 females，aged from 26 to 60 years old，with an average age of (50.21±5.53) years old.There were 32 cases in the control group，including 19 males and 13 females，aged from 29 to 59 years old，with an average age of (50.65±6.12) years old.Both groups were given health education，and the control group was treated with IDD combined with exercise therapy once a day，5 times a week for 4 weeks.The experimental group was treated with IDD combined with Tergumed，and the IDD treatment was the same as the control group.The patients had Tergumed training three times a week for a total of 12 units for 4 weeks.The visual analogue scale (VAS) was used to evaluate the degree of lumbar pain，and the Oswestry disability index (ODI) was used to evaluate the change in the degree of dysfunction.Tergumed was used to evaluate lumbar biomechanical data-changes in lumbar flexion，dorsiflexion range of motion，and maximum muscle strength-in both groups.They were evaluated before treatment，at 4 weeks，and at 16 weeks.Results〓Before treatment，there were no significant differences in VAS score，ODI score，lumbar anterior flexion，dorsiflexion motion and maximum muscle strength between two groups (P＞0.05).After 4 weeks and 16 weeks of treatment，VAS，ODI and biomechanical data of 2 groups were better than before treatment，the difference was statistically significant (P＜0.05).After 16 weeks of treatment，there was no statistically significant difference in pain VAS score between the two groups (P＞0.05)，and the lower limit of 95% confidence interval 0.19(－0.07~1.03) was greater than the preset－1，meeting the non-inferiority test standard.After 4 weeks of treatment，there was no significant difference in the changes of ODI and biomechanical data between the two groups (P＞0.05).At 16 weeks，the changes in the maximum muscular strength values of flexion and extension in the experimental group were better than those in the control group before treatment (P＜0.05).Conclusion〓The clinical efficacy of IDD combined with Tergumed in the treatment of LDH patients is not inferior to that of IDD combined with conventional exercise therapy，which can significantly relieve pain，increase lumbar muscle strength and improve lumbar function under the premise of labor saving，and is safe and reliable，worthy of clinical promotion.

Key words： intervertebral differential dynamic system lumbar disc herniation spinal assessment training system non-inferiority

通讯作者: 刘克敏

作者简介: 樊晨(1989－ )，女，主管治疗师，首都医科大学康复医学院，1585347525@qq.com。

引用本文:

樊晨，石秀秀，樊茹，侯树勋，李晓，刘克敏. 椎间微分动力系统联合Tergumed对腰椎间盘突出症的疗效[J]. 实用骨科杂志, 2024, 30(3): 211-.
Fan Chen，Shi Xiuxiu，Fan Ru，Hou Shuxun，Li Xiao，Liu Kemin. Effect of Intervertebral Differential Dynamic System Combined with Tergumed on Lumbar Disc Herniation. sygkzz, 2024, 30(3): 211-.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2024/V30/I3/211

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