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中华老年骨科与康复电子杂志 ›› 2024, Vol. 10 ›› Issue (06) : 379 -384. doi: 10.3877/cma.j.issn.2096-0263.2024.06.009

综述

腰椎间盘突出症保守治疗进展
吴天宇1, 刘子璇1, 杨浦鑫1, 贾思明1, 丁凯1, 程晓东1, 李泳龙1, 陈伟1, 吕红芝1, 张奇1,()   
  1. 1.050051 石家庄,河北省骨科研究所,河北省骨科生物力学重点实验室,河北医科大学第三医院创伤急救中心
  • 收稿日期:2024-10-15 出版日期:2024-12-05
  • 通信作者: 张奇
  • 基金资助:
    河北省科技厅项目(21377731D)国家自然科学青年基金项目(82102584)

Progress in Conservative Treatment of Lumbar Disc Herniation

Tianyu Wu1, Zixuan Liu1, Puxin Yang1, Siming Jia1, Kai Ding1, Xiaodong Cheng1, Yonglong Li1, Wei Chen1, Hongzhi Lyu1, Qi Zhang1,()   

  1. 1.Orthopedic Research Institution of Hebei Province,Key Laboratory of Biomechanics of Hebei Province,Department of Orthopaedic Surgery,the Third Hospital of Hebei Medical University,Shijia zhuang 050051,China
  • Received:2024-10-15 Published:2024-12-05
  • Corresponding author: Qi Zhang
引用本文:

吴天宇, 刘子璇, 杨浦鑫, 贾思明, 丁凯, 程晓东, 李泳龙, 陈伟, 吕红芝, 张奇. 腰椎间盘突出症保守治疗进展[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 379-384.

Tianyu Wu, Zixuan Liu, Puxin Yang, Siming Jia, Kai Ding, Xiaodong Cheng, Yonglong Li, Wei Chen, Hongzhi Lyu, Qi Zhang. Progress in Conservative Treatment of Lumbar Disc Herniation[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2024, 10(06): 379-384.

腰椎间盘突出症(LDH)是脊柱外科中的常见疾病,主要表现为腰腿痛、下肢麻木等症状严重影响患者的生活质量。LDH的治疗主要分为保守治疗和手术治疗。多数患者无需手术治疗。保守治疗方法多样,每种治疗机理不同,兼具优势与局限性,多种疗法联合应用值得关注。不同患者病情病程差异较大,如何为患者制定个性化治疗方案值得深入探讨。本文综述了LDH 保守治疗的最新进展,包括牵引、运动疗法、物理因子治疗、推拿、针灸等非药物疗法,以及药物治疗的应用现状。通过分析各治疗方式的机制、疗效和适应证,旨在为临床实践提供参考,促进LDH保守治疗的规范化和个体化。

Lumbar disc herniation(LDH)is a common disease in spinal surgery,with the main clinical manifestations including lower back and leg pain, and numbness in the lower limbs, which severely impact patients'quality of life.The treatment of LDH is primarily divided into conservative treatment and surgical treatment. Most patients do not require surgical treatment. There are various methods of conservative treatment, each with different mechanisms of action. These methods have both advantages and limitations.The combined use of multiple therapies is worth attention.Due to the significant differences in the condition and disease progression among patients,exploring how to formulate personalized treatment plans for them is a topic deserving in-depth discussion. This article reviews the latest advances in the conservative treatment of LDH, including non-pharmacological treatments such as traction, exercise therapy, physical factor therapy, massage, and acupuncture, as well as the current status of pharmacological treatment. By analyzing the mechanisms, efficacy, and indications of each treatment, the aim is to offer a reference for clinical practice and to promote the standardization and individualization of conservative treatment for LDH.

1
Cesar A Hincapié,Daniela Kroismayr,Léonie Hofstetter, et al. Incidence of and risk factors for lumbar disc herniation with radiculopathy in adults: a systematic review [J]. Eur Spine J, 2024, 25, Online ahead of print.
2
GBD 2021 Low Back Pain Collaborators. Global, regional, and National burden of low back pain, 1990-2020, its attributable risk factors,and projections to 2050:a systematic analysis of the Global Burden of Disease Study 2021 [J]. Lancet Rheumatology, 2023, 5(6):e316-e329.
3
Chen LX, Sun QY, Chou R, et al. Low back pain-driven inpatient stays in the United States:a nationwide repeated cross-sectional analysis[J].Int J Surg,2024,110(3):1411-1419.
4
Childs JD, Fritz JM, Wu SS, et al. Implications of early and guideline adherent physical therapy for low back pain on utilization and costs [published correction appears in BMC Health Serv Res [J].BMC Health Serv Res,2016,16(1):444.
5
Walston Z, McLester C. Importance of early improvement in the treatment of low back pain with physical therapy[J].Spine(Phila Pa 1976),2020,45(8):534-540.
6
6Jensen RK KAPBD,Treatment OS.BMJ[Z] ,2019:l6273.
7
邵佳申,张志武,孟海,等.单侧双通道脊柱内镜技术治疗腰椎管狭窄症的临床疗效和学习曲线研究[J].中华老年骨科与康复电子杂志,2024,10(4):202-208.
8
Tanabe H, Akai MSI, Doi T, et al. Immediate effect of mechanical lumbar traction in patients with chronic low back pain:A crossover,repeated measures, randomized controlled trial [J]. Journal of Orthopaedic Science,2021,26(6):953-961.
9
Vanti C,Turone L,Panizzolo A,et al.Vertical traction for lumbar radiculopathy:a systematic review[J].Arch Physiother,2021,11(1):7.
10
Chow DHK,Yuen EMK,Xiao L,et al.Mechanical effects of traction on lumbar intervertebral discs:A magnetic resonance imaging study[J].Musculoskelet Sci Pract,2017,29:78-83.
11
Karimi N,Akbarov P,Rahnama L.Effects of segmental traction therapy on lumbar disc herniation in patients with acute low back pain measured by magnetic resonance imaging:A single arm clinical trial[J].J Back Musculoskelet Rehabil,2017,30(2):247-253.
12
Vanti C, Panizzolo A, Turone L, et al. Effectiveness of mechanical traction for lumbar radiculopathy: a systematic review and Meta-Analysis[J].Phys Ther,2021,101(3):pzaa231.
13
Bilgilisoy Filiz M, Kiliç Z, Uçkun A, et al. Mechanical traction for lumbar radicular pain:supine or prone?a randomized controlled trial[J].Am J Phys Med Rehabil,2018,97(6):433-439.
14
Isner-Horobeti ME, Dufour SP, Schaeffer M, et al. High-Force versus Low-Force lumbar traction in acute lumbar sciatica due to disc herniation: a preliminary randomized trial [J]. J Manipulative Physiol Ther,2016,39(9):645-654.
15
Alrwaily M, Almutiri M, Schneider M. Assessment of variability in traction interventions for patients with low back pain:a systematic review[J].Chiropr Man Therap,2018,26:35.
16
Wegner I, Widyahening IS, Van TM, et al. Traction for low-back pain with or without sciatica [J]. Cochrane Database Syst Rev, 2013(8):CD003010.
17
Di Mattia F, Tejani S, Hall T. Bed rest for sciatica: a closer look at the evidence[J].J Orthop Sports Phys Ther,2018,48(6):436-438.
18
Foster NE,Anema JR, Cherkin D, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions [J].Lancet,2018,391(10137):2368-2383.
19
Suh JH,Kim H,Jung GP,et al.The effect of lumbar stabilization and walking exercises on chronic low back pain: A randomized controlled trial[J].Medicine(Baltimore),2019,98(26):e16173.
20
Maharty DC,Hines SC,Brown RB.Chronic low back pain in adults:evaluation and management [J]. Am Fam Physician, 2024, 109(3):233-244.
21
吴卫卫,高文双,郑娅,等.悬吊核心训练对腰椎间盘突出症患者的疗效观察[J].中华老年骨科与康复电子杂志,2019,5(5):255-261.
22
冯渊,何成奇,杨霖.运动疗法治疗慢性非特异性腰痛的临床研究进展[J].中华物理医学与康复杂志,2023,45(2):173-177.
23
Shi ZJ, Zhou HX, Lu L, et al.Aquatic exercises in the treatment of low back pain:a systematic review of the literature and Meta-Analysis of eight studies [J]. Am J Phys Med Rehabil, 2018, 97(2): 116-122.
24
宋宇锋,王安利,武政.主动运动疗法治疗腰椎间盘突出症的疗效及安全性研究[J].中华老年骨科与康复电子杂志,2016,2(4):228-233.
25
Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive treatments for acute,subacute,and chronic low back pain:a clinical practice guideline from the American college of physicians [J]. Ann Intern Med,2017,166(7):514-530.
26
Rajfur J,Pasternok M,Rajfur K,et al.Efficacy of Selected Electrical Therapies on Chronic Low Back Pain:A Comparative Clinical Pilot Study[J].Med Sci Monit,2017,23:85-100.
27
徐红莉,杨钰琳,薛清,等.体外冲击波治疗非特异性腰痛疗效的系统评价和Meta 分析[J].中华老年骨科与康复电子杂志,2023,09(5):307-314.
28
Enthoven WTM,Roelofs PDDM,Deyo RA,et al.Non-steroidal antiinflammatory drugs for chronic low back pain [J]. Cochrane Database Syst Rev,2016,2(2):CD012087.
29
Yu PF, Mao F, Chen JY, et al. Characteristics and mechanisms of resorption in lumbar disc herniation [J]. Arthritis Res Ther, 2022, 24(1):205.
30
Paganoni S. Evidence-Based physiatry: clinical practice guideline:noninvasive treatments for low back pain [J].Am J Phys Med Rehabil,2018,97(10):763.
31
Chen-Yang Z, An-Nan H, Yun-Qi J, et al. The clinical effect of a combination of mouse nerve growth factor and methylcobalamin to treat lumbar disc herniation with foot drop: a retrospective cohort study[J].Orthop Surg,2021,13(5):1602-1608.
32
Cashin AG,Folly T,Bagg MK,et al.Efficacy,acceptability,and safety of muscle relaxants for adults with non-specific low back pain:systematic review and meta-analysis[J].BMJ,2021,7:374.
33
Derry S,Bell RF,Straube S,et al.Pregabalin for neuropathic pain in adults[J].Cochrane Database Syst Rev,2019,1(1):CD007076.
34
Low Back Pain, Sciatica in Over 16s:Assessment, management [J].London:National institute for health and care excellence,2020.
35
葛龙,李镜,尚文茹,等.非手术疗法治疗腰椎间盘突出症的循证实践指南[J].中国循证医学杂志,2024,24(2):125-148.
36
Oray M,Abu Samra K,Ebrahimiadib N,et al.Long-term side effects of glucocorticoids[J].Expert Opin Drug Saf,2016,15(4):457-465.
37
Liu J,Zhou HX,Lu L,et al.The effectiveness of transforaminal versus caudal routes for epidural steroid injections in managing lumbosacral radicular pain: a systematic review and Meta-Analysis [J].Medicine(Baltimore),2016,95(18):e3373.
38
Dhakal GR,Hamal PK,Dhungana S,et al.Clinical efficacy of selective nerve root block in lumbar radiculopathy due to disc prolapse[J].J Nepal Health Res Counc,2019,17(2):242-246.
39
Guclu B, Deniz L, Yuce Y, et al. Transforaminal epidural steroid injection in the treatment of pain in foraminal and paramedian lumbar disc herniations[J].Turk Neurosurg,2020,30(3):394-399.
40
Senkal S, Sir E. Comparison of ultrasonography and conventional fluoroscopy guided caudal epidural injection in chronic low back pain[J].Turk Neurosurg,2021,31(1):119-123.
41
Dernek B,Aydoğmuş S,Ulusoy İ,et al.Caudal epidural steroid injection for chronic low back pain:A prospective analysis of 107 patients[J].J Back Musculoskelet Rehabil,2022,35(1):135-139.
42
Stout A,Friedly J,Standaert CJ.Systemic absorption and side effects of locally injected glucocorticoids[J].PM R,2019,11(4):409-419.
43
罗飞.腰背肌慢性损伤临床诊疗中亟需关注的相关问题[J].中华创伤杂志,2023,39(3):223-228.
44
程艳彬,朱清广,孔令军,等.推拿调控腰椎间盘突出症神经损伤的外周-中枢镇痛机制探讨[J].中华中医药杂志,2022,37(4):2186-2190.
45
Er G,Yüksel İ.A comparison of the effects of connective tissue massage and classical massage on chronic mechanical low back pain [J].Medicine(Baltimore),2023,102(15):e33516.
46
Comachio J, Oliveira CC, Silva IFR, et al. Effectiveness of manual and electrical acupuncture for chronic non-specific low back pain: a randomized controlled trial [J]. J Acupunct Meridian Stud, 2020, 13(3):87-93.
47
许延慧,张志星,张小卿.热敏灸治疗腰椎间盘突出症疗效的Meta分析[J].中华中医药学刊,2020,38(6):138-143,后插12.
48
刘大钊,羊璞,刘智斌.针灸及其相关疗法治疗慢性下腰痛的研究进展[J].中华中医药杂志,2021,36(4):2216-2218.
49
谭黄圣,王银波,黄勇,等.身痛逐瘀汤合地龙汤加减治疗腰椎间盘突出症气滞血瘀证的疗效及机制[J/OL].中国实验方剂学杂志,1-9[2024-11-13].
50
沈毅弘,朱立,吴子健,等.中药熏蒸联合体外冲击波治疗气滞血瘀型腰椎间盘突出症的临床疗效观察[J]. 中国中西医结合杂志,2021,41(7):801-805.
51
樊亚东,陈哲,冀楠,等.红花注射液治疗腰椎间盘突出症Meta 分析[J].中华中医药学刊,2020,38(2):118-122.
52
钟远鸣,万通,何炳坤,等.活血化瘀类中药注射剂辅助治疗腰椎间盘突出症的网状Meta 分析[J].中华中医药学刊,2021,39(3):1-5,后插1.
53
钟毓贤,丁宇,付本升,等.脊柱内镜联合针刀对腰椎间盘突出症病人步行能力的影响[J].中国疼痛医学杂志,2023,29(4):274-280.
54
王宝剑,高春雨,金哲峰,等.超声引导下针刀联合经椎间孔神经根阻滞治疗腰椎间盘突出症40例[J].中国针灸,2020,40(12):1297-1298.
55
Tagliaferri SD, Miller CT, Owen PJ, et al. Domains of chronic low back pain and assessing treatment effectiveness: a clinical perspective[J].Pain Pract,2020,20(2):211-225.
56
Yang H, Hurwitz EL, Li J, et al. Bidirectional comorbid associations between back pain and major depression in US adults[J].Int J Environ Res Public Health,2023,20(5):4217.
57
Zgierska AE, Burzinski CA, Cox J, et al. Mindfulness meditation and cognitive behavioral therapy intervention reduces pain severity and sensitivity in Opioid-Treated chronic low back pain: pilot findings from a randomized controlled trial [J]. Pain Med, 2016, 17(10):1865-1881.
58
Paschali M, Lazaridou A, Sadora J, et al. Mindfulness-based Interventions for Chronic Low Back Pain:A Systematic Review and Metaanalysis[J].Clin J Pain,2024,40(2):105-113.
59
Diez GG, Anitua E, Castellanos N, et al. The effect of mindfulness on the inflammatory,psychological and biomechanical domains of adult patients with low back pain:A randomized controlled clinical trial[J].PLoS One,2022,17(11):e0276734.
60
Cherkin DC, Sherman KJ, Balderson BH, et al. Effect of Mindfulness-Based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain:a randomized clinical trial[J].JAMA,2016,315(12):1240-1249.
61
Blanco-Giménez P,Vicente-Mampel J,Gargallo P,et al.Clinical relevance of combined treatment with exercise in patients with chronic low back pain:a randomized controlled trial [J]. Sci Rep, 2024, 14(1):17042.
62
Taheri P,Khosrawi S,Ramezani M.Extracorporeal shock wave therapy combined with oral medication and exercise for chronic low back pain:a randomized controlled trial[J].Arch Phys Med Rehabil,2021,102(7):1294-1299.
63
吴卫卫,曹建业,董利薇,等.超声波联合悬吊治疗腰椎间盘突出症的临床疗效对比分析[J].中华老年骨科与康复电子杂志,2020,6(5):291-296.
64
王岩,相宏飞,海涌,等.老年腰椎间盘突出症诊疗指南[J].中华老年骨科与康复电子杂志,2021,7(3):132-139.
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