新式牵引治疗床在腰椎间盘突出症患者中的疗效分析

doi:10.3877/cma.j.issn.2096-0263.2025.06.006

目的

评价新型牵引治疗床对腰椎间盘突出症患者的短期疗效。

方法

采用单臂前瞻性设计，纳入于2023年5月至2024年5月于我院脊柱外科门诊就诊的腰间盘突出症患者，均接受新型牵引治疗床规范化干预。于治疗前、末次治疗后即刻及治疗后末次3个月评估Oswestry功能障碍指数（ODI）、日本骨科协会评分（JOA）和视觉模拟评分（VAS）；行腰椎MRI并依据Pfirrmann分级进行影像学评价。研究主要结局为末次治疗后3个月的ODI指数，所有计量资料用配对t检验或非正态数据用Wilcoxon符号秩检验和广义估计方程（GEE）分析。

结果

本研究共计纳入30例LDH患者，其中男性14例（46.67%），女性16例（53.33%），年龄为（46.13±16.38）岁。与治疗前相比，末次治疗后即刻ODI与VAS显著下降、JOA显著升高（均P<0.001）；3个月随访ODI与VAS改善维持，JOA趋于稳定，治疗好转率达90.00%。GEE结果显示时间因素对ODI、JOA、VAS均有显著影响（均P<0.001），成对比较结果与上述一致。

结论

新型牵引治疗床可在短期内显著减轻LDH患者疼痛、改善神经、运动功能，具有一定临床应用价值。

关键词: 腰椎间盘突出, 牵引术, 保守治疗

Objective

To evaluate the short-term efficacy of a novel traction therapy bed for patients with lumbar disc herniation.

Methods

A single-arm prospective design was used. Patients with LDH attending the spine surgery outpatient department of our hospital from May 2023 to May 2024 were enrolled and all received standardized intervention with the novel traction therapy bed. The Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score, and Visual Analog Scale (VAS) score were assessed before treatment, immediately after treatment, and 3 months after treatment. Lumbar MRI was performed for imaging evaluation according to Pfirrmann grade. The primary outcome was the ODI at 3 months post-intervention. All measurement data were analyzed using paired t-tests or Wilcoxon signed-rank tests for non-normal data, and Generalized Estimating Equations (GEE).

Results

A total of 30 LDH patients were included in this study, including 14 males (46,67%) and 16 females (53.33%), with an average age of 46.13±16.38 years. Compared with pre-intervention, ODI and VAS decreased significantly immediately after intervention, while JOA increased significantly (all P<0.001). At the 3-month follow-up, the improvements in ODI and VAS were maintained, and JOA tended to stabilize, the improvement rate of treatment reached 90.00%. GEE results indicated that the time factor had a significant effect on ODI, JOA, and VAS (all P<0.001), and pairwise comparison results were consistent with the above findings.

Conclusions

The novel traction therapy bed can significantly alleviate pain, improve neurological and motor function in LDH patients in the short term, demonstrating certain clinical application value.

Key words: Lumbar Disc Herniation, Traction, Conservative Treatment

图2 新型牵引治疗床的扭转功能示意

表1 新式牵引床治疗的30例腰椎间盘突出症患者ODI、JOA、VAS评分结果[分，中位数M（P₂₅，P₇₅）]

项目	治疗前	末次治疗后即刻	末次治疗后3个月
ODI	33.00（23.50，44.00）	18.00（11.50，30.50）	18.00（11.50，30.00）
JOA	15.50（12.00，19.00）	21.00（16.00，21.00）	21.00（16.00，25.00）
VAS	4.00（3.75，5.00）	3.00（2.00，4.00）	3.00（2.00，4.00）

表1 新式牵引床治疗的30例腰椎间盘突出症患者ODI、JOA、VAS评分结果[分，中位数M（P₂₅，P₇₅）]

项目	治疗前	末次治疗后即刻	末次治疗后3个月
ODI	33.00（23.50，44.00）	18.00（11.50，30.50）	18.00（11.50，30.00）
JOA	15.50（12.00，19.00）	21.00（16.00，21.00）	21.00（16.00，25.00）
VAS	4.00（3.75，5.00）	3.00（2.00，4.00）	3.00（2.00，4.00）

表2 新式牵引床治疗的30例腰椎间盘突出症患者各时间ODI、JOA、VAS对比

项目	类别	统计量Z值
治疗前vs.末次治疗后即刻	ODI	-4.804
	JOA	-4.791
	VAS	-4.340
治疗前vs.末次治疗后3个月	ODI	-4.800
	JOA	-4.791
	VAS	-4.340
末次治疗后即刻vs.末次治疗后3个月	ODI	-2.000
	JOA	0
	VAS	0

表2 新式牵引床治疗的30例腰椎间盘突出症患者各时间ODI、JOA、VAS对比

项目	类别	统计量Z值
治疗前vs.末次治疗后即刻	ODI	-4.804
	JOA	-4.791
	VAS	-4.340
治疗前vs.末次治疗后3个月	ODI	-4.800
	JOA	-4.791
	VAS	-4.340
末次治疗后即刻vs.末次治疗后3个月	ODI	-2.000
	JOA	0
	VAS	0

表3 新式牵引床患者各时间ODI、JOA、VAS的GEE分析

项目	变量	Wald χ²/平均值差值	自由度	P值	95% CI
ODI	时间	205.924	2	<0.001
	治疗前*末次治疗后即刻	12.800	1	<0.001	10.947	14.653
	末次治疗后即刻*末次治疗后3个月	13.068	1	<0.001	11.087	15.046
	末次治疗后即刻*末次治疗后3个月	0.268	1	0.032	0.023	0.510
JOA	时间	88.313	2	<0.001
	治疗前*末次治疗后即刻	-4.800	1	<0.001	-5.801	-3.799
	治疗前*末次治疗后3个月	-4.800	1	<0.001	-5.801	-3.799
	末次治疗后即刻*末次治疗后3个月	0	1	1	0	0
VAS	时间	46.829	2	<0.001
	治疗前*末次治疗后即刻	1.600	1	<0.001	1.142	2.058
	治疗前*末次治疗后3个月	1.600	1	<0.001	1.142	2.058
	末次治疗后即刻*末次治疗后3个月	0	1	1	0	0

表3 新式牵引床患者各时间ODI、JOA、VAS的GEE分析

项目	变量	Wald χ²/平均值差值	自由度	P值	95% CI
ODI	时间	205.924	2	<0.001
	治疗前*末次治疗后即刻	12.800	1	<0.001	10.947	14.653
	末次治疗后即刻*末次治疗后3个月	13.068	1	<0.001	11.087	15.046
	末次治疗后即刻*末次治疗后3个月	0.268	1	0.032	0.023	0.510
JOA	时间	88.313	2	<0.001
	治疗前*末次治疗后即刻	-4.800	1	<0.001	-5.801	-3.799
	治疗前*末次治疗后3个月	-4.800	1	<0.001	-5.801	-3.799
	末次治疗后即刻*末次治疗后3个月	0	1	1	0	0
VAS	时间	46.829	2	<0.001
	治疗前*末次治疗后即刻	1.600	1	<0.001	1.142	2.058
	治疗前*末次治疗后3个月	1.600	1	<0.001	1.142	2.058
	末次治疗后即刻*末次治疗后3个月	0	1	1	0	0

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Evaluation of the therapeutic effect of a novel traction device in patients with lumbar disc herniation

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Evaluation of the therapeutic effect of a novel traction device in patients with lumbar disc herniation