祛痹健腰丸联合骶管神经阻滞对腰椎间盘突出症患者腰痛及下肢窜痛的改善作用分析

Effect of Qubi Jianyao pill combined with sacral nerve block on lower back pain and lower limb pain in patients with lumbar disc herniation

摘要:

目的 分析祛痹健腰丸联合骶管神经阻滞对腰椎间盘突出症患者腰痛及下肢窜痛的改善作用。方法 前瞻性选取2024年1月至2024年6月九江市中医医院收治的120例腰椎间盘突出症患者，按随机数字表分为观察组（n=60）和对照组（n=60）。对照组采用骶管神经阻滞治疗；观察组采用祛痹健腰丸联合骶管神经阻滞治疗。比较两组患者疗效、血清指标及不良反应。结果 与治疗前相比，治疗后及随访3个月的日本骨科协会腰痛评分表（JOA）评分明显升高，Oswestry功能障碍指数（ODI）评分降低，且与对照组JOA评分[（18.42±3.88）分、（16.45±3.71）分]、ODI评分[（13.41±3.54）分、（14.23±4.26）分]相比，观察组JOA评分[（26.33±2.16）分、（24.33±4.36）分]、ODI评分[（6.42±2.23）分、（8.82±2.26）分]更优（均P＜0.05）。两组治疗后肿瘤坏死因子（TNF-α）、白细胞介素（IL-6）、C反应蛋白（CRP）水平低于治疗前，且与对照组TNF-α（1.74±0.48）mg/L、IL-6（126.42±8.77）ng/L、CRP（6.46±1.63）ng/L相比，观察组TNF-α（1.04±0.49）mg/L、IL-6（88.64±8.52）ng/L、CRP（4.75±1.74）ng/L更低（均P＜0.05）。两组治疗后环氧化酶（COX-2）、前列腺素（PGE2）水平高于治疗前，且与对照组COX-2（27.46±4.68）mg/L、PGE2（74.82±8.12）mg/L相比，观察组COX-2（21.35±4.33）mg/L、PGE2（65.83±8.71）mg/L更低（均P＜0.05）。两组治疗后骨特异性碱性磷酸酶（BALP）、骨钙素（OC）水平高于治疗前，且与对照组BALP（42.64±5.68）mg/L、OC（28.76±3.89）mg/L相比，观察组BALP（51.44±6.13）mg/L、OC（36.45±4.51）mg/L更高（均P＜0.05）。治疗后两组中医证候积分低于治疗前，且与对照组（10.36±1.21）相比，观察组（8.36±0.92）更低（均P＜0.05）。观察组疗效（96.67%）高于对照组（83.33%）（P＜0.05）。两组不良反应总发生率的差异无统计学意义（P＞0.05）。结论 祛痹健腰丸联合骶管神经阻滞对腰椎间盘突出症患者有改善腰痛及下肢窜痛的作用。

Abstract:

Objective To analyze the effect of Qubi Jianyao pill combined with sacral nerve block on lumbar disc herniation patients with low back pain and lower limb pain.Methods A total of 120 patients with lumbar disc herniation in the Orthopedics and Traumatology Department of Jiujiang Hospital of Traditional Chinese Medicine from January 2024 to June 2024 were prospectively selected and divided into observation group and control group according to random number table, with 60 cases in each group. The control group was treated with sacral canal nerve block. The observation group was treated with Qubi Jianyao pill combined with sacral canal nerve block. The efficacy, serum indexes and adverse reactions were compared between the two groups. Results Compared with before treatment, the Japanese Orthopaedic Association's Back Pain Assessment (JOA) score significantly increased and the Oswestry Disability Index (ODI) score decreased after treatment and 3 months of follow-up. Compared with the control group's JOA score [(18.42±3.88), (16.45±3.71)], and ODI score [(13.41±3.54), (14.23±4.26)], the observation group's JOA score [(26.33±2.16), (24.33±4.36)], and ODI score [(6.42±2.23), (8.82±2.26)] were better (all P＜0.05). After treatment, the levels of tumor necrosis factor (TNF-α), interleukin (IL-6), and C-reactive protein (CRP) in both groups were lower than before treatment, and compared with the control group, the levels of TNF-α [(1.74±0.48) mg/L], IL-6 [(126.42±8.77) ng/L], and CRP [(6.46±1.63) ng/L] were lower in the observation group [(1.04±0.49) mg/L, (88.64 ± 8.52) ng/L, and (4.75±1.74) ng/L, respectively] (all P＜0.05). After treatment, the levels of cyclooxygenase (COX-2) and prostaglandin E2 (PGE₂) in both groups were higher than before treatment, and compared with the control group, COX-2 [(27.46±4.68) mg/L] and PGE₂ [(74.82±8.12) mg/L] were lower in the observation group [(21.35±4.33) mg/L and (65.83±8.71) mg/L, respectively] (both P＜0.05). After treatment, the levels of bone specific alkaline phosphatase (BALP) and osteocalcin (OC) in both groups were higher than before treatment, and compared with the control group [BALP (42.64±5.68) mg/L and OC (28.76±3.89) mg/L], the observation group [BALP (51.44±6.13) mg/L and OC (36.45±4.51) mg/L] were higher (both P＜0.05). After treatment, the scores of traditional Chinese medicine syndrome in both groups were lower than before treatment, and compared with the control group (10.36±1.21), the observation group (8.36±0.92) was lower (both P＜0.05). The therapeutic effect of the observation group (96.67%) was higher than that of the control group (83.33%) (P＜0.05). There was no statistically significant difference in the total incidence of adverse reactions between the two groups (P＞0.05). Conclusion Qubi Jianyao Pill combined with sacral nerve block can improve lumbago and lower limb pain in patients with lumbar disc herniation.