[Acupuncture with yin- yang regulation method for chronic low back pain in elderly patients with lumbar disc herniation: a randomized controlled Trial]
- PMID: 40369918
- DOI: 10.13703/j.0255-2930.20240522-k0002
[Acupuncture with yin- yang regulation method for chronic low back pain in elderly patients with lumbar disc herniation: a randomized controlled Trial]
Abstract
Objective: To compare the clinical efficacy of acupuncture with yin-yang regulation method versus local acupuncture in treating chronic low back pain (CLBP) in elderly patients with lumbar disc herniation (LDH), and to evaluate the changes in the multifidus muscle before and after treatment using musculoskeletal ultrasound.
Methods: A total of 128 elderly patients with CLBP due to LDH were randomly assigned to an observation group (64 cases, 2 cases dropped out) and a control group (64 cases, 2 cases dropped out). The control group received local acupuncture at bilateral L3-L5 Jiaji points (EX-B2), Shenshu (BL23), Dachangshu (BL25), Weizhong (BL40), Yaoyangguan (GV3), and ashi points. The observation group received acupuncture with yin-yang regulation method, which included an abdominal protocol with Baihui (GV20), Zhongwan (CV12), Qihai (CV6), Guanyuan (CV4), bilateral Tianshu (ST25), and Dahe (KI12), etc., and a lumbar protocol with Baihui (GV20), Dazhui (GV14), Jizhong (GV6), Yaoyangguan (GV3), and ashi points, etc., alternated bilaterally. Both groups were treated once every other day, three times per week, for a total of 12 sessions. The visual analogue scale (VAS) score, Oswestry disability index (ODI) score, and the indexs of musculoskeletal ultrasound multifidus muscle (resting and functional thickness and Young's modulus values) were observed before and after treatment, and the clinical efficacy was evaluated in the two groups.
Results: After 1 and 4 weeks of treatment, both groups showed lower VAS scores compared to baseline (P<0.05), the VAS scores in the observation group were lower than those in the control group (P<0.001). ODI scores in both groups were decreased after 1 and 4 weeks of treatment compared to baseline (P<0.05), with a further reduction at 4 weeks of treatment compared to 1 week of treatment (P<0.05); the observation group showed lower ODI score than the control group after 1 week of treatment (P<0.001). After treatment, both groups demonstrated increased resting and functional multifidus muscle thickness bilaterally compared to baseline (P<0.01), with an increased right-side thickness change rate (P<0.01), though no significant difference was observed between groups (P>0.05). Compared to baseline, after treatment, the observation group exhibited decreased Young's modulus values for bilateral resting and functional multifidus muscle (P<0.01), while the control group showed reductions only in bilateral resting and right-side functional Young's modulus values (P<0.01). After treatment, the bilateral functional Young's modulus values in the observation group were lower than that in the control group (P<0.05), and the bilateral resting and functional changes in Young's modulus values were greater in the observation group than those in the control group (P<0.01). The overall effective rate was 93.5% (58/62) in the observation group, which was higher than 79.0% (49/62) in the control group (P<0.05).
Conclusion: Acupuncture with yin-yang regulation method effectively alleviates pain, improves functional disability, increases multifidus muscle thickness, and reduces Young's modulus values in elderly patients with CLBP due to LDH, which has superior therapeutic effect compared to local acupuncture.
目的：比较阴阳调衡法针刺与局部针刺治疗老年腰椎间盘突出症慢性腰痛患者的临床疗效，并通过肌骨超声观察治疗前后多裂肌的变化。 方法：将128例老年腰椎间盘突出症慢性腰痛患者随机分为观察组（64例，脱落2例）和对照组（64例，脱落2例）。对照组予局部针刺治疗，穴取双侧L3-L5夹脊穴、肾俞、大肠俞、委中，腰阳关、阿是穴；观察组予阴阳调衡法针刺，腹侧方案选取百会、中脘、气海、关元，双侧天枢、大赫等；腰侧方案选取百会、大椎、脊中、腰阳关、阿是穴等，两侧间隔交替治疗。两组均隔日1次，每周治疗3次，共治疗12次。观察两组患者治疗前后疼痛视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI）评分及肌骨超声检查相关指标（静息态、功能态双侧多裂肌厚度及杨氏模量值），并评定两组临床疗效。 结果：治疗1、4周后，两组患者疼痛VAS评分均低于治疗前（P<0.05），且观察组低于对照组（P<0.001）。两组患者ODI评分治疗1、4周后较治疗前降低（P<0.05），治疗4周后较治疗1周后降低（P<0.05）；观察组治疗1周后ODI评分后低于对照组（P<0.001）。治疗后，两组患者静息态、功能态双侧多裂肌厚度较治疗前增加（P<0.01），右侧多裂肌厚度变化率较治疗前升高（P<0.01），双侧多裂肌厚度变化值比较差异无统计学意义（P>0.05）。治疗后，观察组患者静息态、功能态双侧多裂肌杨氏模量值较治疗前降低（P<0.01），对照组患者静息态双侧及功能态右侧多裂肌双侧杨氏模量值较治疗前降低（P<0.01）；观察组患者功能态双侧多裂肌杨氏模量值低于对照组（P<0.05），静息态、功能态双侧杨氏模量值变化值下降幅度大于对照组（P<0.01）。观察组总有效率为93.5%（58/62），高于对照组的79.0%（49/62，P<0.05）。 结论：阴阳调衡法针刺可减轻老年腰椎间盘突出症慢性腰痛患者的疼痛症状，改善功能障碍，增加多裂肌厚度、降低杨氏模量值，较局部针刺治疗效果更显著。.
Keywords: acupuncture; chronic low back pain; lumbar disc herniation; musculoskeletal ultrasound; randomized controlled trial (RCT); yin-yang regulation method.