【目的】分析恒古骨伤愈合剂 （主要成分为陈皮、红花、三七、杜仲、人参、洋金花、黄芪、钻地风、鳖甲等） 口服联 合经皮定向离子导入 （简称透药） 治疗对腰椎间盘突出症 （LDH） 患者疼痛、腰椎功能、血清学指标的影响。 【方法】将92例 LDH患者随机分为对照组31例、口服组31例和联合组30例。对照组给予塞来昔布口服治疗，口服组给予恒古骨伤愈合剂口 服治疗，联合组给予恒古骨伤愈合剂口服联合透药治疗，疗程为6周。观察3组患者治疗前后疼痛视觉模拟量表 （VAS） 评分、 腰椎功能日本骨科协会（JOA）评分及血清肿瘤坏死因子 α（tumor necrosis factor α，TNF-α）、基质金属蛋白酶 3（matrix metalloproteinase 3，MMP-3） 水平的变化情况。 【结果】（1） 研究过程中，对照组和口服组各失访2例，联合组无失访病例，最 终对照组和口服组各29例、联合组30例患者纳入统计分析。 （2） 治疗后，3组患者的疼痛VAS评分和腰椎功能JOA评分均较 治疗前明显下降 （P＜0.05） ；组间比较，联合组对疼痛VAS评分和腰椎功能JOA评分的下降幅度均明显优于对照组和口服组 （P＜0.05） ，而对照组与口服组比较，差异均无统计学意义 （P＞0.05） 。 （3） 治疗后，3组患者的血清TNF-α水平均较治疗前明 显下降 （P＜0.05） ；但治疗后3组间比较，差异无统计学意义 （P＞0.05） 。 （4） 治疗后，口服组与联合组患者的血清MMP-3水平 均较治疗前明显下降 （P＜0.05） ，而对照组患者的血清MMP-3水平较治疗前无明显下降 （P＞0.05） ；组间比较，口服组、联 合组对血清MMP-3水平的下降幅度均明显优于对照组 （P＜0.05） ，而口服组与联合组比较，差异无统计学意义 （P＞0.05） 。 【结论】恒古骨伤愈合剂能够有效减轻LDH患者疼痛症状，改善患者腰椎活动功能，同时可有效降低血清TNF-α、MMP-3 水平，其中以恒古骨伤愈合剂口服联合透药治疗的效果最佳。

Abstract：Objective To investigate the effects of oral use combined with percutaneous iontophoresis of Osteoking （mainly composed of Citri Reticulatae Pericarpium，Carthami Flos，Notoginseng Radix et Rhizoma，Eucommiae Cortex，Ginseng Radix et Rhizoma，Daturae Flos，Astragali Radix，Radix et Caulis Schizophragma Integrifolia， and Trionycis Carapax） on the pain，lumbar function and serological indicators of the patients with lumbar disc herniation（LDH） . Methods Ninety-two patients with LDH were randomly divided into control group（31 cases）， oral use group（31 cases） and combination group（30 cases） . The control group was given oral administration of Celecoxib，the oral use group was given oral administration of Osteoking，and the combination group was given oral administration combined with percutaneous iontophoresis of Osteoking. The course of treatment for the 3 groups covered 6 weeks. The changes of pain visual analogue scale （VAS） score，lumbar function Japanese Orthopedic Association （JOA） score，serum tumor necrosis factor alpha （TNF-α） and matrix metalloproteinase 3 （MMP-3） levels in the three groups were observed before and after treatment. Results （1） During the trial，there were 2 patients from both control group and oral use group lost to follow-up，but none of the combination group was lost to follow-up. Eventually，29 patients in the control group，29 patients in the oral group and 30 patients in the combination group were included in the statistical analysis. （2）After treatment，the pain VAS score and lumbar function JOA score in the three groups were significantly lower than those before treatment （P＜0.05） . The intergroup comparison showed that the decrease of pain VAS score and lumbar function JOA score in the combination group was significantly superior to that in the control group and the oral use group （P＜0.05） ，while there was no significant difference between the control group and the oral use group （P＞0.05） . （3） After treatment， the serum TNF-α level in the three groups was significantly lower than that before treatment （P＜ 0.05） ，while no significant difference of TNF-α level was presented among the three groups after treatment（P＞0.05） . （4） After treatment，the serum MMP-3 level in the oral use group and combination group was significantly lower than that before treatment （P＜0.05），but no obvious change of MMP-3 level was shown in the control group（P＞0.05） . The intergroup comparison showed that the decrease of serum MMP-3 level in the oral use group and combination group was significantly superior to that in the control group （P＜0.05） ，while no significant difference of TNF-α level was presented between the oral use group and combination group（P＞0.05） . Conclusion Osteoking is effective on relieving the pain symptoms of LDH patients，improving the lumbar activity function，and decreasing the levels of serum TNF- α and MMP-3. The efficacy of Osteoking by oral use combined with percutaneous iontophoresis is stronger than that of Osteoking orally alone or Celecoxib.

R681.5+ 7；R274.9

云南省教育厅科学研究基金资助项目 （编号：2023Y0956）；云南省“兴滇英才支持计划”项目 （编号：YNWR-MY-2020-033）