【目的】观察“三位动正”整脊手法联合通络活血方治疗气虚血瘀型腰椎管狭窄症 （lumbar spinal stenosis，LSS） 的临床 疗效。 【方法】将60例气虚血瘀型LSS患者随机分为试验组和对照组，每组各30例。试验组给予“三位动正”整脊手法联合 通络活血方治疗，对照组给予“三位动正”整脊手法联合常规西药治疗，疗程为4周。观察2组患者治疗前后疼痛程度视觉 模拟量表 （VAS） 评分、腰椎功能日本骨科协会 （JOA） 评分、Oswestry 功能障碍指数 （ODI） 评分、直腿抬高试验结果以及血清 白细胞介素6 （IL-6） 、C反应蛋白 （CRP） 水平的变化情况，并评价2组患者的临床疗效和安全性。 【结果】（1） 疗效方面，治疗 4周后，试验组的总有效率为 96.67% （29/30） ，对照组为 63.33% （19/30） ，组间比较 （Fisher精确检验） ，试验组的临床疗效明 显优于对照组 （P＜0.05） 。 （2） 腰部功能方面，治疗后，试验组的VAS、ODI评分较治疗前明显降低 （P＜0.05） ，JOA评分较治 疗前明显升高 （P＜0.05） ，而对照组仅ODI评分较治疗前明显降低 （P＜0.05） ；组间比较，试验组对VAS、ODI评分的降低幅 度及对JOA评分的升高幅度均明显优于对照组 （P＜0.05或P＜0.01） 。 （3） 直腿抬高试验方面，治疗后，试验组的直腿抬高试验 较治疗前明显改善 （P＜0.05） ，而对照组无明显改善 （P＞0.05） ；组间比较，试验组对直腿抬高试验的改善幅度明显优于对照 组 （P＜0.01） 。 （4） 血清炎症因子方面，治疗后，2组患者的血清IL-6、CRP水平均较治疗前降低 （P＜0.05） ，且试验组对血清 IL-6水平的降低幅度明显优于对照组 （P＜0.05） ，而2组患者治疗后的血清CRP水平比较，差异无统计学意义 （P＞0.05） 。 （5） 安全性方面，试验组的不良反应发生率为6.67% （2/30） ，对照组为13.33% （4/30） ，组间比较 （Fisher精确检验） ，差异无统 计学意义 （P＞0.05） 。 【结论】“三位动正”整脊手法联合通络活血方治疗气虚血瘀型LSS患者疗效确切，在改善患者腰部功 能、促进患者康复以及降低血清炎症因子水平方面相比“三位动正”整脊手法联合常规西药治疗有明显优势。

Objective To observe the clinical efficacy of “triple-posture positive bone-setting” chiropractic manipulation combined with Tongluo Huoxue Formula for the treatment of lumbar spinal stenosis （LSS） with qi deficiency and blood stasis syndrome. Methods Sixty patients with LSS of qi deficiency and blood stasis type were randomly divided into trial group and control group，with 30 cases in each group. The trial group was treated with “triple-posture positive bone-setting”chiropractic manipulation （a chiropractic manipulation performed under the positive cooperation of the patients at three postures） combined with Tongluo Huoxue Formula，while the control group was treated with “triple-posture positive bone-setting” chiropractic manipulation combined with conventional western medicine. The course of treatment for the two groups covered 4 weeks. Before and after treatment，the patients of the two groups were observed in the changes of pain visual analogue scale （VAS） score，Japanese Orthopedic Association （JOA） score of lumbar function，Oswestry Disability Index （ODI） score，straight-leg raising test results and serum interleukin 6（IL-6） and C-reactive protein （CRP） levels. After treatment，the clinical efficacy and safety of the two groups were evaluated. Results （1） After 4 weeks of treatment，the total effective rate of the trial group was 96.67%（29/30） and that of the control group was 63.33%（19/30） . The intergroup comparison （tested by Fisher’ s exact test） showed that the clinical efficacy of the trial group was significantly superior to that of the control group （P＜0.05） . （2） After treatment，the lumbar function indicators of pain VAS scores and ODI scores in the trial group were significantly lower （P＜0.05） ，and the JOA scores were significantly higher than those before treatment （P＜0.05） ，while in the control group，only the ODI scores were significantly lower than those before treatment （P＜0.05） . The intergroup comparison showed that the decrease of VAS and ODI scores and the increase of JOA scores in the trial group were significantly superior to those in the control group （P＜0.05 or P＜0.01） . （3） After treatment，the Laseque’ s sign of the trial group was significantly improved compared with that before treatment （P＜0.05） ，while no significant improvement was presented in the control group （P＞0.05） . The intergroup comparison showed that the improvement of Laseque’ s sign in the trial group was significantly superior to that in the control group （P＜0.01） . （4） After treatment，the levels of serum inflammatory factors of IL-6 and CRP in the two groups were lower than those before treatment （P＜0.05），and the decrease of serum IL-6 level in the trial group was significantly superior to that in the control group （P＜0.05） ，but CRP level in the two groups after treatment did not differ from that before treatment，no statistically significant difference was shown between the two groups after treatment，either （P＞0.05） . （5） The incidence of adverse reactions in the trial group was 6.67% （2/30） and that in the control group was 13.33% （4/30） ，and the intergroup comparison （by Fisher’ s exact test） showed that there was no significant difference between the two groups （P＞ 0.05） . Conclusion The therapeutic effect of“triple-posture positive bone-setting”chiropractic manipulation combined with Tongluo Huoxue Formula exert certain effect for the treatment of LSS patients with qi deficiency and blood stasis syndrome，and it has more obvious advantages in improving the lumbar function，promoting the rehabilitation of the patients，and lowering the level of serum inflammatory factors than “triple-posture positive bone-setting”chiropractic manipulation combined with conventional western medication.

R274.9

广东省自然科学基金面上项目 （编号：2021A1515011723）；广东省自然科学省企联合基金面上项目 （编号：2022A1515220093）