【目的】 观察调督理筋针法联合揿针治疗腰椎间盘突出症的临床疗效。【方法】 将98例腰椎间盘突出症患者随机分为观 察组和对照组，每组各 49 例，对照组给予调督理筋针法治疗，观察组在对照组治疗的基础上，给予揿针治疗。连续治疗 1 个月。治疗1个月后，评价2组临床疗效，观察2组患者治疗前后日本骨科协会（JOA）评分和疼痛视觉模拟评分法（VAS）的 变化情况，以及腰椎活动度和 ERK 蛋白、ERK mRNA 表达的情况。比较 2 组患者治疗前后 β-内啡肽（β-EP）、神经肽 Y （NPY）、5-羟色胺（5-HT）、P物质（SP）水平和白细胞介素 6（IL-6）、肿瘤坏死因子 α（TNF-α）、白细胞介素 1β（IL-1β）水平 的变化情况。并评价2组的安全性。【结果】（1）观察组总有效率为93.88%（46/49），对照组为79.59%（39/49）。观察组疗效优 于对照组，差异有统计学意义（P＜0.05）。（2）治疗后，2 组患者的 JOA、VAS 评分均明显改善（P＜0.05），且观察组在改善 JOA、VAS评分方面明显优于对照组，差异有统计学意义（P＜0.05）。（3）治疗后，2组患者的β-EP、NPY、5-HT、SP水平明 显改善（P＜0.05），且观察组在改善β-EP、NPY、5-HT、SP水平方面明显优于对照组，差异有统计学意义（P＜0.05）。（4）治 疗后，2组患者的IL-6、IL-1β、TNF-α水平明显改善（P＜0.05），且观察组在改善 IL-6、IL-1β、TNF-α水平方面明显优于 对照组，差异有统计学意义（P＜0.05）。（5）治疗后，2组患者的腰椎前屈、后伸活动度明显改善（P＜0.05），且观察组在改善 腰椎前屈、后伸活动度方面明显优于对照组，差异有统计学意义（P＜0.05）。（6）治疗后，2 组患者的 ERK 蛋白表达、ERK mRNA水平明显改善（P＜0.05），且观察组在改善ERK蛋白表达、ERK mRNA水平方面明显优于对照组，差异有统计学意义 （P＜0.05）。（7）观察组不良反应发生率为8.16%（4/49），对照组为4.08%（2/49），组间比较，差异无统计学意义（P＞0.05）。【结论】 调督理筋针法联合揿针治疗腰椎间盘突出症，疗效显著，能明显改善患者的疼痛症状，降低血清疼痛介质、炎性因子水平， 改善腰椎功能，其作用机制可能与抑制ERK的信号通路相关。

Objective To observe the clinical efficacy of Tiaodu Lijin Acupuncture combined with thumb-tack needling for subcutaeous embedding in the treatment of lumbar disc herniation. Methods A total of 98 patients with lumbar disc herniation were randomly divided into observation group and control group，49 cases in each group. The control group was treated with Tiaodu Lijin Acupuncture，and the observation group was treated with thumbtack needling for subcutaeous embedding on the basis of the control group. Both groups were treated for one month. After one month of treatment， the clinical efficacy of the two groups was evaluated. The changes of Japanese Orthopaedic Association（JOA）score and Visual Analogue Scale（VAS）of pain were observed before and after treatment in the two groups，as well as the activity of lumbar spine and the expressions of ERK protein and ERK mRNA. The levels of β-endorphin（β-EP），neuropeptide Y（NPY），5-hydroxytryptamine（5-HT），substance P（SP），interleukin 6（IL-6），tumor necrosis factor α（TNF- α）and interleukin 1β（IL-1β）were compared between the two groups before and after treatment. The safety of the two groups was evaluated. Results（1）The total effective rate was 93.88%（46/49）in the observation group and 79.59%（39/49）in the control group. The curative effect of the observation group was superior to that of the control group， and the difference was statistically significant（P＜0.05）.（2）After treatment，the JOA and VAS scores of the two groups were significantly improved （P＜0.05），and the improvement of JOA and VAS scores in the observation group was significantly superior to that in the control group， the difference was statistically significant（P＜0.05）.（3）After treatment， the levels of β-EP，NPY，5-HT and SP in the two groups were significantly improved（P＜0.05），and the observation group was significantly superior to the control group in improving the levels of β -EP， NPY， 5-HT and SP， the difference was statistically significant（P＜0.05）.（4）After treatment，the levels of IL-6，IL-1β and TNF-α in the two groups were significantly improved （P＜0.05）， and the levels of IL-6， IL-1β and TNF- α in the observation group were significantly superior to those in the control group（P＜0.05）.（5）After treatment，the lumbar flexion and extension activities of the two groups were significantly improved （P＜0.05）， and the improvement of lumbar flexion and extension activities in the observation group was significantly superior to that in the control group，the difference was statistically significant（P＜0.05）.（6）After treatment，the expressions of ERK protein and the level of ERK mRNA in the two groups were significantly improved（P＜0.05）， and the observation group was significantly superior to the control group in improving the expressions of ERK protein and the level of ERK mRNA， the difference was statistically significant（P＜0.05）.（7）The incidence of adverse reactions in the observation group was 8.16%（4/49），while the control group was 4.08%（2/49）. There was no significant difference between the observation group and the control group（P＞0.05）. Conclusion Tiaodu Lijin Acupuncture combined with thumb-tack needling for subcutaeous embedding exerts certain effect in the treatment of lumbar disc herniation. It can significantly improve the pain symptoms of patients，reduce the levels of serum pain mediators and inflammatory factors， and improve lumbar function. The mechanism may be related to the inhibition of ERK signaling pathway.

R246.9

江苏省优势学科建设工程资助项目（编号：BE2021751）