【目的】观察调脊通督针法联合腺苷钴胺肌注治疗腰椎间盘突出症 （LDH） 的临床疗效。 【方法】将124例LDH患者随机分为观察组和对照组，每组各62例，对照组给予常规治疗联合腺苷钴胺肌肉注射。观察组在对照组治疗的基础上，给予调脊通督针法治疗。2组均连续治疗1个月。治疗1个月后，评价2组临床疗效，观察2组患者治疗前后视觉模拟量表 （VAS） 评分、日本骨科协会评估治疗分数 （JOA） 评分和腰椎Oswestry功能障碍指数 （ODI） 评分的变化情况，以及腰椎活动度包括腰椎屈伸、旋转、侧屈活动度的情况。比较2组患者治疗前后血清血栓素B2 （TXB2） 、白细胞介素1β （IL-1β） 、白细胞介素10（IL-10） 水平的变化情况。并评价2组不良反应的发生情况。 【结果】（1） 观察组总有效率为91.94% （57/62） ，对照组为79.03%（49/62） 。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VAS、JOA与ODI评分均明显改善（P＜0.05） ，且观察组在改善VAS、JOA与ODI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组患者的腰椎屈伸、旋转、侧屈活动度明显改善 （P＜0.05） ，且观察组在改善腰椎屈伸、旋转、侧屈活动度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组患者的血清TXB2、IL-1β、IL-10水平均明显改善 （P＜0.05） ，且观察组在改善血清TXB2、IL-1β、IL-10水平方面明显优于对照组，差异有统计学意义 （P＜0.05） 。 （5） 观察组与对照组的不良反应发生率比 较，差异无统计学意义 （P＞0.05） 。 【结论】调脊通督针法联合腺苷钴胺肌注治疗腰椎间盘突出症，可明显缓解患者的疼痛症状，改善患者的腰椎功能与活动度，促进血清IL-10及抑制TXB2、IL-1β表达，且安全有效，临床疗效显著。

Objective To observe the clinical efficacy of regulating the spine and unblocking governor vessel acupuncture combined with Cobamamide intramuscular injection in the treatment of lumbar disc herniation （LDH） . Methods A total of 124 patients with LDH were randomly divided into observation group and control group，62 cases in each group，and the control group was given conventional treatment combined with Cobamamide intramuscular injection. The observation group was treated with regulating the spine and unblocking governor vessel acupuncture on the basis of the treatment of the control group，and both groups were treated for one month continuously. After one month of treatment，the clinical efficacy of the two groups was evaluated，and the changes of Visual Analogue Scale （VAS） score， Japanese Orthopaedic Association （JOA） score， lumbar Oswestry Disability Index （ODI） score and lumbar range of motion，including Lumbar flexion and extension，rotation，lateral flexion mobility， were observed in the two groups before and after treatment. Serum thromboxane B2（TXB2），interleukin-1β （IL-1β），and interleukin-10 （IL-10） levels were compared between the two groups before and after treatment. And the occurrence of adverse reactions in the two groups was evaluated. Results （1）The total effective rate was 91.94% （57/62） in the observation group and 79.03% （49/62） in the control group. The efficacy 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 scores of VAS，JOA and ODI of the patients in the two groups were improved significantly （P＜0.05） ，and the improvement in the observation group was significantly superior to that in the control group，with a statistically significant difference （P＜0.05） . （3） After treatment，the lumbar flexion and extension，rotation and lateral flexion mobility of patients in the two groups were improved significantly （P＜0.05） ，and the improvement in the observation group was significantly superior to that in the control group，with statistically significant differences （P＜0.05） . （4） After treatment，the levels of serum TXB2，IL-1β，and IL-10 of patients in the two groups were significantly improved （P＜0.05） ，and the improvement in the observation group was significantly superior to that in the control group，with statistically significant differences （P＜0.05） . （5） Comparison of the incidence of adverse reactions between the observation group and the control group showed that the difference was not statistically significant （P＞0.05） . Conclusion Regulating the spine and unblocking governor vessel acupuncture combined with Cobamamide intramuscular injection in the treatment of LDH can significantly alleviate pain of the patients，improve their lumbar function and range of motion，and promote the expression of serum IL-10 and inhibit the expression of TXB2 and IL-1β，which is safe and effective，and the clinical efficacy is remarkable.

R246.9

国家自然科学基金资助项目 （编号：81873322）