广西医学

目的探讨银质针导热联合三维牵引治疗中老年Ⅰ度退行性腰椎滑脱症（DLS）的临床疗效。方法选取120例中老年Ⅰ度DLS患者作为研究对象，将其随机分成牵引组、牵引镇痛组、牵引银质针组，每组40例。牵引组采用三维牵引治疗，牵引镇痛组采用三维牵引治疗联合口服布洛芬缓释胶囊治疗，牵引银质针组采用三维牵引联合银质针导热治疗。比较治疗前后3组患者的腰骶角、骶骨倾斜角、腰椎滑脱角、视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI），评估3组患者的治疗效果。结果治疗前3组患者的腰骶角、骶骨倾斜角、腰椎滑脱角、VAS评分、ODI比较，差异无统计学意义（P>0.05）；治疗后各时间节点3组患者上述指标优于治疗前（P<0.05）。牵引银质针组治疗后各时间点的腰骶角、腰椎滑脱角，出院后各时间节点的骶骨倾斜角，以及出院后3个月、6个月、12个月的VAS评分、ODI小于或低于牵引组和牵引镇痛组（P<0.05）。牵引银质针组的总有效率高于牵引组和牵引镇痛组（P<0.05）。结论银质针导热联合三维牵引可明显改善中老年Ⅰ度DLS患者的腰痛症状及腰椎功能，复位滑脱椎体的疗效确切，且效果持久、稳定，具有推广意义。

Objective To explore the clinical efficacy of silver needle diathermy combined with three⁃dimensional traction in the treatment of middle⁃aged and elderly patients with grade Ⅰ degenerative lumbar spondylolisthesis (DLS). Methods A total of 120 middle⁃aged and elderly patients with grade Ⅰ DLS were selected as the research subjects, and they were randomly divided into traction group, traction analgesia group or traction silver needle group, with 40 cases in each group. The traction group was treated with three⁃dimensional traction, the traction analgesia group was treated with three⁃dimensional traction combined with oral Ibuprofen Sustained⁃release Capsule, and the traction silver needle group was treated with three⁃dimensional traction combined with silver needle diathermy. The lumbosacral angle, sacral slope, lumbar spondylolisthesis angle, Visual Analogue Scale (VAS) score and Oswestry disability index (ODI) before and after treatment were compared between the three groups, and therapeutic effect in the three groups was evaluated. Results Before treatment, there was no statistically significant difference in lumbosacral angle, sacral slope, lumbar spondylolisthesis angle, VAS score and ODI between the three groups (P>0.05). At each time point after treatment, the aforementioned indices of the three groups were superior to compare with before treatment (P<0.05). The traction silver needle group exhibited smaller lumbosacral angle at each time point after treatment, lumbar spondylolisthesis angle at each time point after treatment and smaller sacral slope at various time points after discharge, as well as lower VAS score and ODI after 3, 6, and 12 months after discharge as compared with the traction and traction analgesia groups (P<0.05). The total effective rate in the traction silver needle group was higher than that in the traction group and the traction analgesia group (P<0.05). Conclusion Silver needle diathermy combined with three⁃dimensional traction can significantly ameliorate the symptoms of low back pain and lumbar vetebra function in middle⁃aged and elderly patients with grade Ⅰ DLS, the effect of reduction of spondylolisthesis is exact, and the effect is lasting and stable, which is worthy of promotion.