超声引导下中医内热针治疗腰椎内固定术后腰痛的疗效分析及对血清5-HT、SP、β-EP水平的影响

Efficacy of ultrasound-guided traditional Chinese medicine internal heat acupuncture in treating lumbago after internal fixation of lumbar spine and its effects on serum levels of 5-HT, SP, and β-EP

摘要:

目的 探讨超声引导下中医内热针对腰椎内固定术后腰痛患者的疗效及血清5-羟色胺（5-HT）、P物质（SP）、β-内啡肽（β-EP）水平的影响。方法 选取2021年1月—2022年11月惠州市中医医院收治的80例腰椎内固定术后腰痛患者纳入研究，脱落后共63例，采取区组随机方法将其分为实验组（32例）、对照组（31例）。两组均给予基础治疗，对照组给予基础治疗和塞来昔布胶囊，实验组在对照组基础上给予超声引导下中医内热针治疗，疗程为2周。比较两组临床疗效；测量两组治疗前后腰椎活动度（前屈、后伸、侧屈角度）；分别于治疗前后采用视觉模拟评分法（VAS）评估两组疼痛情况，日本骨科协会（JOA）评分评估两组腰椎功能；检测两组治疗前后疼痛介质［5-羟色胺（5-HT）、P物质（SP）、β-内啡肽（β-EP）］水平；采用健康调查简表（SF-36）评估两组治疗前后生活质量；记录两组治疗期间不良反应；收集两组治疗前后红外热成像结果。结果 实验组总有效率高于对照组（P <0.05）。实验组与对照组治疗前，以及治疗后2、4和12周腰椎活动度（前屈、后伸、侧屈角度）、VAS、JOA、SF-36评分及5-HT、SP、β-EP水平比较，经重复测量设计的方差分析，结果 ①不同时间点前屈、后伸、侧屈角度，VAS、JOA、SF-36评分及5-HT、SP、β-EP水平比较，差异均有统计学意义（P <0.05）；②实验组与对照组的前屈、后伸、侧屈角度，VAS、JOA、SF-36评分及5-HT、SP、β-EP水平比较，差异均有统计学意义（P <0.05）；③两组前屈、后伸、侧屈角度，VAS、JOA、SF-36评分及5-HT、SP、β-EP水平变化趋势比较，差异均有统计学意义（P <0.05）。两组不良反应总发生率比较，差异无统计学意义（P >0.05）；治疗后2、4和12周，实验组针刺穴位区域温度图像趋于正常水平，对照组与治疗前无明显变化。结论 超声引导下中医内热针对腰椎内固定术后腰痛具有较好疗效，可减轻患者疼痛，改善腰椎功能，调节5-HT、SP、β-EP水平，提高患者生活质量，同时不良反应较少，具有临床应用价值。

Abstract:

Objective To investigate the therapeutic efficacy of ultrasound-guided traditional Chinese medicine internal heat acupuncture in treating lumbago after internal fixation of lumbar spine and its effects on serum levels of 5-hydroxytryptamine (5-HT), substance P (SP) and β-endorphin (β-EP).Methods Eighty patients with lumbago after internal fixation of lumbar spine admitted to Huizhou Traditional Chinese Medicine Hospital from January 2021 to November 2022 were included in the study, and a total of 63 patients were finally included after excluding those who were lost to follow-up. These patients were divided into experimental group (32 cases) and control group (31 cases) via block randomization. On the basis of general treatment, the control group was additionally administrated with the celecoxib capsule, while the experimental group was additionally given ultrasound-guided traditional Chinese medicine internal heat acupuncture plus the celecoxib capsule. The course of treatment was 2 weeks, and then the therapeutic efficacy of the two groups was compared. Lumbar range of motion (anterior flexion, posterior extension, and lateral flexion) was measured before and after the treatment. Visual analog scale (VAS) was used to assess pain in both groups before and after the treatment, and the lumbar function was assessed by the Japanese Orthopaedic Association (JOA) score. The levels of pain mediators [5-HT, SP and β-EP] before and after the treatment were detected. The quality of life of the two groups before and after the treatment was assessed by the Short-Form 36 questionnaire (SF-36). Adverse reactions during the treatment were recorded in both groups. The results of infrared thermal imaging before and after the treatment were collected.Results The overall effective rate of the experimental group was higher than that of the control group (P < 0.05). The lumbar range of motion (anterior flexion, posterior extension, and lateral flexion), VAS, JOA and SF-36 scores, and levels of 5-HT, SP and β-EP before and 2, 4, and 12 weeks after the treatment in the two groups were compared via repeated measures analysis of variance, and the results revealed that they were different among the time points (P < 0.05) and between the groups (P < 0.05), and that the change trends of these indicators were different between the experimental group and the control group (P < 0.05). There was no difference in the overall incidence of adverse reactions between the two groups (P > 0.05). After 2, 4 and 12 weeks of treatment, the temperature image of the area around the acupuncture point in the experimental group tended to be normal, while that in the control group after the treatment was not different from that before the treatment (P > 0.05).Conclusions Ultrasound-guided traditional Chinese medicine internal heat acupuncture exhibits great therapeutic efficacy for lumbago after internal fixation of lumbar spine. It ameliorates the pain of patients, enhances their function of lumbar spine, regulates the levels of 5-HT, SP and β-EP, and improves the quality of life of patients with few adverse reactions, thus being of value for clinical application.