基于椎间盘重吸收探讨推拿干预巨大/破裂型 腰椎间盘突出症的研究进展

Research Progress on Tuina Intervention for Giant/Ruptured Lumbar Disc Herniation Based on Intervertebral Disc Reabsorption

摘要: 巨大/破裂型腰椎间盘突出症因椎间盘组织突出程度重、神经压迫明显，传统上多倾向于手术治疗。然而，近年研究发现该类患者腰椎间盘突出后重吸收现象发生率显著高于其他类型，保守治疗存在重要价值。推拿作为中医骨伤科核心疗法之一，在促进巨大/破裂型腰椎间盘突出症重吸收方面展现出独特优势。本文系统综述巨大/破裂型腰椎间盘突出症的定义特征与重吸收规律，阐述推拿疗法在促进该类突出重吸收中的临床研究进展，并从生物力学调整、免疫–炎症调节、细胞凋亡与自噬调控、血管生成与组织脱水等多个层面探讨其作用机制，同时分析推拿治疗的安全性及禁忌证，以期为推拿治疗巨大/破裂型腰椎间盘突出症的临床实践和后续研究提供参考。

Abstract: Giant/Ruptured lumbar disc herniation, characterized by severe disc tissue protrusion and significant nerve compression, has traditionally been treated surgically. However, recent studies have found that the incidence of post-herniation reabsorption in such patients is significantly higher than that of other types, suggesting the potential value of conservative treatment. As one of the core therapies in traditional Chinese orthopedics, tuina demonstrates unique advantages in promoting the reabsorption of massive/ruptured lumbar disc herniation. This article systematically reviews the definition, characteristics, and reabsorption patterns of massive/ruptured lumbar disc herniation, summarizes the clinical research progress of tuina therapy in promoting reabsorption of this condition, and explores the mechanisms from multiple perspectives, including biomechanical modulation, immune-inflammatory regulation, apoptosis and autophagy regulation, angiogenesis, and tissue dehydration. Safety considerations and contraindications of tuina treatment are also analyzed, aiming to provide references for clinical practice and future research on tuina in the treatment of massive/ruptured lumbar disc herniation.