腰椎间盘突出症保守治疗后复发的再认识及分阶段干预思路——基于蒙医临床体会

Re Recognition and Staged Intervention Approach for Recurrence of Lumbar Disc Herniation after Conservative Treatment—Based on Clinical Experience in Mongolian Medicine

摘要: 腰椎间盘突出症(Lumbar Disc Herniation, LDH)是临床常见的腰腿痛病因之一，对患者生活质量影响较大。针灸作为常用的非手术治疗手段，在缓解急性期疼痛、改善功能方面具有确切疗效，但从临床随访来看，症状反复仍较为常见，也是影响疗效评价和患者信心的重要问题。围绕这一现象，本文结合现有研究与临床观察，对针灸治疗LDH后的复发情况及相关影响因素进行梳理与分析。在此基础上，从蒙医学角度出发，尝试将温针灸的温通调理作用与现代康复训练相结合，提出一套更偏向长期管理的干预思路。同时，针对当前研究中“复发率”界定不一、随访标准差异较大的问题，本文亦作出相应讨论，并对不同针灸技术(如温针灸与电针)在远期疗效方面的差异进行简要比较。进一步地，结合临床实际，构建了涵盖急性期处理、恢复期巩固及后期预防的分阶段管理方案。本文旨在从临床实践出发，对针灸治疗LDH后“易复发”这一问题提供一种更具连续性与可操作性的思路，为优化远期疗效提供参考。

Abstract: Lumbar Disc Herniation (LDH) is one of the common causes of lower back and leg pain in clinical practice, which has a significant impact on the quality of life of patients. Acupuncture and moxibustion, as a commonly used non-surgical treatment, has a definite effect in alleviating pain in the acute phase and improving function. However, according to clinical follow-up, repeated symptoms are still common, which is also an important issue affecting the efficacy evaluation and patient confidence. Focusing on this phenomenon, this paper combs and analyzes the recurrence and related influencing factors after acupuncture and moxibustion and moxibustion treatment of LDH in combination with existing research and clinical observation. On this basis, from the perspective of Mongolian medicine, we try to combine the warming and calming effects of warm acupuncture and moxibustion with modern rehabilitation training, and propose a set of intervention ideas that are more inclined to long-term management. At the same time, in view of the different definitions of “recurrence rate” and the large differences in follow-up standards in the current study, this paper also made corresponding discussions, and briefly compared the differences in long-term efficacy of different acupuncture and moxibustion techniques (such as warm acupuncture and moxibustion and electroacupuncture). Furthermore, based on clinical practice, a phased management plan covering acute phase management, recovery phase consolidation, and post prevention has been constructed. The purpose of this paper is to provide a more continuous and operable idea for the problem of “easy recurrence” after acupuncture and moxibustion treatment of LDH from clinical practice, and provide a reference for optimizing long-term efficacy.