Analysis of influencing factors of clinical effect of TCM treatment for degenerative lumbar spondylolisthesis

摘要

Objective:To explore the related factors that may affect the efficacy of traditional Chinese medicine in treating degenerative lumbar spondylolisthesis.Methods:A total of 535 patients with DLS who were treated in Wangjing Hospital of China Academy of Chinese Medical Sciences and other hospitals from June 2011 to October 2014 were selected.The central random system was used to randomly divide the treatment group and control group.This study included 267 patients in the treatment group using the traditional Chinese medicine program((lumbar spine reduction and lumbar spine rehabilitation),36 cases of severely missing data were excluded,and a total of 231 DLS patients were included.Observation indicators were selected using the Visual Analog Scale(VAS)and the Japanese Orthopaedic Association(JOA)for the evaluation of lumbar vertebral disorders.The clinical efficacy was evaluated using the JOA lumbar pain curative effect evaluation standard[7].[(Joa score after treatment-JOA score before treatment]/(out of 29 points-JOA score before treatment)]×100%.The JOA score and the change of the efficacy index of the patients were observed.According to the JOA efficacy index after the treatment,it was divided into significant effect(≥50%)and poor effect(<50%).Single-factor screening and multi-factor Logistic regression analysis were used.Gender,age,course of disease,BMI index,slip-off segment,slip-off direction,back pain VAS score,total JOA score,back pain-score,lower limb pain and numbness-score,walking ability-score,straight leg elevation test-score,Feeling-scoring,muscle strength-scoring,supine turn-scoring,standing action-scoring,washing action-scoring,standing posture and continuous standing-scoring,long sedentary-scoring,weight lifting and holding-scoring,walking-scoring 2.Bladder function-scores were assigned to logistic regression models for univariate analysis,and meaningful independent variables were screened for multivariate logistic regression.Results:No serious adverse reactions occurred in the patients included in this study.According to the comparison of JOA scores before and after treatment,the results of the index of efficacy index showed that the effective rate of DLS in this project was 96.6%,and a significant effect of 77.6%was achieved.Univariate Logistic regression analysis showed that the duration of disease,supine turn-scoring,washing action-scoring,prolonged sedentary-scoring,weight lifting and keeping-scoring had statistically significant effects on the inclusion of patients with significant efficacy(P<0.05);single factor logistic regression analysis of total score of JOA score before treatment was not statistically significant(P=0.215),but because it is important for evaluating the patient''s condition,it was included in multifactor logistic regression analysis at the same time.Course of onset,supine turn-scoring,washing action-scoring,prolonged sedentary-scoring,weight lifting and holding-scoring,JOA score before treatment.Six independent variables were substituted into the two-class logistic regression model for multivariate analysis..Multivariate logistic regression analysis showed that the effects of total JOA score and supine turn-scoring before treatment on the efficacy of patients were statistically significant(P<0.05).There are many factors influencing the efficacy of traditional Chinese medicine treatment of DLS,and the probability of obtaining a significant effect for each additional point of JOA score and supine turn-score before treatment increases by 1.167 and 0.410 times,respectively.Conclusion:The clinical application of lumbar spine reduction combined with lumbar rehabilitation exercises in patients with degenerative lumbar spondylolisthesis with a higher total JOA score or a lower limit of supine turning can achieve better clinical results.This finding has certain guiding significance for the clinical application of this therapy in the treatment of DLS,and is beneficial to improving patient satisfaction and clinical effectiveness.