针刺刺激筋膜联合再灌注活动对腰椎间盘突出症患者腰大肌与腰多裂肌横截面面积的影响OA

Objective To observe the effects of fascia-stimulating acupuncture combined with reperfusion activities on the cross-sectional area(CSA)of the psoas major and lumbar multifidus muscles,as well as clinical efficacy,in patients of lumbar disc herniation(LDH).Methods A total of 80 patients of LDH treated in the Acupuncture,Moxibustion,and Traumatology Department of Luodian Hospital,Baoshan District,Shanghai from October 2022 to August 2024 were selected and randomly divided into a treatment group and a control group using a random number table,with 40 cases in each group.The treatment group received fascia-stimulating acupuncture combined with reperfusion activities,while the control group received conventional acupuncture therapy.Clinical efficacy,as well as the CSA of the psoas major and lumbar multifidus muscles,Visual Analogue Scale(VAS)score,Japanese Orthopaedic Association(JOA)low back pain score,and Oswestry Disability Index(ODI)were compared between the two groups at three time points:before treatment,2 and 4 weeks of treatment.Multiple linear regression was used to analyze the correlations between changes in the CSA of the psoas major,multifidus muscles,and changes in VAS,JOA,and ODI scores.Log-binomial regression was used to analyze adverse events between the two groups.Results The total effective rate in the treatment group was 95%(38/40),which was significantly higher than 77.5%(31/40)in the control group(P<0.05).After 4 weeks of treatment,the treatment group showed greater CSA in both the psoas major and lumbar multifidus muscles compared to the control group.Furthermore,both groups showed an increase over time,with the treatment group demonstrating a significantly greater magnitude of change(P<0.05).The repeated-measures ANOVA showed that the main effects for group and time,and their interaction,were statistically significant(P<0.05).Scores on the JOA,VAS,and ODI all showed significant group and time effects,with a significant group-by-time interaction(P<0.05).After 4 weeks of treatment,the treatment group showed significantly higher JOA scores,and lower VAS and ODI scores compared to the control group.Notably,JOA scores increased over time in both groups after treatment,while VAS and ODI scores decreased;the magnitude of these changes was greater in the treatment group(P<0.05).Multiple linear regression analysis indicated that increases in the CSA of the psoas major and multifidus muscles and increases explained over 30%of the variance in the changes of VAS,JOA,and ODI scores(P<0.05).There was no statistically significant difference in the overall incidence of adverse reactions between the two groups(P>0.05).The control group had a higher number of patients with treatment failure than the treatment group,these patients were predominantly characterized by the following:age≥45 years,acute phase of LDH,bulging or protrusion type,VAS score≥3,JOA score<18,and ODI score≥20(P>0.05).Conclusion Fascia-stimulating acupuncture combined with reperfusion activities can effectively increase the CSA of the psoas major and lumbar multifidus muscles in patients of LDH,improve lumbar function,and alleviate pain.The clinical efficacy of this combined therapy is superior to conventional acupuncture treatment,with a good safety profile.