目的 通过观察不同力学参数下立体定位斜扳法治疗腰椎间盘突出症患者的临床效应，并在最佳力学参数下探讨立体定位斜扳法与传统腰椎斜扳法治疗腰椎间盘突出症的舒筋效应。 方法 采用三因素三水平正交试验法，将纳入本研究的27例LDH患者随机分为9个参数组，每组3例患者，分别进行不同参数的立体定位斜扳法治疗，设按压力度、次数、治疗间隔3因素，各因素包含3水平，即按压力度设立3个水平：300 ~ 400、400 ~ 500、500 ~ 600 N；按压次数设立3个水平：6、9、12次；治疗间隔3个水平：间隔1、2、3日。通过VAS、ODI和FDD评价指标筛选出最佳力学参数后，纳入94例患者随机分为两组，治疗组为最佳力学参数配置下的立体定位斜扳法，对照组为传统腰椎斜扳法，观察治疗前后两组患者VAS、ODI评分以及多裂肌厚度与横截面积变化。通过健康志愿者与腰椎间盘突出症患者腰椎多裂肌的对比，明确腰椎间盘突出症患者多裂肌的特征。通过统计分析软件SPSS 26.0分析各观察指标与参数之间的相关性，得出最佳的手法治疗参数。 结果 正交试验分析得出对疗效影响顺序为按压力度>治疗间隔>按压次数，疗效最佳的压力区间为：500 ~ 600 N，次数为12次，治疗间隔2日1次。腰椎间盘突症患者腰部多裂肌与健康志愿者比较，退变程度更明显，差异有统计学意义（P < 0.05）。两组腰椎间盘突出症患者经6周观察，两组治疗后的VAS和ODI评分均较治疗前有明显下降（P < 0.05），其中治疗组的改善幅度更大。多裂肌结果表明，经治疗后治疗组可显著增加多裂肌静息厚度、收缩厚度、收缩率和横截面积有显著变化（P < 0.05），其中缩厚度、收缩率治疗前后变化较对照组更显著。 结论 立体定位斜扳法治疗腰椎间盘突出症有效，其中以手法参数压力500 ~ 600 N，按压次数12次，治疗间隔2日1次治疗腰椎间盘突出症有更佳的镇痛，降低肌肉张力以及改善功能障碍作用。与传统腰椎斜扳法相比，立体定位斜扳法在改善腰椎间盘突出症患者疼痛症状、功能障碍，以及多裂肌静息厚度、收缩厚度、收缩变化率、横截面积疗效更优。

Objective To observe the clinical effects of the stereotaxic oblique-pulling manipulation under different mechanical parameters in the treatment of patients with lumbar disc herniation， and to explore the muscle-relaxing effects of the stereotaxic oblique-pulling manipulation and the traditional lumbar oblique-pulling manipulation in the treatment of lumbar disc herniation under the optimal mechanical parameters. Methods Using a three-factor， three-level orthogonal test method， 27 LDH patients included in this study were randomly divided into 9 parameter groups， with 3 patients in each group， and were treated with different parameters of the stereotactic angled wrench method. 3 factors were set up for the pressing force， the number of times， and the treatment interval， and each factor consisted of 3 levels， i.e.， pressing force： 300 ~ 400 N， 400 ~ 500 N， and 500 ~ 600 N； the number of times pressed 3 levels were set up： 6 times， 9 times， 12 times； 3 levels of treatment interval： 1 day interval， 2 days interval， 3 days interval. After screening the optimal mechanical parameters through VAS， ODI and FDD evaluation indexes， 94 patients were included and randomly divided into two groups； the treatment group was stereotaxic oblique-pulling manipulation under the configuration of optimal mechanical parameters， and the control group was the traditional lumbar oblique-pulling manipulation， and the changes of patients' VAS and ODI scores as well as the thickness of multifidus muscle and cross-sectional area before and after treatment were observed in the treatment of the two groups of patients. Through the comparison of lumbar multifidus muscle between healthy volunteers and patients with lumbar keyboard herniation， the characteristics of lumbar disc herniation multifidus muscle were clarified. The correlation between each observation index and parameter was analyzed by the statistical analysis software SPSS 26.0 to derive the optimal parameters for manipulative treatment. Results Orthogonal test analysis yielded that the order of influence on the efficacy was pressing force > treatment interval > pressing times， and the pressure interval with the best efficacy was： 500 ~ 600 N， the number of times was 12 times， and the Treatment internal of 2 days. The degree of degeneration of lumbar multifidus muscle in patients with lumbar disc herniation was more obvious compared with that of healthy volunteers， and the difference was stati stically significant （P < 0.05）. Observed in both groups of patients with lumbar disc herniation after 6 weeks of treatment time， the VAS and ODI scores of both groups decreased significantly after treatment compared with those before treatment （P < 0.05）， with greater improvement in the treatment group. The results of the multifidus muscle showed that after treatment， the treatment group could significantly increase the resting thickness， contraction thickness， contraction rate and cross-sectional area of the multifidus muscle had significant changes （P < 0.05）， in which the contraction thickness， contraction rate before and after the treatment changes were more significant than the control group. Conclusions The stereotaxic oblique-pulling manipulation is effective in the treatment of lumbar disc herniation， in which the manipulation parameter pressure of 500 ~ 600 N， the number of presses 12 times， and the treatment interval of 2 days once for the treatment of lumbar disc herniation has better analgesia and improves the dysfunction effect. Compared with the traditional lumbar oblique-pulling manipulation， the stereotaxic oblique-pulling manipulation is better in improving the pain symptoms and dysfunction of patients with lumbar disc herniation， as well as the resting thickness of the multifidus muscle， the contraction thickness， the contraction rate of change， and the cross-sectional area.