Abstract:

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.

Key words: stereotaxic oblique-pulling manipulation, lumbar disc herniation, mechanical parameters, multifidus muscle, soothing effect