腰椎椎間盤突出以傳統機械式腰椎牽引介入時治療姿勢擺位的考量：系統性文獻回顧

Prone or Supine Position During Mechanical Lumbar Traction for Lumbar Disc Herniation: Systematic Literature Review

王仁強(Jen-Chiang Wang) ； 林燕慧(Yang-Hua Lin) ； 陳貞吟(Chen-Yin Chen)

《物理治療》 43卷2期 (2018/06) Pp. 76-84

https://doi.org/10.6215/FJPT.201806_43(2).0003

摘要

背景與目的：腰椎牽引為改善椎間盤突出引起的下背痛的治療方式之一。本篇研究欲進行系統性回顧探討當今研究證據是否支持因不同姿勢影響機械式腰椎牽引介入時改善椎間盤突出引起之下背痛治療效果。方法：本篇研究使用PubMed、Cochrane Library、華藝線上圖書館等資料庫，以腰椎椎間盤突出(lumbar disc herniation)、牽引(traction)、姿勢擺位(posture/position)、仰躺(supine)及俯臥(prone)作為關鍵字進行搜尋，搜尋從1986年11月至2016年11月所發表的文章。以英國牛津大學實證醫學中心及皮卓量表評分檢核文獻品質及實證層級。結果：共計65篇，納入條件總計10篇符合進行文獻評析，大多為實證等級2級之研究。無論牽拉姿勢對於多項成效評估具有治療前後之改善。結論：本篇系統性文獻回顧，顯示對於腰椎椎間盤突出病患於腰椎牽引時所採取的姿勢尚無直接比較療效之研究證據，但分別檢視各牽引姿勢（仰躺或俯臥）之腰椎牽引，均呈現改善腰椎椎間盤突出相關症狀包括結構、神經症狀、生活障礙之功能程度等之成效。

關鍵字

椎間盤突出 ； 腰椎 ； 牽引 ； 俯臥 ； 仰臥

並列摘要

Background and Purpose: Lumbar traction is a treatment for lower back pain associated with disc herniation. The purpose of this study was to investigate that effects of supine or prone positions on the mechanical lumbar traction intervention in patients with disc herniation by conducting a systematic review. Methods: The key words of ＂lumbar disc herniation,＂ ＂traction,＂ ＂posture/position,＂ and ＂supine＂ or ＂prone＂ were searched in PubMed, Cochrane Library, and Airiti Library. Meanwhile, the search outcomes were limited with that, the full text is available,the languages were in Mandarin or English, and the study subjects were human during the period from November 1986 to November 2016. The quality of the literature and the level of evidence were assessed by the Evidence Center of the University of Oxford and the PEDro scale. Results: There were 65 articles reported by the search database and only ten articles were conducted into the process of the literature review. The PEDro scores were from 3 to 9 and the levels of evidence were from level II to level IV. All of the articles revealed that supine or prone positions did not affect the positive outcomes of the mechanical lumbar traction intervention in low back pain associated with disc herniation. Conclusions: This systematic literature review suggested that there were no direct comparisons between different effects of traction positions; however, the mechanical lumbar traction with either supine or prone position could improve the pain, neurological sign, disability level in patients with lumbar disc herniation.

並列關鍵字

Disc herniation ； Lumbar spine ； Traction ； Prone ； Supine