腰椎滑脫之整脊合併針灸治療病例報告

Treatment Combined with Spinal Manipulation and Acupuncture on Low Back Pain and Spondylolisthesis: A Case Report

張祝霖(Chu-Lin Chang) ； 李東煌(Tung-Huang Li)

《臺灣中醫醫學雜誌》 17卷2期 (2019/09) Pp. 5-14

摘要

本病例記錄一名六十六歲男性患者因下背痛相關症狀，接受一般復健治療改善有限故轉由中醫治療的病案。下背痛是顯著影響生活品質的疾病之一，每年與此相關診斷在健保花費的統計中名列前茅。常見的下背痛主要原因有：急性腰肌拉傷、椎間盤突出、椎間孔狹窄、以及腰椎滑脫……等。其中腰椎滑脫因涉及脊椎結構改變所以相對嚴重，此症在現代醫學的積極處置常只有手術固定一途，替代性或非侵入性的治療方法有限。病人近一年經歷下背痛合併逐漸加重之左下肢痠麻感，經放射線檢查發現並診斷為第五腰椎滑脫（Grade II）、下背痛合併左側坐骨神經痛。患者接受中醫整脊以及針灸治療六個月後，在症狀及影像皆有明顯改善。本文欲藉由分享此病例來探討中醫可提供早期腰椎滑脫患者的有效且低侵入性之治療手段。

關鍵字

下背痛 ； 坐骨神經痛 ； 整脊 ； 腰椎滑脫 ； 中醫 ； 動態脊椎矯正

並列摘要

This is a case of 66 year-old male with low back pain induced by spondylolisthesis treated by Traditional Chinese Medicine therapy. Low back pain, one of the most costly diseases in health insurance of Taiwan, seriously diminished patient's quality of life. Sprain or strain of lumbar muscle, hernia of vertebral disc, stenosis of nerve foramen, and spondylolisthesis are the most common causes of low back pain. Among these factors, spondylolisthesis, due to the structural change of spine, is more severe and often needed operation as an aggressive therapy. This case suffered from low back pain and progressive left-side sciatica for more than 1 year. The X-ray film revealed grade 2 spondylosithesis of 5^(th) lumbar spine, and we choose dynamic spinal manipulation as our main therapy for the patient. After the treatment combined with dynamic spinal manipulation and acupuncture in three months, significant improvements were found in both low back pain relevant syndrome and X-ray images of lumbar spine. We would like to share this case to discuss the possibility of the lower invasive but effective Traditional Chinese Medicine therapy on early-grades spondylolisthesis.

並列關鍵字

Low back pain ； Sciatica ； Spinal manipulation ； Spondylolisthesis ； Traditional Chinese medicine ； Dynamic spinal manipulation

參考文獻

維基百科：下背痛。https://zh.wikipedia.org/wiki/下背痛

李東煌：《中醫傷骨科學─結構醫學》（台北：五南圖書出版股份有限公司2013）

Elmekaty M. Kotani Y. Mehy EE. Robinson Y, Tantawy AE, Sekiguchi I. Fujita R. Clinical and Radiological Comparison between Three Different Minimally Invasive Surgical Fusion Techniques for Single-Level Lumbar Isthmic and Degencrarivt Spondylolisthesis: Minimally Invasive Surgical Posterolateral Fusion versus Minimally Invasive Surgical Transforaminal Lumbar Interbody Fusion versus Midline Lumbar Fusion. Asian Spine J. 2018 Oct; 12（5）: 870-879

長庚醫療財團法人衛教資料文章查詢系統：認識腰椎滑脫症。https://www.cgmh.org.w/asproot/healthedu/view/health_01.aspx

財團法人脊椎醫學研究基金會：脊椎滑脫症之診療，https://www.taiwanspine.org.tw/treasure/脊椎滑脫症之診療-37.htm