腰椎伸展運動療法による急性腰椎椎間板へルニアの治療

The Use of Lumbar Extension Exercises in the Treatment of Patients with Acute Herniated Nucleus Pulposus

　抄録：発症後30日以内の急性腰椎椎間板ヘルニア患者の臥位伸展運動群（1群）105人と持続伸展運動群（2群）35人に，外来でMcKenzieの腰椎伸展運動療法を行った．対照として，それ以前に入院で従来の治療法を行った急性腰痛患者44人を用い，30日以内の治療期間で成績を分析した．指床間距離については入院群は外来1群とは差はなく，2群とは有意に改善していた．SLR角度は，外来群と比べ入院群の改善が著明であった．腰痛・下肢痛の改善は，「全く消失したもの」に「時にあるもの」を加えた比率は，1群68.5％，2群85.7％，入院群59.1％で，伸展による外来治療は良好であった．MRIを多数回撮像した1群33人のヘルニア腫瘤の変化は，消失と著明に縮小したもの24.2％，何らかの縮小を示したもの30.3％で，変性と突出が高度なものに多かった．X線計測値はtotal lumbar angleとposterior projectionが，症状改善と大きく関連していた．追跡調査した42人では自覚症状と他覚所見を加えたJOAスコアは，治療直後12.1点が追跡調査時13.5点と改善していた．

　A clinical trial was conducted to compare the effectiveness of MacKenzie-type extension exercises for outpatients with acute herniated nucleus pulposus, with that of classical therapies for inpatients with acute low back pain. In this study 140 consecutive patients with acute herniated nucleus pulposus less than 30days symptom duration were assigned to two groups and they both performed McKenzie's extension exercises and received posturer instructions in the outpatient clinic. Group 1 was treated by extension lying prone (n＝105) and Group 2 was treated by sustained extension (n＝35). Inpatients were treated by classical conservative therapies (n＝44). The subjects were evaluated prior to the start of treatment, and within 30 days following treatment. As objective symptoms, finger-floor distance improved more among the inpatients than outpatient Group 1, and SLR angles showed more in the improvement in the inpatients than the outpatients. Assesment of improvement of the subjective manifestations following treatment showed that 68.6％ of the Group 1 outpatients and 85.7％ of the Group 2 outpatients experienced little or no low back pain and lower extremity pain, as opposed to only 56.8％ of the inpatients. Thirty-three outpatients in Group 1 underwent follow-up MRI examination, and the results showed unequivocal or total regression of the herniation in 24.2％ of the patients and a slight decrease in size in 30.3％. High grade degenerative changes and a large disc were important factors in regression of the herniated mass. There was a relationship between increased total lumbar angle and posterior projection on the follow-up standing lateral roentgenograms and improvement of symptoms. The follow-up data of 42 patients showed improvement in their JOA score (subjective and objective) from 12.1 to 13.5. Therefore, performance of McKenzie's extension exercises is useful as a means of primary care for patients with an acute herniated nucleus pulposus.