基于全科理念和优势中医专科相结合的腰突患者管理模式研究报告
Research Report on the Management Model of Lumbar Disc Herniation Patients Combining General Practice Concept and Advantageous Traditional Chinese Medicine Specialty

本研究旨在构建全科理念与优势中医专科相结合的腰椎间盘突出症患者管理模式。选取2022年8月至2024年8月上海市浦东新区曹路社区卫生服务中心120例患者，依据相关诊断标准纳入研究，排除特定患者。按疾病阶段分类管理，高危期针对特定人群开展健康档案随访与科普宣教等；急性期无马尾刺激或肌力下降者保守治疗，有症状者转诊手术并配合中药康复；亚急性期行适度活动及多种治疗；缓解期回社区康复，包括功能锻炼、中药、针灸、导引及心理干预等，同时进行慢病管理。通过分层分析数据，结果显示男性患者居多，发病高峰在30~55岁，职业因素影响显著，中医证型与体质类型有一定分布特点。各阶段治疗方法应用有别，整体治疗依从性良好，复发率为13.3%且复发多在6~12个月，与重体力劳动、特定中医证型体质及缓解期康复锻炼依从性相关。体质、症状、生活质量评分在治疗过程中有相应趋势变化且标准差逐渐减小。本模式在改善症状、恢复功能、减轻疼痛与降低复发率方面效果良好，为优化管理模式提供依据，也为临床决策提供参考。
The aim of this study was to construct a management model for lumbar disc herniation patients combining the general practice concept and the advantageous traditional Chinese medicine specialty. A total of 120 patients from Caolu Community Health Service Center in Pudong New Area, Shanghai from August 2022 to August 2024 were selected and included in the study according to relevant diagnostic criteria, excluding specific patients. The patients were managed according to the disease stage. In the high-risk stage, health file follow-up, popular science education and other activities were carried out for specific populations; in the acute stage, conservative treatment was recommended for those without cauda equina irritation or muscle strength decline, and those with symptoms were referred for surgery and accompanied by traditional Chinese medicine rehabilitation; in the sub-acute stage, moderate activities and a variety of treatments were carried out; in the remission stage, patients returned to the community for rehabilitation, including functional exercises, traditional Chinese medicine, acupuncture, guidance and psychological intervention, as well as chronic disease management. Through stratified analysis of data, the results showed that male patients were predominant, the peak age of onset was 30~55 years old, occupational factors had a significant impact, and there were certain distribution characteristics of TCM syndrome types and constitution types. The application of treatment methods in each stage was different. The overall treatment compliance was good. The recurrence rate was 13.3% and most recurrences occurred within 6~12 months, which was related to heavy physical labor, specific TCM syndrome types and constitutions, and compliance with rehabilitation exercises in the remission stage. The scores of constitution, symptoms and quality of life had corresponding trend changes and the standard deviation gradually decreased during the treatment process. This model has a good effect in