推拿治疗LDH的作用机制和研究进展
Mechanism of Action and Research Progress of Massage Therapy for LDH

腰椎间盘突出症(Lumbar Disc Herniation, LDH)作为脊柱退行性疾病的典型病理类型，其临床管理亟待建立安全有效的非侵入性治疗范式。中医推拿通过构建多靶点调控网络在LDH治疗中展现独特治疗优势：其一，三维生物力学调整机制(包含软组织黏弹性修复、椎间关节运动学参数优化)可有效降低神经根机械压迫指数(MCI)；其二，靶向调控机制显著抑制关键促炎因子(IL-6, TNF-α)的过度表达，通过NF-κB/COX-2信号通路活性调控实现炎症级联阻断，并重塑免疫平衡(促进Th2/Treg细胞亚群分化、诱导巨噬细胞向M2抗炎表型极化)，从而改善神经根复合损伤病理进程。其三，通过激活Piezo1机械敏感离子通道增强局部微循环灌注效率，改善椎间盘营养代谢微环境(提升Aggrecan、Collagen II合成速率)，延缓椎间盘细胞外基质降解进程。临床实践创新方面，影像导航技术(如超声-MRI融合成像)与生物力学建模技术的应用实现了手法参数的定量化调控，与针灸、中药等形成多模态协同治疗方案(协同效应指数SEI = 1.32)。当前研究瓶颈集中于机制研究呈现多组学关联性不足、手法生物力学参数标准化欠缺，后续需整合分子影像(PET-MRI分子探针)与人工智能(深度学习辅助手法力学分析系统)构建机制网络图谱，并通过基于真实世界研究(RWS)的大样本循证体系推动精准医学框架下的治疗方案国际标准化制定。
Lumbar Disc Herniation (LDH), as a typical pathologic type of spinal degenerative diseases, is in urgent need of a safe and effective non-invasive treatment paradigm for its clinical management. Traditional Chinese Medicine (TCM) Tuina demonstrates unique therapeutic advantages in the treatment of LDH through the construction of a multi-target regulatory network: first, the three-dimensional biomechanical adjustment mechanism (including soft tissue viscoelasticity repair and optimization of intervertebral joint kinematics parameters) effectively reduces the Mechanical Compression Index (MCI) of the nerve root; second, the targeted regulatory mechanism significantly inhibits the overexpression of key pro-inflammatory factors (IL-6, TNF-α), and the over-expression of key proinflammatory factors (IL-6 and TNF-α) through the NF-κB/COX-2 signaling pathway to block the inflammatory cascade and reshape the immune homeostasis (promoting the differentiation of Th2/Treg cell subpopulations and inducing the polarization of macrophages to the M2 anti-inflammatory phenotype), thus improving the pathological process of nerve root complex injury. Thirdly, activation of Piezo1 mechanosensitive ion channels enhances local microcirculation perfusion efficiency, improves the microenvironment of intervertebral disc nutrient metabolism (enhances the synthesis rate of Aggrecan and Collagen II), and slows down the process of extracellular matrix degradation in the intervertebral disc. In terms of clinical practice innovation, the application of image navigation technology (e.g., ultrasound-MRI fusion imaging) and biomechanical modeling technology has realized the quantitative regulation of manipulation parameters, and formed a multimodal synergistic treatment plan with acupuncture and traditional Chinese medicine (synergistic effect index SEI =