目的 探讨小针刀联合通痹活络汤治疗腰椎间盘突出症（LDH）在疼痛和脊柱稳定性方面的疗效。方法 回顾性分析荆州市中医医院骨科及康复医学科于2022年10月—2025年10月期间纳入的96例LDH患者临床资料,根据其接受的治疗方案分为对照组（常规西医治疗,n=48）与研究组（对照组基础上的小针刀手术联合通痹活络汤口服治疗,n=48）。观察评估两组患者功能及症状评分、脊柱稳定性指标（L4/L5及L5/S1节段矢状位位移、角位移、椎间隙高度指数）、血清炎症因子水平及不良反应发生情况。结果 治疗前两组患者各项观察指标水平基线一致（P>0.05）,经相应干预后,两组患者疼痛视觉模拟评分法（VAS）评分、Oswestry功能障碍指数（ODI）均有明显降低,日本骨科协会（JOA）评估治疗分数明显升高（P<0.05）,且研究组治疗后VAS、ODI水平低于对照组,JOA水平高于对照组（P<0.05）;脊柱稳定性指标方面,治疗后两组患者病变节段的矢状位位移及角位移均显著降低（P<0.05）,且研究组改善更为明显（P<0.05）;血清炎症因子方面,治疗后两组白介素-6（IL-6）及肿瘤坏死因子α（TNF-α）水平均显著降低（P<0.05）,且研究组改善更为明显（P<0.05）。两组患者不良反应总发生率无明显差异（P>0.05）。结论 在常规西医治疗基础上采用小针刀微创松解术联合通痹活络汤治疗LDH有助于进一步改善患者功能及症状,增强脊柱动态稳定性,降低炎症反应且安全性良好。

Objective To investigate the efficacy of miniscalpel-needle combined with Tongbi Huoluo Decoction on pain and spinal stability in the treatment of lumbar disc herniation （LDH）. Methods The clinical data of 96 patients with LDH admitted to the Department of Orthopedics and Rehabilitation Medicine of Jingzhou Hospital of Traditional Chinese Medicine from October 2022 to October 2025 were retrospectively analyzed. According to the treatment plans, they were divided into a control group （conventional Western medicine treatment, n=48） and a research group （miniscalpel-needle combined with Tongbi Huoluo Decoction on the basis of the control group, n=48）. Function and symptom scores, spinal stability indicators （sagittal displacement, angular displacement, disc height index of L4/L5 and L5/S1 segments）, serum inflammatory factor levels, and adverse reactions were evaluated. Results Before treatment, the baseline of all iindicators was comparable between the two gruops （P>0.05）. After treatment, the visual analog scale （VAS） and Oswestry disablity index （ODI） scores decreased significantly, while the Japanese Orthopaedic Association （JOA） scores increased significantly in both groups （P<0.05）; the research group showed lower VAS and ODI scores, and higher JOA scores than the control group （P<0.05）. Regarding spinal stability, sagittal and angular displacement decreased in both groups, with more significant improvement in the research group （P<0.05）. Serum interleukin-6 （IL-6） and tumor necrosis factor-α （TNF-α） levels were also significantly decreased in both groups, and lower levels were found in the research group （P<0.05）. There was no significant difference in the incidence of adverse reactions between the two groups （P>0.05）. Conclusion On the basis of conventional Western medicine treatment, miniscalpel-needle micro-invasive loosening combined with Tongbi Huoluo Decoction can further improve the function and relieve the symptoms of LDH patients, enhance dynamic spinal stability, and reduce inflammatory response with good safety.