网络首发时间：2023-04-1214：36：25网络首发地址：https:kns.cnki.net/cms典晁由厍莎223o年d4月第4邺4卷第7棚·59.腰椎间盘突出症中西医结合诊疗专家共识世界中医药学会联合会骨质疏松专业委员会上海中医药大学附属龙华医院中日友好医院教育部筋骨理论与治法重点实验室摘要腰椎间盘突出症(LDH)是一种骨科常见的退行性脊柱病变，近年来呈高发病率及低龄化趋势。为明确中西医结合诊疗在LDH诊疗中的作用，提高中西医结合诊疗水平，根据近年来LDH最断诊疗进展，参考国内外指南、共识和最新循证医学证据，结合临床经验，组织专家经过多次讨论形成IDH中西医结合诊疗专家共识。本共识综合了中西医相关领域专家的意见，形成了中西医结合诊断和治疗的方案，为同道在临床工作中提供参考，为骨科、针灸科、推拿科和康复科等相关科室从业人员提供临床指导。关键词腰椎间盘突出症；中西医结合；分期论治；专家共识Expert Consensus on the Diagnosis and Treatment of Lumbar Disc Herniationwith Integrated Traditional Chinese and Western MedicineOsteoporosis Professional Committee of the World Federation of Chinese Medicine Societies,Longhua HospitalShanghai University of Traditional Chinese Medicine,China-Japan Friendship Hospital,Key Laboratoryof Muscle and Bone Theory and Treatment of Ministry of EducationAbstract Lumbar disc herniation(LDH)is a common degenerative spinal disease in orthopedics,with a high incidence and alow age trend in recent years.In order to clarify the role of integrated traditional Chinese and western medicine in the diagnosisand treatment of LDH and to improve the level of integrated medicine diagnosis and treatment,an expert consensus on the diagno-sis and treatment of LDH with integrated traditional Chinese and westem medicine has been developed after several rounds of dis-cussion among experts by consulting the latest medical guidelines,consensus,and evidence-based medicine evidence in combina-tion of clinical experience.This consensus integrates the opinions of experts in related fields of traditional Chinese and westernmedicine and forms a diagnosis and treatment protocol of integrated traditional Chinese and western medicine,hoping to providereferences for colleagues in clinical practice and provide clinical guidance for practitioners in related departments such as orthope-dics,acupuncture and moxibustion,tuina,and rehabilitation.Keywords Lumbar disc herniation;Integrated traditional Chinese and western medicine;Treatment by stages;Expert consensus中图分类号：274文献标识码：Adoi:10.3969/j.issn.1673-7202.2023.07.0091概述影响患者的日常生活和社交，从而影响患者的生命腰椎间盘突出症(Lumbar Disc Herniation,LDH)质量，更会导致职业人群丧失劳动能力，给家庭和社是一种以腰痛、下肢放射痛为主的退行性脊柱病变，会经济造成巨大的负面影响[6。其特征是皮肤感觉减退，肌力下降，腱反射减弱山。国际腰椎研究会将腰椎间盘突出分为退变型、属于中医“痹病”“腰痛”范畴，腰痛一词首见于《黄膨出型、突出型、脱出（后纵韧带下和后纵韧带后）》帝内经》，《素问·刺腰痛论》记载“足太阳脉令人腰型以及游离型。痛，引项脊尻背如重状”，详细描述了腰脊及脊旁两DH的典型症状是腰背痛和下肢放射痛、坐骨侧疼痛为主症的临床表现]。根据世界卫生组织神经痛、马尾神经损害的症状；体征有腰椎侧弯、腰(World Health Organization,WHO)的资料，LDH的主部活动受限、压痛、骶棘肌痉挛及神经损害等。腰背要症状为腰痛及坐骨神经痛，在发展中国家和发达痛和下肢放射痛的症状可同时发生，也可先出现腰国家中均有较高患病率，且有较高的致残率[)，约背痛后出现腿痛，或可先出现腿痛后出现腰背痛。2/3的成年人曾出现过腰背痛4]，其中约85%的直腿抬高试验及加强试验阳性，股神经牵拉试验阳LDH患者伴有坐骨神经痛)。由于其病情反复，迁性等。延难愈，极易使患者出现不同程度的功能障碍，直接由于腰椎间盘突出的节段不同，神经损害支配基金项目：国家自然科学基金项目(81930116,81730107,81873321)：国家中医药“传承创新团队”计划项目(ZYYCXTD-C-202202):上海市重中之重研究中心建设项目(2022201009)：国家科技部重点领域“创新团队”计划项目(2015RA4002):国家教育部“创新团队”计划项目(RT1270):上海高水平地方高校创新团队计划项目（沪教委人[2022]3号）：上海市促进市级医院临床技能与临床创新三年行动计划重大临床研究项目(SHDC2020CR1010A):上海市长宁区卫生与计划生育委员会光华卓越PI工程(2016-01,201606)通信作者：阁小萍(1945.08一），女，主任医师，教授，全国名中医，首都国医名师，研究方向：中西医结合治疗关节炎等风湿免疫疾病的
