【作者】 周斌；

【导师】 王荣茂；

【作者基本信息】 福建中医学院 ， 中医骨伤科学， 2003， 硕士

【摘要】 目的：探讨活血消瘢冲剂预防腰椎间盘突出术后硬膜外瘢痕形成的有效性。 方法：收集我院2001年4月至2002年12月骨科住院病人，经临床表现及CT检查确诊为腰椎间盘突出症者，共45例，随机分为3组，即活血消瘢冲剂组（中药组）、双氯芬酸钠组（西药组）、空白对照组（空白组）。3组病例均行标准的后正中入路、单侧椎板开窗、髓核摘除术，术后每日均给予头孢哌酮钠4.0g，共3天。中药组于术后次日即给予活血消瘢冲剂（组成包括丹参、川芎、桃仁、红花、元胡、地龙、当归、黄芪8味中药）口服，每日3次，每次1包（每包含生药15g）至术后2周；西药组于术后次日给予扶他林缓释片（Votalin，北京诺华制药有限公司生产，（98）卫药准字J-30）一次75mg至术后2周；空白组则不给药。3组分别于术前及术后1、2周测定以下指标：1．血液流变学；2．血浆前列腺素E₂（PGE₂）的含量；3．尿羟脯氨酸（HOP）的含量。3组于术后8周行增强CT扫描，观察对比硬膜外瘢痕的范围及增强程度。术后8周判定疗效，疗效判定标准按陆裕朴标准。统计数据主要应用SPSS10.0软件处理。 结果：1．血流变：术后第1、2周空白组病人血液呈现高凝、高粘状态，表现为高切粘度、低切粘度、红细胞聚集指数（VAL）、血浆粘度均明显升高，与术前比差异显著（P＜0.01）；与同期中药组、西药组差异均非常显著（P＜0.01）。中药组与西药组比较则无显著差异（P＞0.05）。2．血浆PGE₂含量：术后1周空白组PGE₂含量较术前明显升高（P＜0.01），而中药组、西药组PGE₂含量较术前均显著降低（P＜0.01），空白组分别与中、西药组比较均差异非常显著（P＜0.01），中、西药组两组间则无显著差异（P＞0.05）。至术后2周各组PGE₂含量较术前均有显著降低（P＜0.01）。3．尿HOP含量：术后1周各组无显著差别（P＞0.05）。至术后2周空白组尿HOP含量较术前及术后1周明显升高（P＜0.01），与中、西药组均差异显著（P＜0.05），中、西药两组间无显著差异（P＞0.05），同术前比亦无显著差异（P>O.05）。4.术后8周增强CT扫描:各组硬膜周围均可见不同范围及密度的突出物与硬膜囊相接触，软组织信号增强程度空白组与中、西药组比均差异显著（P<0 .05），而中、西药两组间无显著差异（P>0.05）。5.术后8周按陆裕朴标准评判术后疗效:中药组及西药组优良率与空白组均有显著差别（分别为P<0 .01，P<0 .05），中、西药组之间则无显著差异（P>0.05）。 小结:1.活血消瘫冲剂有减少腰椎间盘术后硬膜外瘫痕的作用。2.活血消瘫冲剂可用来预防腰椎间盘术后硬膜外瘫痕形成;服用方便，与双氯芬酸钠比无显著副作用，临床应用安全可靠。3.活血消瘫冲剂可推广应用于其他脊柱外科手术术后，减少腰椎手术失败综合征（FBSS）的发生，具有较大的社会效益与经济效益。更多还原

【Abstract】 Object: To evaluate the clinical effect of HuoXueXiaoBan Chongji used as inhibitor to prevent the formation of epidural scar after discectomy.Methods: All subjects stemmed from the inpatients in department of orthopaedics from Apr, 2001 to Dec, 2002 who sufferde from PLID. 45 patients were divided into three groups randomly: HuoXueXiaoBan Chongji group(Herb group), diclofenac sodium group (Western Medicine group) and vacuity control group (Control group) and underwent classic discectomies. 4. Og cefoperazone sodium was given to all postoperative patients each day. The first day after operation HuoXueXiaoBan Chongji (It included 8 herbs: dan-shen root, Szechwan lovge rhizome, peach seed, safflower, yuan-hu, earth-worm, Chinese angelica, membranous milkvetch root) was given to Herb group’ s patients TID and a packet one time which had 15g herbs till the 2nd week. 75mg diclofenac sodium (Votalin, which was made in Beijing NuoHua company limited ) was given to each patient of Western Medicine group. Pol lowing markers were observed preoperatively and in the 1st week and the 2nd week postoperatively: 1. Hemorheology. 2. The content of inflammation medium: PGEL.. 3. The content of urinary hydroxyproline(HOP). Enhanced CT scan was examined in the 8th week. The clinical effect of operation was judged according to the norm of Lu Yupu.Results: 1. Hemorheology: All markers of patients in Control group rised in the 1st week postoperatively and the condition continued till the 2nd week. Comparedwith Herb group and Western group there was very significant difference in two weeks (P<0. 01). However there was no difference between Herb group a’nd Western Medicine group(P>0. 05). 2. The content of PGE2: Compared with the preoperative content, it rised notably in control group (P<0. 01). On the contrast it reduced in both Herb group and Western Medicine group (P<0.01). There was very notable difference between Control group and Herb group, Control group and Western Medicine group(P<0. 01). No difference existed between Herb group and Western Medicine group (P>0. 05). 3. The content of urinary HOP: There was no difference in three groups in the 1st week(P>0.05). The content rised in the 2nd week compared with it preoperatively and in the 1st week (P<0. 01). There was significant difference between Control group and Herb group, Control group and Western Medicine group (P<0. 01). 4. Enhanced CT scan : Protrusion with different scope and and density around dura mater were observed in all groups but enhanced extent was different (P<0. 05) in the 8th week. 5. To judge the clinical effect of operation after 8 weeks: The excellent rate was different in three groups (P<0.05).Conclusion: 1. HuoXueXicioBan Chongji could reduce the epidural scar formation after discectomy. 2. HuoXueXiaoBan Chongji could be used to prevent the epidural fibrosis and adhesion after discectomy. Compared with diclofenac sodium it had no notable side effects and was safer in clinical application. 3. HuoXueXiaoBan Chongji could be popularized to other spine surgeries to reduce the incidence of FBSS and produce great social effects and economic returns.更多还原