【作者】 任志富； 卢俊范； 吕龙龙； 王景彦；

【机构】 山东省潍坊市中医院脊柱骨科；

【摘要】 [目的]观察腰椎后路融合术联合中药封包疗法治疗腰椎退行性病变的临床疗效及优势。[方法]分析我院脊柱骨科2014年5月～2017年9月腰椎后路融合手术治疗的98例腰椎退行性病变患者,腰椎间盘突出症28例、腰椎管狭窄症52例、腰椎滑脱症18例。分为治疗组51例与对照组47例,对照组为单纯腰椎后路减压固定融合术(TLIF),治疗组为TLIF手术联合中药封包疗法,中药封包疗法所用中药为潍坊市中医院骨伤科经验中药外用方。比较两组患者术后后3天、7天、14天、1个月、3个月、6个月、12个月VAS评分、ODI功能障碍指数、外周静脉血CK数值、MRI腰椎肌肉容积,采用重复测量资料的方差分析。[结果]所有患者均顺利完成手术,全部获得随访,随访时间12～24个月,平均18个月。两组均未出现神经损伤、感染、下肢静脉血栓、内固定松动或断裂、椎间隙高度丢失、椎间融合器移位等并发症,所有融合椎体均获得骨性愈合。VAS评分:两组患者术后6个月、12个月无统计学差异,术后3天、7天、14天、1个月、3个月有统计学差异。ODI指数:两组患者术后12个月无统计学差异,术后3天、7天、14天、1个月、3个月、6个月有统计学差异。静脉血CK数值:两组患者术后6个月、12个月无统计学差异,术后3天、7天、14天、1个月、3个月有统计学差异。MRI腰椎肌肉容积:两组患者术后3天无统计学差异,术后7天、14天、1个月、3个月、6个月、12个月有统计学差异。[结论]腰椎后路融合术联合中药封包疗法比单纯腰椎后路融合术治疗腰椎退行性病变,在术后VAS评分、ODI指数、CK数值及MRI腰椎肌肉容积等方面有明显优势,能够早期缓解术后疼痛、减少肌酸激酶释放、修复腰椎肌肉、促进腰椎功能恢复。更多还原

【Abstract】 [Objective] To observe the clinical efficacy and advantages of lumbar posterior fusion combined with traditional Chinese medicine encapsulation therapy in the treatment of lumbar degenerative diseases.[Method] To analyse 98 cases of degenerative lumbar diseases treated by posterior lumbar fusion from May 2014 to September 2017, including 28 cases of lumbar disc herniation, 52 cases of lumbar897 spinal stenosis and 18 cases of lumbar spondylolisthesis. They were divided into treatment group(51 cases) and control group(47 cases). The control group was treated with posterior decompression, fixation and fusion(TLIF). The treatment group was treated with TLIF operation combined with traditional Chinese medicine encapsulation therapy. The traditional Chinese medicine used in encapsulation therapy was the external prescription of traditional Chinese medicine in orthopaedics and traumatology department of Weifang Hospital of Traditional Chinese Medicine.VAS score, ODI dysfunction index, CK value of peripheral venous blood and lumbar muscle volume were compared between the two groups 3 days, 7 days, 14 days, 1 month, 3 months, 6 months and 12 months after operation. The variance analysis of repeated measurements was used.[Result] All patients were followed up for 12 to 24 months, with an average of 18 months. No complications such as nerve injury,infection, lower extremity venous thrombosis, loosening or rupture of internal fixation, loss of intervertebral space height and displacement of interbody fusion cage were found in both groups. Bone healing was achieved in all fused vertebrae. VAS score: There was no statistical difference between the two groups at 6 months and 12 months after operation, but there was statistical difference at 3 days, 7 days, 14 days,1 month and 3 months after operation. ODI index: There was no statistical difference between the two groups at 12 months after operation, but there was statistical difference at 3 days, 7 days, 14 days, 1 month, 3 months and 6 months after operation.CK value of venous blood: There was no statistical difference between the two groups at 6 months and 12 months after operation, but there was statistical difference at 3 days, 7 days, 14 days, 1 month and 3 months after operation. MRI lumbar muscle volume: There was no significant difference between the two groups at 3 days after operation, but there was significant difference at 7 days, 14 days, 1 month, 3 months,6 months and 12 months after operation.[Conclusion] Posterior lumbar fusion combined with traditional Chinese medicine encapsulation therapy has obvious advantages in VAS score, ODI index, CK value and lumbar muscle volume after operation compared with posterior lumbar fusion alone. It can alleviate postoperativepain early, reduce creatine kinase release, repair lumbar muscle and promote lumbar functional recovery更多还原