经皮椎间孔镜技术结合中医疗法治疗不同突出类型的腰椎间盘突出症近期临床疗效分析

发布时间：2018-04-27 18:17

本文选题：腰椎间盘突出症 + 髓核摘除术　；参考：《南京中医药大学》2017年硕士论文

【摘要】：目的:本研究通过对经皮椎间孔镜技术结合中医疗法治疗不同突出类型的LDH的近期临床疗效进行分析比较,探讨经皮椎间孔镜技术结合中医疗法在何种类型的LDH的近期临床治疗中更具有优势。方法:收集2016年5月至2016年10月在苏州市中医医院骨科住院的腰椎间盘突出症(LDH)患者共90例,并根据纳入标准选取中央区型、中央旁区型、外侧区型LDH患者各30例,按照不同类型分为三组,同时分别命名为:中央区组、中旁区组,外侧区组。三组患者均在局麻下采用经皮椎间孔镜技术取出突出的髓核。术前30min予以静滴抗生素预防感染,术后当天予以止痛、脱水消肿、营养支持等药物对症治疗,术后第1天嘱患者下地行走,并于手术后第1天开始服用中药消髓化核汤每日1剂,共1月,根据病人具体情况辩证加减用药。术后对三组患者随访2月。在术前、术后第1周、术后1月、术后2月时,对三组患者采用VAS评分、JOA评分及指地距离评价指标结果予以记录;在术后2月时通过中医疗效标准记录各组患者治愈情况。结果:(1)本研究发现术后1周:从VAS评分指标来看中旁区组与外侧区组要优于中央区组,而中旁区组与外侧区组见无明显区别;三组J0A评分进行比较存在差异,中央区组要劣于中旁区组与外侧区组,且中旁区组与外侧区组见无明显差异;术后1月及2月三组VAS及JOA评分对比不存在差异性。(2)从指地距离来看,各个时间节点三组患者的指地距离均不存在显著性差异。(3)三组术前与术后、术后1周与术后1月的VAS评分、JOA评分与指地距离比较,P值均小于0.05,说明术前、术后上述三类指标相比存在显著性差异,术后要优于术前。(4)从中医疗效评价指标来看,中央区组总有效率93.30%,中旁区组总有效率与外侧区组相同均为96.70%,比中央区组稍高,但统计学分析表明三组患者的总有效率无明显不同。结论:经皮椎间孔镜技术结合中医疗法治疗腰椎间盘突出症面近期疗效显著,但对于不同突出类型的腰椎问盘突出症的近期治疗效果不存在差异。不同类型的腰椎间盘突出症患者的弯腰活动度不存在明显区别。
[Abstract]:Objective: to analyze and compare the short-term clinical effects of percutaneous intervertebral foramen technique combined with traditional Chinese medicine (TCM) therapy in the treatment of different types of LDH. To explore the advantages of percutaneous intervertebral foramen technique combined with traditional Chinese medicine (TCM) in the treatment of LDH in the near future. Methods: a total of 90 patients with lumbar disc herniation were collected from May 2016 to October 2016 in the Orthopaedics Department of Suzhou traditional Chinese Medicine Hospital. According to the inclusion criteria, 30 patients with LDH were selected as central, paracentral and lateral LDH. They were divided into three groups according to different types. The protruding nucleus pulposus was removed by percutaneous foramen technique under local anesthesia in all three groups. 30min was given intravenously to prevent infection before operation, pain relief, dehydration and swelling relief, nutritional support and other drugs were given to prevent infection. The patients were told to walk on the first day after operation. And on the first day after operation, we began to take one dose of Xiaoshuihuanhe decoction, one dose per day, according to the specific conditions of the patients, add and subtract drugs. The patients in the three groups were followed up for 2 months. Before operation, 1 week after operation, 1 month after operation and 2 months after operation, the results of VAS score and finger distance evaluation were recorded in the three groups, and the cure status of each group was recorded by TCM curative effect standard at 2 months after operation. Results one week after operation, this study found that the VAS score between the middle paracentral group and the lateral group was better than that of the central group, but there was no significant difference between the middle paracentral group and the lateral group, and there were differences in J0A score among the three groups. The scores of VAS and JOA in the central region group were inferior to those in the middle and lateral region group, and there was no significant difference between the middle side area group and the lateral area group, and there was no difference in VAS and JOA scores between the three groups at 1 and 2 months after operation. There was no significant difference in the distance between the fingers and the ground of the three groups at each time node. 3) before and after operation, the VAS scores of 1 week and 1 month after operation were lower than 0.05 (P < 0.05), which indicated that there was no significant difference in the distance of fingers between the three groups before and after operation. There was significant difference in the above three indexes after operation, which was superior to that before operation.) the total effective rate of the central group was 93.30, and the total effective rate of the middle paracentral group was 96.70, which was slightly higher than that of the central area group, according to the evaluation index of the curative effect of traditional Chinese medicine. However, statistical analysis showed that the total effective rate of the three groups was not significantly different. Conclusion: percutaneous transforaminal foramen technique combined with traditional Chinese medicine is effective in the treatment of lumbar disc herniation, but there is no difference in the treatment of different types of lumbar disc herniation. There was no significant difference in stoop activity in patients with different types of lumbar disc herniation.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R681.53

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