多节段椎板开窗潜行扩大术及围手术期应用消肿止痛合剂治疗退变性腰椎管狭窄症的临床研究

发布时间：2018-03-03 12:31

本文选题：CT椎管测量　切入点：开窗　出处：《甘肃中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:对采用多节段椎板开窗潜行扩大术治疗退变性腰椎管狭窄症的患者,手术前后进行CT椎管测量分析及临床评价,共同探讨多节段椎板开窗潜行扩大术治疗退变性腰椎管狭窄症的临床疗效。并对围手术期应用甘肃省中医院自制药剂“消肿止痛合剂”对患者的影响进行临床对比观察,以期探讨多节段椎板开窗潜行扩大术及围手术期应用“消肿止痛合剂”治疗退变性腰椎管狭窄症的安全性和有效性,并为此方案治疗退变性腰椎管狭窄症提供临床依据。方法:严格按照退变性腰椎管狭窄症手术的纳入标准及排除标准,入选2014年3月~2015年9月甘肃省中医院脊柱骨三科所收治的退变性腰椎管狭窄症患者60例。以就诊顺序,将60例退变性腰椎管狭窄症患者随机分为两组,每组各30例,60例患者均采用多节段椎板开窗潜行扩大术治疗。术前及术后对60例患者行腰椎CT扫描,运用Digimizer图像分析测量软件对CT扫描片进行椎管矢径、椎板间距、上关节突内缘间距、椎管截面积的测量;对60例患者手术前后进行JOA评分(日本骨科学会下腰痛评分法)及VAS评分(视觉模拟评分法),对术前及术后所测得的椎管数据及评分结果进行比较评价,以分析多节段椎板开窗潜行扩大术治疗退变性腰椎管狭窄症的疗效。术后,一组患者给予常规对症治疗如抗炎、补液等,作为手术治疗组;另一组患者在以上常规治疗的基础上,术后3天给予甘肃省中医院自制药剂“消肿止痛合剂”,作为手术及围手术期应用中药治疗组。“消肿止痛合剂”用法:口服,50ml/次,3次/天,服用4周。通过对两组患者JOA及VAS评分结果的组间比较,分析“消肿止痛合剂”对患者术后的影响。在上述研究结果及统计学分析的基础上,综合分析多节段椎板开窗潜行扩大术及围手术期应用消肿止痛合剂治疗退变性腰椎管狭窄症的安全性和有效性。结果:将本研究60例患者手术前后所摄取的CT扫描片运用Digimizer图像分析软件测量后得出,各测量平面的椎管矢径、椎板间距、上关节突内缘间距、椎管截面积均比术前显著增大,且P0.05,具有统计学意义。说明60例患者通过多节段椎板开窗潜行扩大术治疗后,原本狭窄的椎管得到了充分的减压、扩大。通过VAS评分结果比较,采用多节段椎板开窗潜行扩大术治疗后,两组60例患者的疼痛情况均比治疗前明显缓解,P0.05;且两组间比较,手术及围手术期应用中药治疗组的疼痛缓解情况要优于手术治疗组,P0.05。根据JOA评分结果比较,采用多节段椎板开窗潜行扩大术治疗后,两组60例患者均比治疗前功能恢复明显,P0.05;根据两组患者治疗前及治疗后3个月的JOA评分计算改善率,手术及围手术期应用中药治疗组平均改善率为86.90%,手术治疗组平均改善率为80.93%,两组患者通过多节段椎板开窗潜行扩大术治疗后改善率均达到“优”标准,且手术及围手术期应用中药治疗组改善率高于手术治疗组。结论:多节段椎板开窗潜行扩大术能够保留腰椎后部大部分骨韧带结构,尽量减小对脊柱的破坏,并对中央椎管及神经根管狭窄部分、侧隐窝进行充分彻底的减压,改善了马尾神经、神经根的血液循环及功能,解除了患者下肢麻木、疼痛、无力,间歇性跛行等临床症状,极大的提高了患者的工作生活质量。与其他手术方式相比,在保证脊柱稳定与充分减压之间,找到了更好的平衡,值得临床推广。同时,围手术期应用中药“消肿止痛合剂”在治疗退变性腰椎管狭窄症与促进患者术后恢复方面,取得了良好的效果,体现了中西医结合治疗退变性腰椎管狭窄症的优势,是安全可靠的治疗方案。
[Abstract]:Objective: to adopt multi segmental fenestration laminectomy augmentation in treatment of degenerative lumbar spinal stenosis patients before and after surgery and clinical evaluation of spinal CT measurement, discuss multi segmental fenestration for treatment of clinical curative effect of enlarge undercutting of degenerative lumbar spinal stenosis. And the perioperative application of TCM Hospital of Gansu province homemade pharmacy "swelling" Zhitong mixture for patients with clinical observation, to evaluate the effectiveness and safety of multisegmental laminectomy fenestration enlargement and perioperative application of "Xiaozhongzhitong mixture" in the treatment of degenerative lumbar spinal stenosis in order to provide the clinical basis for the treatment of degenerative lumbar spinal stenosis. Methods: according to the strict inclusion of degenerative lumbar stenosis surgery criteria, selected in March 2014 September ~2015 spine Hospital of Gansu Province, three from degeneration 60 cases of lumbar spinal stenosis patients. In clinical order. 60 cases of degenerative lumbar spinal stenosis were randomly divided into two groups, each group of 30 cases, 60 cases were treated with multisegmental laminectomy fenestration expand surgery. Preoperative and postoperative in 60 cases of patients with lumbar CT scan, using Digimizer image analysis the measurement software of CT scans of sagittal diameter of the spinal canal, posterior superior facet spacing, edge distance, measuring the cross-sectional area of spinal canal; JOA score of 60 cases of patients before and after surgery (Japanese Department of orthopedics Association low back pain score) and VAS score (visual analogue scale), to evaluate the spinal canal and the results measured by the score data well before and after surgery, to analyze the multi segmental fenestration laminectomy expanding effect in treatment of degenerative lumbar spinal stenosis. Postoperative treatment such as anti-inflammatory, a group of patients given conventional symptomatic fluid infusion, surgery as treatment group; another group of patients The conventional treatment based on the above, the 3 day after the Gansu Provincial Hospital of traditional Chinese medicine pharmacy homemade "Xiaozhongzhitong mixture", as the surgical and perioperative application of traditional Chinese medicine treatment group. "Xiaozhongzhitong mixture" usage: oral, 50ml/ time, 3 times / day, taking 4 weeks. By the comparison of two groups of patients with JOA and VAS scores between groups, analysis of the influence of "Xiaozhongzhitong mixture" on postoperative patients. Based on analysis of the research results and statistics, a comprehensive analysis of the safety and effectiveness of multi segmental fenestration laminectomy enlargement and perioperative application of Xiaozhongzhitong mixture in the treatment of degenerative lumbar spinal stenosis. Results: the study of 60 patients before and after surgery the intake of CT scans using Digimizer image analysis software measurement results, the measurement plane of the sagittal diameter of the spinal canal, posterior superior facet spacing, edge distance, spinal canal cross-sectional area were compared with preoperative significant Increased, and P0.05, with statistical significance. 60 patients with multisegmental laminectomy fenestration enlargement after treatment had stenosis of the vertebral canal was fully expanded. Through decompression, VAS scores were compared with multiple segmental fenestration laminectomy enlargement after treatment, the pain of two groups of 60 patients than before treatment significantly alleviated, P0.05; and the comparison between the two groups. The pain of surgery and perioperative application of traditional Chinese medicine treatment group to ease the situation better than the surgical treatment group, P0.05. according to the JOA scores compared with multiple segmental fenestration laminectomy enlargement after treatment, two groups of 60 patients were recovered obviously than before treatment, P0.05; according to the two groups before and after treatment for 3 months JOA score improvement rate was calculated, surgical and perioperative application of traditional Chinese medicine treatment group, the average improvement rate was 86.90%, treatment group average improvement rate was 80.93%, two groups of patients Expand the treatment of multi segmental fenestration laminectomy by improved rate of "excellent" standard, and the surgical and perioperative application of traditional Chinese medicine treatment group improved rate is higher than the surgical treatment group. Conclusion: multi segmental fenestration operation can retain the posterior lumbar spile expand most bone ligament structure, reduce the damage to the spine. And part of the central spinal canal stenosis and nerve root, lateral recess were completely decompression, improve the cauda equina, blood circulation and nerve root function, relieve patients pain, weakness, numbness, intermittent claudication clinical symptoms, greatly improves the work quality of life of patients compared with other surgical methods. And in ensuring the spinal stability and sufficient decompression, found a better balance, it is worthy of clinical promotion. At the same time, the application of traditional Chinese medicine "peri operation period Xiaozhongzhitong mixture" in the treatment of degenerative lumbar spinal stenosis It has achieved good results in promoting postoperative recovery. It reflects the advantages of integrated traditional Chinese and Western medicine in the treatment of degenerative lumbar spinal stenosis, and is a safe and reliable treatment plan.

【学位授予单位】：甘肃中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

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