中药联合Hybrid术式治疗颈椎病的临床疗效分析

发布时间：2018-04-25 07:18

本文选题：痹症 + Hybrid术　；参考：《北京中医药大学》2016年硕士论文

【摘要】：背景脊髓型颈椎病(CSM)是颈椎病中的一种常见且严重的临床类型,它以颈椎间盘及小关节的退行性病变为基本病理基础,形成椎体缘骨赘,继而压迫脊髓、神经根及营养脊髓的血管,造成压迫颈椎节段的颈椎管管腔狭窄。脊髓的慢性压迫及血供障碍,最终导致了与受损节段相关的脊髓功能障碍。据全球调查结果显示在50岁以上脊髓功能损伤的成年人中,脊髓型颈椎病在占首要原因。临床上CSM主要以颈脊髓损害为主要表现,可伴有颈痛、上肢痛及麻木等,影像学检查CT、MRI可辅助诊断。1955年,Robinsion和Smith首次开创颈椎前路减压植骨融合术,因其术中入路简便、暴露良好、出血较少,且能彻底去除受压脊髓前方的致压物,椎间植骨及加用钢板内固定后使颈椎更为稳固等特点,是临床治疗脊髓型颈椎病的“标准术式”。然而脊椎减压融合手术治疗颈椎退变性疾病虽疗效确切,仍存在有并发症如临近节段退行性病变(ASD)、生理活动丢失、继发性失稳,部分患者甚至需要再次手术。颈椎前路经椎间隙减压植骨融合(ACDF)联合人工椎间盘置换(CADR)术,即颈椎前路融合与非融合“混搭”手术(Hybrid Surgery)。该术式在保证脊髓充分减压和融合的同时,也尽量减少了脊椎的生理活动的丢失,有效延缓了ASD的发生。中医理论认为,脊髓型颈椎病属于“痿证”、“痹证”范畴。运用中药、针灸、推拿手法等传统中医手段治疗轻、中度脊髓型颈椎病疗效确切,目前临床多主张采用中医综合疗法治疗脊髓型颈椎病。本研究通过分析本组病例短期临床疗效的结果,探论中医与西医治疗脊髓型颈椎病的各自优势及存在的问题,探讨中西医结合治疗CSM的优势。目的通过对比观察中药联合Hybrid Surgery术式(中西医结合组)与单纯Hybrid Surgery术式(单纯手术组)治疗颈椎病的临床疗效,探讨中西医结合治疗颈椎病的优势及存在的问题。方法对自2013年9月至2015年10月的36例颈椎病患者进行回顾性研究,其中采用中西医结合组患者17例,单纯手术组患者19例。术前、术后1、3、6、12个月分别行脊髓功能JOA评分(17分法)、颈椎残障功能指数评分(NDI)评定临床症状的改善情况及日常生活状态、疼痛视觉模拟评分(VAS)、神经功能Odom标准评级术后的疗效优良率、颈椎活动度(颈椎活动度评估：用Cobb法测量动力位X线片C2-C7整体活动度以及手术上位及下位相邻节段活动度)结果两组患者手术均顺利完成,伤口均I期愈合。围手术期未出现血管、神经损伤、硬脊膜撕裂,未出现切口血肿和感染及脊髓功能损伤加重等并发症。患者术后脊髓性及神经性症状明显改善,感觉和肌力均有不同程度的好转。从数据分析中可以看出,中西医结合组术后JOA评分略高于单纯手术组,但不具有统计学差异(p0.05)。术后第12月,Odom标准分级方法,结合组优良率分别为94.1%、89.4%。两组术后神经功能恢复情况良好,结合组在数据上显示要高于单纯手术组,但差异未出现统计学差异(p0.05)。颈椎活动度Cobb角两组比较未见明显统计学差异(p0.05)。VAS评分及颈椎残障功能指数评分(NDI)中西医结合组略低于单纯手术组,两组具有明显统计学差异(p0.05)。结论治疗颈椎病,中药联合Hybrid术式(中西医结合方法)较单纯西医Hybrid术不仅能改善术后活动度,而且可以更加满意的改善患者的神经功能和脊髓症状。
[Abstract]:Background cervical spondylotic myelopathy (CSM) is a common and serious clinical type of cervical spondylosis. It is based on the degenerative lesion of the cervical intervertebral disc and the small joint as the basic pathological basis, forming the vertebral marginal osteophyte, then pressing the spinal cord, nerve root and the vascular of the nutrient spinal cord, causing the stenosis of the cervical spinal canal and the chronic compression of the spinal cord. The result of global survey shows that cervical spondylotic myelopathy is the primary cause of spinal cord injury in adults over 50 years of age. The main clinical manifestation of CSM is cervical spinal cord injury, including neck pain, upper limb pain and numbness, imaging examination of CT, MRI For the first time in the diagnosis of.1955, Robinsion and Smith first pioneered anterior cervical decompression and fusion for the first time because of its simple operation, good exposure, less bleeding, and a thorough removal of pressure in front of the compressed spinal cord, intervertebral bone graft and the fixation of the plate with steel plate to make the cervical spine more stable, which is the "standard" for the clinical treatment of cervical spondylotic myelopathy. Although spinal decompression and fusion is effective in the treatment of cervical degenerative disease, there are still complications such as adjacent segment degenerative disease (ASD), physiological activity loss, secondary instability, and some patients need reoperation. Anterior cervical intervertebral space decompression, bone fusion (ACDF) combined with artificial disc replacement (CADR) It is the anterior cervical fusion and the non fusion "Hybrid Surgery". The operation can reduce the loss of the physiological activity of the spine as much as possible while guaranteeing the full decompression and fusion of the spinal cord, and effectively postpone the occurrence of ASD. The theory of Chinese medicine holds that the spinal cervical spondylosis belongs to "flaccid syndrome", "arthralgia syndrome" category. The treatment of mild and moderate myelopathy with traditional Chinese medicine and other traditional Chinese medicine is effective in the treatment of cervical spondylotic myelopathy with traditional Chinese medicine. This study is to discuss the advantages and problems of traditional Chinese medicine and Western medicine in the treatment of spinal cervical spondylosis by analyzing the results of short term clinical effect in this group. The advantages of combination of traditional Chinese medicine combined with Hybrid Surgery (combination of traditional Chinese medicine and Western Medicine) and simple Hybrid Surgery (simple operation group) in the treatment of cervical spondylosis were compared, and the advantages and problems of the combination of traditional Chinese and Western medicine in the treatment of cervical spondylosis were compared and observed in 36 cases of cervical vertebra from September 2013 to October 2015. A retrospective study was carried out in the patients, including 17 patients with integrated traditional Chinese and Western medicine and 19 patients in simple operation group. Before operation, the spinal function JOA score (17 points) was performed 1,3,6,12 months after operation, and the cervical disability functional index score (NDI) was used to evaluate the improvement of clinical symptoms and daily living condition, pain visual analogue score (VAS) and nerve work. The good rate of curative effect after the Odom standard rating, the activity of cervical vertebra (evaluation of cervical vertebra activity), the results of two groups of patients were successfully completed with Cobb method to measure the overall activity degree of the power position X-ray film and the activity degree of adjacent segments of the upper and lower segments of the operation. All the wounds healed at I stage. No blood vessels, nerve injuries, and tulle of the spinal cord were found in the perioperative period. There were no complications such as incision hematoma and infection and aggravation of spinal cord function injury. The patients with spinal and neurogenic symptoms improved significantly after operation, and the sensation and muscle strength were improved in different degrees. From the data analysis, the JOA score of the combined Chinese and Western medicine group was slightly higher than that of the simple operation group, but there was no statistical difference (P0.05). Twelfth months, Odom standard classification method, combined group excellent rate of 94.1%, 89.4%. two groups after the recovery of nerve function good, the combination group on the data showed that the group was higher than the simple operation group, but the difference was not statistically significant (P0.05). There was no significant statistical difference (P0.05).VAS score and cervical disability in the two groups of cervical activity degree (P0.05). The barrier function index score (NDI) was slightly lower than that of the simple operation group, and the two groups had significant difference (P0.05). Conclusion the treatment of cervical spondylosis, the combination of traditional Chinese medicine and traditional Chinese medicine (combined traditional Chinese and Western Medicine) can not only improve the postoperative activity, but also improve the nerve function and spinal cord of the patients more satisfactorily. Symptom.

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

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