后柱重建联合损伤胶囊治疗中央型腰椎间盘突出症的临床研究

发布时间：2018-11-17 19:21

【摘要】：目的:对后柱重建治疗中央型腰椎间盘突出症的术式评价,围手术期联合使用甘肃省中医院“损伤胶囊”(治疗组)与传统全椎板减压椎间盘切除组(对照组)治疗中央型腰椎间盘突出症的指标及疗效进行对比研究,以期探讨后柱重建治疗中央型椎间盘突出症的临床疗效。旨在较大限度地保持脊柱的生物力学稳定,预防传统的椎板切除减压手术引起的不良综合症,为此术式治疗中央型椎间盘突出症提供临床依据。并在治疗过程中给予中药制剂损伤胶囊干预,对中药联合手术治疗中央型腰椎间盘突出症进行临床研究。方法:严格按照中央型腰椎间盘突出症的纳入标准及排除标准,入选2012年1月~2014年1月甘肃省中医院中央型腰椎间盘突出症患者78例,将符合入选的中央型腰椎间盘突出症核患者38例采用后柱重建术式联合围手术期损伤胶囊干预作为治疗组。并将另40例患者采用传统全椎板减压椎间盘切除组作为对照组,分别从腰椎JOA标准及功能障碍指数(ODI)对术前、术后腰椎及下肢功能恢复情况进行对比分析,结合患者术后实际临床症状缓解情况、重建后柱的骨性愈合情况以及是否存在术后腰椎不稳定等方面,评价后柱重建术对治疗中央型椎间盘突出症患者的疗效,并作统计学分析。结果:后柱重建治疗中央型腰椎间盘突出症在解除脊髓压迫、保证脊柱的稳定性等有显著优越性。临床研究显示,后柱重建术式联合损伤胶囊治疗中央型腰椎间盘突出症较对照组在腰椎JOA标准及功能障碍指数(ODI)、术后腰椎的稳定性及下肢功能恢复情况等方面有显著优势,均存在统计学意义。结论:后柱重建术治疗中央型腰椎间盘突出症不仅能彻底解除脊髓压迫,大大缩短手术时间,充分解决了椎管狭窄、椎管内硬膜及神经根受压。对脊柱整体结构的破坏较小,后柱重建内固定又可以同时实现脊柱的牢固融合。
[Abstract]:Objective: to evaluate the method of posterior column reconstruction in the treatment of central lumbar disc herniation. The index and effect of central lumbar disc herniation treated by combined use of "injury capsule" in Gansu Provincial traditional Chinese Medicine Hospital (treatment group) and traditional total laminectomy discectomy group (control group) during perioperative period were compared. To explore the clinical effect of posterior column reconstruction in the treatment of central disc herniation. The aim is to maintain the biomechanical stability of the spine to prevent the adverse syndrome caused by the traditional laminectomy and decompression surgery and to provide the clinical basis for the treatment of central disc herniation. The treatment of central lumbar disc herniation with traditional Chinese medicine combined with surgery was studied. Methods: 78 patients with central lumbar disc herniation were selected from January 2012 to January 2014 according to the inclusion and exclusion criteria of central lumbar disc herniation. Thirty-eight patients with central lumbar disc herniation were treated with post reconstruction combined with perioperative injury capsule intervention. Another 40 patients were treated with traditional total lamina decompression discectomy group as control group. The recovery of lumbar vertebrae and lower extremities were compared and analyzed from JOA criteria and dysfunction index (ODI) before and after operation. To evaluate the efficacy of post reconstruction in the treatment of central disc herniation, the clinical symptoms were alleviated, the bone healing of the reconstructed post column and the instability of lumbar vertebrae were evaluated. Statistical analysis was made. Results: posterior column reconstruction in the treatment of central lumbar disc herniation has significant advantages in relieving spinal cord compression and ensuring spinal stability. Clinical study showed that posterior column reconstruction combined with injury capsule in the treatment of central lumbar disc herniation compared with the control group in lumbar JOA standards and dysfunction index (ODI), The stability of lumbar vertebrae and the recovery of lower limb function were significant. Conclusion: reconstruction of posterior column in the treatment of central lumbar disc herniation can not only completely relieve spinal cord compression, greatly shorten the operation time, but also fully solve the spinal canal stenosis, spinal canal dural and nerve root compression. The damage to the whole structure of the spine is small, and the posterior column reconstruction and internal fixation can also realize the solid fusion of the spine at the same time.
【学位授予单位】：甘肃中医药大学(原名：甘肃中医学院)
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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