术中应用丹参注射液对预防椎板开窗术后硬膜外粘连的临床观察

发布时间：2018-12-17 08:06

【摘要】：目的：本研究是针对腰椎开窗术后局部血肿形成,不能及时吸收,导致大量瘢痕组织形成的研究。通过试验研究及临床应用观察丹参注射液对血肿吸收的影响,期望达到减少硬膜外疤痕粘连的形成,提高腰椎手术疗效。方法：采用前瞻性研究方法,收集2014年8月至2015年6月,因腰椎间盘突出症(血瘀型)需行腰椎手术治疗患者40例,按照入院时间随机分为丹参组和生理盐水组,最后纳入数据统计的有40例,即试验组(丹参注射液+胶原蛋白组,20例)、对照组(生理盐水+胶原蛋白组,20例)。观察随访期限6个月。术后两天内观察引流量并计量,采用VAS、ODI评分法于术前1天及术后3、6个月评价临床症状改善情况,并行腰椎术后MRI检查,观察瘢痕变化情况,所有数据采用SPSS20.0软件进行比较分析。结果：临床中患者有40例,均得到随访,且术后都恢复效果好。比较两组患者术前基线特征(年龄),均未见显著性差异(P0.05),具有可比性。两组患者均获得6个月的随访,无椎管狭窄、神经、血管损伤等并发症发生。两组VAS不同时间比较,丹参组术后3、6个月VAS评分低于生理盐水组,差异有统计学意义(P0.05)。两组在术后3、6个月各观察点ODI评分均有显著差异(P0.05),且丹参组的临床疗效优于生理盐水组。MRI检查示丹参组瘢痕形成及突入椎管情况明显小于生理盐水组,差异具有统计学意义(P0.05)。结论：局部应用丹参注射液可有效促进局部血肿吸收与清除,减少瘢痕形成,减轻硬膜外粘连。术后随访发现术后粘连引起的并发症减少。
[Abstract]:Objective: this study is aimed at the formation of local hematoma after lumbar fenestration, which can not be absorbed in time, resulting in a large number of scar tissue formation. The effect of Salvia miltiorrhiza injection on hematoma absorption was observed in order to reduce the formation of epidural scar adhesion and improve the effect of lumbar surgery. Methods: from August 2014 to June 2015, 40 patients with lumbar disc herniation (blood stasis type) were randomly divided into Salvia miltiorrhiza group and saline group according to their admission time. Finally, 40 cases were included in the data, that is, the experimental group (20 cases of Danshen injection collagen group) and the control group (20 cases of normal saline collagen group). The follow-up period was 6 months. The drainage flow was observed and measured within two days after operation. The improvement of clinical symptoms was evaluated 1 day before operation and 3 months and 6 months after operation by VAS,ODI score. The changes of scar were observed by MRI examination after lumbar vertebra operation. All the data were compared and analyzed by SPSS20.0 software. Results: 40 patients were followed up and recovered well after operation. The baseline characteristics (age) of the two groups were not significantly different (P0.05). The patients in both groups were followed up for 6 months without complications such as spinal canal stenosis, nerve and vascular injury. Compared with VAS in two groups, the VAS score of salvia miltiorrhiza group was significantly lower than that of saline group at 3 and 6 months after operation (P0.05). There were significant differences in ODI scores between the two groups at 3 and 6 months after operation (P0.05), and the clinical efficacy of salvia miltiorrhiza group was better than that of normal saline group. MRI examination showed that the scar formation and the process of spinal canal in Salvia miltiorrhiza group were significantly lower than those in saline group. The difference was statistically significant (P0.05). Conclusion: local application of Salvia miltiorrhiza injection can effectively promote the absorption and clearance of local hematoma, reduce scar formation and reduce epidural adhesion. The postoperative follow-up showed that the complications caused by postoperative adhesions were reduced.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

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