恒古骨伤愈合剂促进腰椎板开窗微小骨粒回植骨重建的研究
发布时间：2019-04-09 09:23
【摘要】：目的：观察恒古骨伤愈合剂对腰椎板开窗术后微小骨粒回植骨重建的实验研究及初步临床应用,探讨恒古骨伤愈合剂促进椎板开窗处自体微小骨粒骨重建的疗效及作用机制。方法：(1)动物实验研究：选取清洁级健康雄性新西兰大白兔22只,随机分为3组,A组(治疗组,n=9)；B组(对照组,n=9)；C组(正常组,n=4)。A组建立兔腰椎板开窗术后微小骨粒回植的模型,给予恒古骨伤愈合剂治疗,(按经由人与兔体表面积用药量换算计算出的剂量,兔用药量为1.30ml/kg)灌胃,1次／2d,服用3个月；B组建立模型后,服用相同剂量的生理盐水,C组未进行手术处理,相同剂量的生理盐水灌服,治疗后4、8、12周分别行大体标本粘连组织观察、羟脯氨酸(hydroxyproline, Hyp)测定、CT检查及组织形态学观察。(2)初步临床应用：采用前瞻性研究方法,收集2013年10月至2014年8月,因腰椎间盘突出症(血瘀型)需行腰椎手术治疗患者50例,按照入院时间随机分为治疗组和对照组,最后因随访问题纳入数据统计的有41例(41/50),即治疗组(常规治疗+恒古骨伤愈合剂组,21例)、对照组(常规治疗组,20例),观察随访期限6个月。采用VAS、ODI评分法于术前1天及术后1、3、6月评价临床症状改善情况,并行腰椎术后CT检查,观察骨重建变化情况,所有数据采用SPSS18.0软件进行比较分析。结果：(1)实验部分：大体观察及组织学发现,A组的粘连程度Rydell分级及组织学分级要远低于B组(P0.05)。羟脯氨酸浓度分析结果显示A组瘢痕组织中羟脯氨酸浓度要明显低于B组(P0.05)。CT检查示术后12周A组微小骨粒形成骨板与开窗椎板骨质相连、骨梁连续,无明显界限,椎管形态及容积无明显变化,未见脊髓受压；B组对照节段椎板缺损,少量瘢痕突入椎管内,椎管重建未完成。(2)临床中患者有41例(41/50)获随访(随访率为82.0%)。比较两组患者基线特征(年龄、病程、突出节段、腰椎间盘突出类型、术前VAS、ODI评分及术后3天CT值),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,治疗组术后1、3、6个月VAS评分低于对照组,差异有统计学意义(P0.05)。两组在术后1、6个月各观察点ODI评分均有显著差异(P0.05),且治疗组的临床疗效优于对照组。CT检查示治疗组微小骨粒植骨区CT值在术后3、6个月较对照组均明显增高,差异具有统计学意义(P0.05)。结论：(1)恒古骨伤愈合剂可有效促进兔椎板开窗处再植自体微小骨粒的骨重建,形成的骨板可遮挡疤痕侵入椎管,减少椎管内粘连。(2)恒古骨伤愈合剂联合腰椎后路髓核摘除微小骨粒回植应用于腰椎间盘突出症手术治疗,回植微小骨粒重建椎管(骨性结构)效果好,术后随访发现术后粘连引起的并发症减少。
[Abstract]:Aim: to observe the experimental study and preliminary clinical application of Henggu Gushangyu mixture (HGJM) in the reconstruction of small bone granule bone graft after lumbar laminar fenestration, and to explore the therapeutic effect and mechanism of Henggu Gu Shuangyu mixture on autogenous small bone particle bone reconstruction at lamina fenestration. Methods: (1) Animal experiment: 22 healthy male New Zealand rabbits of clean grade were randomly divided into 3 groups: group A (treatment group, n = 9); B); Group C (normal group, n = 4). A) was used to establish the model of small bone particle reimplantation after fenestration of lumbar lamina in rabbits and treated with Henggu Gushangyu mixture (according to the dose calculated by the amount of drugs used in the conversion between human and rabbit body surface area). The dosage of 1.30ml/kg was given to rabbits once a day for 3 months. After the model was established in group B, the rats in group B were treated with the same dose of saline, while the group C was not treated surgically. The same dose of saline was administered in group C. After 4, 8 and 12 weeks of treatment, the adhesive tissues of gross specimens were observed and the hydroxyproline (hydroxyproline, Hyp) was measured. CT examination and histomorphology observation. (2) preliminary clinical application: from October 2013 to August 2014, 50 patients with lumbar disc herniation (blood stasis type) who needed lumbar spine surgery were collected by prospective study method. According to the admission time, 41 cases (41 cases) were randomly divided into the treatment group and the control group according to the time of admission. The treatment group (21 cases) and the control group (routine treatment group, 21 cases) and the control group (routine treatment group) were included in the data statistics according to the follow-up problem. The follow-up period was 6 months. VAS,ODI scoring method was used to evaluate the improvement of clinical symptoms 1 day before operation and 1, 3 and 6 months after operation. The changes of bone reconstruction were observed by CT after lumbar surgery. All the data were compared and analyzed with SPSS18.0 software. Results: (1) the experimental part: gross observation and histology showed that the adhesion degree of group A was significantly lower than that of group B (P 0.05). The Rydell grade and histological grade of group A were significantly lower than those of group B (P0.05). The results of hydroxyproline concentration analysis showed that the concentration of hydroxyproline in scar tissue of group A was significantly lower than that of group B (P0.05). Ct examination showed that the bone plate of group A was connected with the bony of fenestrated lamina at 12 weeks after operation, the bone beam was continuous, and there was no obvious limit. There were no significant changes in the shape and volume of spinal canal and no compression of spinal cord. (2) 41 patients (41 / 50) were followed up (follow-up rate was 82.0%) in group B compared with segmental laminae defect, a small number of cicatricial processes entered the spinal canal, and the spinal canal reconstruction was not completed. (2) in the clinic, 41 cases (41%) were followed up. There was no significant difference in baseline characteristics (age, course of disease, herniation segment, type of lumbar disc herniation, preoperative VAS,ODI score and CT value 3 days after operation) between the two groups (P0.05). The patients in both groups were followed up for 6 months without complications such as spinal canal stenosis, nerve and vascular injury. The VAS scores in the treatment group were significantly lower than those in the control group at 1, 3 and 6 months after operation (P0.05). The VAS scores of the two groups were significantly lower than those of the control group at different time (P0.05). There were significant differences in ODI scores between the two groups at 1 and 6 months after operation (P0.05), and the clinical efficacy of the treatment group was better than that of the control group. Ct examination showed that the CT value of the minimal bone graft area in the treatment group was significantly higher than that in the control group at 3 and 6 months after operation. The difference was statistically significant (P0.05). Conclusion: (1) Henggu Guishuangyu mixture can effectively promote the reconstruction of autogenous tiny bone particles at the fenestration of lamina in rabbits, and the resulting bone plate can occlude scar and invade the spinal canal. (2) Henggu Gu Shuangyu mixture combined with posterior lumbar nucleus pulposus implantation for lumbar disc herniation was applied to the surgical treatment of lumbar intervertebral disc herniation, and the reconstruction of spinal canal (bony structure) with small bone particle was good, and the effect of reconstruction of spinal canal (bony structure) was good. Postoperative follow-up showed that complications caused by postoperative adhesion decreased.
【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】：2015
【分类号】：R687.3
本文编号：2455049
[Abstract]:Aim: to observe the experimental study and preliminary clinical application of Henggu Gushangyu mixture (HGJM) in the reconstruction of small bone granule bone graft after lumbar laminar fenestration, and to explore the therapeutic effect and mechanism of Henggu Gu Shuangyu mixture on autogenous small bone particle bone reconstruction at lamina fenestration. Methods: (1) Animal experiment: 22 healthy male New Zealand rabbits of clean grade were randomly divided into 3 groups: group A (treatment group, n = 9); B); Group C (normal group, n = 4). A) was used to establish the model of small bone particle reimplantation after fenestration of lumbar lamina in rabbits and treated with Henggu Gushangyu mixture (according to the dose calculated by the amount of drugs used in the conversion between human and rabbit body surface area). The dosage of 1.30ml/kg was given to rabbits once a day for 3 months. After the model was established in group B, the rats in group B were treated with the same dose of saline, while the group C was not treated surgically. The same dose of saline was administered in group C. After 4, 8 and 12 weeks of treatment, the adhesive tissues of gross specimens were observed and the hydroxyproline (hydroxyproline, Hyp) was measured. CT examination and histomorphology observation. (2) preliminary clinical application: from October 2013 to August 2014, 50 patients with lumbar disc herniation (blood stasis type) who needed lumbar spine surgery were collected by prospective study method. According to the admission time, 41 cases (41 cases) were randomly divided into the treatment group and the control group according to the time of admission. The treatment group (21 cases) and the control group (routine treatment group, 21 cases) and the control group (routine treatment group) were included in the data statistics according to the follow-up problem. The follow-up period was 6 months. VAS,ODI scoring method was used to evaluate the improvement of clinical symptoms 1 day before operation and 1, 3 and 6 months after operation. The changes of bone reconstruction were observed by CT after lumbar surgery. All the data were compared and analyzed with SPSS18.0 software. Results: (1) the experimental part: gross observation and histology showed that the adhesion degree of group A was significantly lower than that of group B (P 0.05). The Rydell grade and histological grade of group A were significantly lower than those of group B (P0.05). The results of hydroxyproline concentration analysis showed that the concentration of hydroxyproline in scar tissue of group A was significantly lower than that of group B (P0.05). Ct examination showed that the bone plate of group A was connected with the bony of fenestrated lamina at 12 weeks after operation, the bone beam was continuous, and there was no obvious limit. There were no significant changes in the shape and volume of spinal canal and no compression of spinal cord. (2) 41 patients (41 / 50) were followed up (follow-up rate was 82.0%) in group B compared with segmental laminae defect, a small number of cicatricial processes entered the spinal canal, and the spinal canal reconstruction was not completed. (2) in the clinic, 41 cases (41%) were followed up. There was no significant difference in baseline characteristics (age, course of disease, herniation segment, type of lumbar disc herniation, preoperative VAS,ODI score and CT value 3 days after operation) between the two groups (P0.05). The patients in both groups were followed up for 6 months without complications such as spinal canal stenosis, nerve and vascular injury. The VAS scores in the treatment group were significantly lower than those in the control group at 1, 3 and 6 months after operation (P0.05). The VAS scores of the two groups were significantly lower than those of the control group at different time (P0.05). There were significant differences in ODI scores between the two groups at 1 and 6 months after operation (P0.05), and the clinical efficacy of the treatment group was better than that of the control group. Ct examination showed that the CT value of the minimal bone graft area in the treatment group was significantly higher than that in the control group at 3 and 6 months after operation. The difference was statistically significant (P0.05). Conclusion: (1) Henggu Guishuangyu mixture can effectively promote the reconstruction of autogenous tiny bone particles at the fenestration of lamina in rabbits, and the resulting bone plate can occlude scar and invade the spinal canal. (2) Henggu Gu Shuangyu mixture combined with posterior lumbar nucleus pulposus implantation for lumbar disc herniation was applied to the surgical treatment of lumbar intervertebral disc herniation, and the reconstruction of spinal canal (bony structure) with small bone particle was good, and the effect of reconstruction of spinal canal (bony structure) was good. Postoperative follow-up showed that complications caused by postoperative adhesion decreased.
【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】：2015
【分类号】：R687.3
【引证文献】
相关会议论文 前1条
1 喻赣鹏;李刚;荆浩;周岳;胡宁敏;;自体微小颗粒骨复合万古霉素治疗感染性骨缺损的实验研究[A];宁夏医学会第八届骨科学术会议论文汇编[C];2013年
，本文编号：2455049
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