脊愈汤对于促进腰椎间盘突出症术后康复的临床观察

发布时间：2018-08-26 06:45

【摘要】：目的本临床研究针对腰椎间盘突出症(LIDP)行腰椎后路单一腰椎髓核摘除、椎管减压、cage植骨融合、双侧椎弓根钉内固定手术术后患者设立对照组和实验组。通过观察、随访患者腰椎融合术后康复情况,证实脊愈汤对腰椎间盘突出症行单一腰椎间盘髓核摘除、椎体融合手术后患者康复的促进作用。方法采用临床观察的方法,选取许昌仁和骨科医院2015年4月至2015年10月患腰椎间盘突出症,行腰椎后路单一腰椎髓核摘除、椎管减压、腰椎植骨cage植入融合、椎弓根钉内固定手术的住院患者40例,符合纳入标准,依据治疗方法的不同,分为对照组和实验组。其中对照组20例,其中男9例,女11例,本组采用术后两周内塞来昔布胶囊与甲钴胺片两种西药联合用药;实验组20例,其中男10例,女10例,本组采用术后两周内塞来昔布胶囊与甲钴胺片联合用药,并加脊愈汤服用。采用日本骨科协会评估治疗(JOA)(Japanese Orthopedic Association Scores)评分,记录患者治疗前及治疗后的下腰痛JOA分值,包括术前、术后1天,2周及4周复诊随访评分,评估患者术后恢复情况,记录数据并分别对比,证实实验组疗效优于对照组。结果实验组2周、4周JOA评分均高于对照组评分,其疗效稳定性及疗效趋势均优于对照组。实验组术后2周的改善率为(63.1±10.59)%、实验组术后2周改善率为(45.0±8.98)%,数据比较差异有明显的统计意义(P0.05)。实验组术后4周的改善率为(84.0±6.18)%,对照组手术后4周的改善率为(74.9±9.18)%,差异也具有统计学意义(P0.05);实验组的总显效比2周后为50.0%,对照组2周后的总显效比为5.0%;4周后两组比较,对照组总显效比95.0%,实验组总显效比100.0%,实验组疗效明显优于对照组。通过对JOA评分各项分值统计学分析后,结果表明实验组在腰椎间盘突出症腰椎融合手术术后患者的各项JOA单项评分(除膀胱功能外)改善方面均优于对照组,尤其在改善患者日常活动方面,实验组相较对照组更显优势。塞来昔布胶囊与甲钴胺片两种西药联合用药,配合服用脊愈汤治疗方法(实验组)较单纯上述两种西药联合用药治疗(对照组)临床治疗效果更好,患者症状恢复更快,证实实验组对于腰椎间盘突出症术后患者的治疗效果优胜于对照组。结论腰椎间盘突出症临床常见,传统直视手术是当今临床标准手术方法,应用较为广泛,行手术疗法后患者常见残余神经症状,包括不同程度的下肢神经支配区酸胀、麻木,皮肤感觉差、肌力恢复不佳等一系列临床表现。因手术花费较高,患者对预后期望值也较高,希望尽早完成术后康复。目前通过长期、系统的临床观察,结果显示,实验组及对照组在治疗过程中均具有较高的安全性。在疗效方面,统计结果表明,塞来昔布胶囊与甲钴胺片两种西药联合用药配合服用脊愈汤的治疗方法(实验组)对于减少患者术后自身感觉疼痛麻木症状的恢复快慢、改善患者临床症状、促进较快速地恢复患者生活质量、早期帮助患者术后下地活动,增加患者治疗的信心等项均优于单纯塞来昔布胶囊与甲钴胺片两种西药联合用药(对照组)的治疗方法,证实塞来昔布胶囊与甲钴胺片两种西药联合用药,配合服用脊愈汤的治疗方法对于促进腰椎间盘突出症腰椎融合手术术后患者恢复的临床疗良好,可以在临床大范围推广。
[Abstract]:Objective To establish a control group and an experimental group for patients with lumbar disc herniation (LIDP) treated by posterior lumbar single lumbar nucleus pulposus removal, spinal canal decompression, cage fusion and bilateral pedicle screw fixation. Methods Clinical observation was carried out in Xuchangrenhe Orthopaedic Hospital from April 2015 to October 2015 for lumbar disc herniation. Single lumbar nucleus pulposus removal, spinal canal decompression, lumbar cage implantation and fusion, pedicle screw internal fixation were performed. Forty hospitalized patients were divided into control group and experimental group according to the inclusion criteria. 20 patients in the control group, including 9 males and 11 females, were treated with celecoxib capsules and Mecobalamin tablets within two weeks after operation. 20 patients in the experimental group, including 10 males and 10 females, were treated with intravenous tamponade within two weeks after operation. The Japanese Orthopedic Association Scores (JOA) score was used to record the JOA scores of patients with low back pain before and after treatment, including preoperative, postoperative follow-up scores of 1 day, 2 weeks and 4 weeks, and to evaluate the recovery of patients after surgery. Results The JOA scores of the experimental group were higher than those of the control group at 2 weeks and 4 weeks, and the curative effect stability and trend were better than those of the control group. Significance (P 0.05). The improvement rate of the experimental group was (84.0 (+ 6.18)% at 4 weeks after operation, and that of the control group was (74.9 (+ 9.18)% at 4 weeks after operation. The difference was statistically significant (P 0.05); the total effective ratio of the experimental group was 50.0% after 2 weeks, and that of the control group was 5.0% after 2 weeks; after 4 weeks, the total effective ratio of the control group was 95.0%, and the total effective ratio of the experimental group was 50.0%. Compared with 100.0%, the curative effect of the experimental group was obviously better than that of the control group. After statistical analysis of the JOA scores, the results showed that the experimental group was superior to the control group in improving the JOA scores (except bladder function) of the patients with lumbar disc herniation after lumbar fusion surgery, especially in improving the daily activities of patients, the experimental group phase. Celecoxib capsules and Mecobalamin tablets combined with Jiyu decoction treatment (experimental group) than the two western medicine alone (control group) clinical treatment effect is better, faster recovery of symptoms in patients with lumbar intervertebral disc herniation confirmed the experimental group for patients after surgery efficacy Conclusion Lumbar intervertebral disc herniation is common in clinic. Traditional direct vision surgery is the standard operation method in clinic. It is widely used. The common residual neurological symptoms of patients after operation include acid distension, numbness, poor skin sensation, and poor muscle strength recovery. At present, through long-term and systematic clinical observation, the results show that both the experimental group and the control group have high safety in the course of treatment. In terms of curative effect, statistical results show that celecoxib capsules and Mecobalamin tablets are combined with two western medicine. The experimental group was superior to celecoxib capsule and cerecoxib capsule alone in terms of reducing the recovery rate of pain and numbness symptoms, improving clinical symptoms, promoting a faster recovery of patients'quality of life, helping patients to move under the operation early and increasing patients' confidence in treatment. Cobalamin tablet two kinds of Western medicine combined treatment (control group), confirmed that celecoxib capsule and Mecobalamin tablet two kinds of Western medicine combined treatment, combined with the treatment of Jiyu Decoction to promote the recovery of patients with lumbar disc herniation after lumbar fusion surgery good clinical treatment, can be widely promoted in clinical.
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R274.9

【相似文献】