补阳还五汤对CSM术后脊髓功能康复的疗效观察

发布时间：2018-11-14 17:15

【摘要】：目的：观察补阳还五汤对脊髓型颈椎病(Cervical Spondylotic Myelopathy, CSM)术后脊髓功能康复的临床疗效,探讨其临床应用价值。方法：选取2014年11月至2015年12月在南京军区福州总医院骨一科行颈前路减压植骨融合内固定术的CSM患者60例,按就诊时间顺序,随机分成试验组和对照组,各30例。试验组采用补阳还五汤联合CSM术后常规康复疗法；对照组采用CSM术后常规康复疗法。共4疗程,每个疗程7d,疗程间隔为2d。采用脊髓JOA评分和改良的Barthel指数评分在术前、术后7d和术后36d分别对两组患者进行脊髓功能评定,并采用《中医病症诊断疗效标准》评价两组患者术后7d及术后36d脊髓功能康复情况。所得数据,使用软件SPSS18.0进行统计学处理。结果：1.一般资料分析：两组CSM患者在性别、年龄、脊髓病变节段及病程上比较,均无统计学差异(P0.05)。2.脊髓JOA评分：术前试验组、对照组的脊髓JOA评分分别为(9.03±1.33)、(9.17±1.11)分,术后7d两组的脊髓JOA评分分别为(13.26±1.56)、(12.37±1.58)分,术后36d两组的脊髓JOA评分分别为(15.05±1.58)、(13.74±1.73)分。术前试验组的脊髓JOA评分同对照组比较无统计学差异(P0.05)。与术前比较,两组在术后7d、术后36d的脊髓JOA评分均有不同程度改善,均有显著性差异(P0.01)。术后7d,试验组与对照组比较,差异有统计学意义(P0.05)；术后36d,试验组与对照组比较,有显著性差异(P0.01)。3.日常生活能力：术前试验组、对照组改良Barthel指数评分分别为(50.87±6.27)、(53.80±5.60)分,术后7d两组的改良Barthel指数评分分别为(77.70±7.40)、(73.01±8.12)分,术后36d两组的改良Barthel指数评分分别为(89.03±7.13)、(81.70±8.11)分。术前试验组的日常生活能力改良Barthel指数同对照组比较无统计学差异(P0.05)。与术前比较,两组在术后7d、术后36d的日常生活能力改良Barthel指数均有不同程度改善,均有显著性差异(P0.01)。术后7d,试验组与对照组比较,差异有统计学意义(P0.05)；术后36d,试验组与对照组比较,有显著性差异(P0.01)。4.中医病症诊断疗效标准：试验组、对照组CSM患者经治疗后,在《中医病症诊断疗效标准》评价方面上比较。术后7d,试验组总有效率83.3%,对照组总有效率76.7%,差异有统计学意义(P0.05)；术后36d,试验组总有效率93.3%,对照组总有效率86.70%,有显著性差异(P0.01)。结论：补阳还五汤可以促进CSM术后脊髓功能康复,具有良好的临床疗效。
[Abstract]:Objective: to observe the clinical effect of Buyang Huanwu decoction on the rehabilitation of spinal cord function after (Cervical Spondylotic Myelopathy, CSM) for cervical Spondylotic myelopathy. Methods: from November 2014 to December 2015, 60 patients with CSM who were treated with anterior cervical decompression, bone grafting and internal fixation in Department of Bone of Fuzhou General Hospital of Nanjing military region were randomly divided into experimental group and control group, 30 cases in each group. The experimental group was treated with Buyang Huanwu decoction combined with conventional rehabilitation therapy after CSM and the control group with routine rehabilitation therapy after CSM. A total of 4 courses of treatment, each course of 7 days, the interval of 2 days. Spinal cord function was evaluated by spinal cord JOA score and modified Barthel index score before operation, 7 days after operation and 36 days after operation, respectively. The recovery of spinal cord function was evaluated 7 days after operation and 36 days after operation. The data were processed by software SPSS18.0. Results: 1. General data analysis: two groups of CSM patients in sex, age, spinal cord disease segment and course of comparison, there was no statistical difference (P0.05). Spinal cord JOA score: the spinal cord JOA score of the experimental group and the control group was (9.03 卤1.33), (9.17 卤1.11) before operation, and the JOA score of spinal cord in the two groups was (13.26 卤1.56), (12.37 卤1.58 on the 7th day after operation. The JOA score of spinal cord in the two groups was (15.05 卤1.58), () 13.74 卤1.73 on the 36th day after operation. There was no significant difference in JOA score between the experimental group and the control group (P0.05). Compared with pre-operation, the spinal cord JOA scores of the two groups were improved in different degrees on the 7th day and 36th day after operation, and there were significant differences between the two groups (P0.01). On the 7th day after operation, the difference between the experimental group and the control group was statistically significant (P0.05), and at 36 days after operation, there was a significant difference between the experimental group and the control group (P0.01). Activity of daily living (ADL): the scores of modified Barthel index in preoperative group and control group were (50.87 卤6.27), (卤5.60) and (77.70 卤7.40), (, 73.01 卤8.12), respectively. The scores of modified Barthel index were (89.03 卤7.13), (, 81.70 卤8.11), respectively. There was no significant difference in ADL Barthel index between the experimental group and the control group (P0.05). Compared with before operation, the improved Barthel index of ADL in the two groups were improved in different degree on the 7th day and 36th day after operation, and there was significant difference between the two groups (P0.01). At 7 days after operation, the difference between the experimental group and the control group was statistically significant (P0.05), and at 36 days after operation, there was a significant difference between the experimental group and the control group (P0.01). Criteria for the diagnosis of TCM symptoms: the patients in the experimental group and the control group were compared in the evaluation of the criteria for the diagnosis of TCM symptoms after treatment. At 7 days after operation, the total effective rate of the trial group was 83.3%, while that of the control group was 76.70.The difference was statistically significant (P0.05). At 36 days after operation, the total effective rate was 93.3 in the experimental group and 86.70 in the control group, with significant difference (P0.01). Conclusion: Buyang Huanwu decoction can promote the recovery of spinal cord function after CSM and has good clinical effect.
【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】：R274.9

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