单边双通道内镜技术配合独活寄生汤治疗寒湿痹阻型腰椎间盘突出症临床观察

Clinical study of Duhuo Jisheng decoction combined with unilateral biportal endoscopy in treatment of cold and dampness type lumbar disc herniation

目的观察独活寄生汤联合单边双通道内镜技术(UBE)治疗寒湿痹阻型腰椎间盘突出症(LDH)的临床疗效及血清中炎症因子的变化情况。方法2019年3月—2021年2月,中国人民解放军联勤保障部队第九八八医院收治的80例寒湿痹阻型LDH患者根据随机数字表法分为治疗组和对照组,每组40例。对照组仅行UBE治疗,治疗组在UBE术后口服独活寄生汤。术后3个月时观察两组腰腿痛VAS评分、ODI、血清中肿瘤坏死因子a(TNFa)及白细胞介素1a(IL1a)水平变化情况,并对比两组的临床疗效。结果治疗组和对照组的腰腿痛VAS评分均比术前下降,差异有统计学意义(t=23.063,13.675;P均<0.05)。治疗组和对照组的ODI均比术前下降,差异有统计学意义(t=48.894,44.848;P均<0.05)。治疗组和对照组血清中的TNFa水平均比术前下降,差异有统计学意义(t=10.264,7.456;P均<0.05)。治疗组和对照组血清中的IL1a均比术前下降,差异有统计学意义(t=16.718,9.594;P均<0.05)。治疗组的腰腿痛VAS评分、ODI、TNFa、IL1a改善情况均优于对照组,差异有统计学意义(t=9.751,6.593,3.609,8.723;P均<0.05)。治疗组总有效率97.5%(39/40)优于对照组总有效率85.00%(34/40),差异有统计学意义(Z=2.072,P=0.038)。结论独活寄生汤联合单边双通道内镜技术治疗寒湿痹阻型LDH在改善腰椎功能、提高临床疗效、降低血清中的炎症因子等方面优于单纯的单边双通道内镜技术。

Objective To observe the clinical efficacy of Duhuo Jisheng decoction combined with unilateral biportal endoscopy(UBE)in the treatment of cold and dampness type lumbar disc herniation(LDH)and the changes of serum inflammatory factors.Methods From March 2019 to February 2021,totally 80 patients with cold and dampness type LDH were divided into treatment and control groups according to the random number table method,with 40 cases in each group.The control group was only treated with UBE treatment,and the treatment group was treated with UBE surgery combined with Duhuo Jisheng decoction.The changes of indicators such as VAS score of low back and leg pain,ODI,TNFa and IL1 a and clinical efficacy were observed in the two groups after 3 months after surgery.Results Both the treatment group and the control group had lower back and leg pain VAS scores than before the operation,and there was a significant difference(t=23.063,13.675;all P<0.05).The ODI of the treatment group and the control group was lower than that before the operation,and there was a significant difference(t=48.894,44.848;all P<0.05).The serum levels of TNFa in the treatment group and the control group were lower than those before the operation,and there was a significant difference(t=10.264,7.456;all P<0.05).The serum IL-1 a of the treatment group and the control group were both lower than that before the operation,and there was a significant difference(t=16.718,9.594;all P<0.05).The improvement of VAS score,ODI,TNFa,IL1 a of the treatment group was better than that of the control group,and the difference was statistically significant(t=9.751,6.593,3.609,8.723;all P<0.05).The total effective rate of the treatment group was 97.5%(39/40)better than the control group’s total effective rate of 85.00%(34/40),the difference was statistically significant(Z=2.072,P=0.038).Conclusion Duhuo Jisheng Decoction combined with unilateral biportal endoscopy in the treatment of cold and dampness type lumbar disc herniation is better than unilateral biportal endoscopy in improving lumbar spine function,improving clinical efficacy,and reducing inflammatory factors in the serum.