中西医结合诊治腰椎间盘突出症1586例回顾分析

Integration of traditional Chinese and western medicine for treating lumbar intervertebral disc herniation: Review analysis of 1 586 cases

目的:观察腰椎间盘突出症患者中西医结合非手术治疗的近期及远期疗效,并与手术治疗进行比较。方法:选择2000-01/2005-12在广西中医学院瑞康临床学院骨科住院的腰椎间盘突出症患者1586例,腰椎CT或MRI扫描结果符合腰椎间盘突出症的诊断标准,均自愿参加观察。①手术治疗612例。以开窗髓核摘除术、扩大开窗髓核摘除术、髓核摘除并椎管减压术、半椎板切除髓核摘除术、髓核摘除并椎管减压术、椎间盘镜髓核摘除术为主;部分做了半椎板切除髓核摘除术、全椎板切除髓核摘除术、椎板切除并椎弓根内固定术、髓核摘除并部分椎体切除术及其他手术。②中西医结合非手术治疗974例。采用中西药物注射剂静脉滴注,内服非类固醇止痛药及中药以本院制剂活血止痛胶囊、驱风散寒胶囊、补肾舒筋胶囊(所有中药材均从本地药材公司购入),封闭、卧硬板床休息、牵引、手法治疗及局部烫疗等方法中的一种或多种同时应用。疗程根据病变部位和程度具体制定。治疗后或术后3个月～2年回访为近期疗效;2年以上为远期疗效,远期疗效改为电话追访。疗效标准:①优:症状缓解,能恢复原来的工作和生活。②良:症状部分缓解,不能恢复原来的工作和生活。结果:远期疗效电话追访时失访996例。手术及中西医结合非手术治疗患者近期及远期疗效比较:手术组患者近期疗效的优良率显著高于非手术组[95.42%,72.9%(u=14.3333,P<0.01)],但手术组患者远期疗效的优良率与非手术组相比,差异无显著性意义[92.65%,88.0%(u=0.4586,P>0.05)]。结论:近期效果手术优于保守治疗,远期效果手术与保守治疗无明显差异,提示即使行手术治疗后,保守治疗措施及术后康复训练亦十分重要。

To summarize the shortand long-term curative effects of lumbar intervertebral disc herniation （LIDH） with integration of traditional Chinese and western medicine, and compare with the effect of surgical treatment. METHODS： Totally 1 586 inpatients treated in the Department of Orthopaedics, Ruikang Hospital of Guangxi College of Traditional Chinese Medicine from January 2000 to December 2005 were volunteered to join the study, and they were diagnosed as LIDH by CT or MRI of lumbar spine.①There were 612 cases treated with operations. Operative style was mainly the removals of nucleus pulpesus by lamina windowing, enlarge windowing of lamina, hemilaminectomy, vertebral canal decompression and microendoscopic discectomy, and partly the removals of nucleus pulpesus by hemilaminectomy, laminectomy and transpedicular fixation, etc.②And 974 cases were treated with integration of traditional Chinese and western medicine. Chinese or western drugs were injected by intravenous drips, and the patients were also orally administrated with non-steroid analgesics and homemade traditional Chinese medicine preparations such as Huoxue Zhitong capsule or Qufeng Sanhan capsule and Bushen Shujin capsule （all the herbs were purchased from local medical materials company）, which was followed by block therapy, lying in plank bed for resting, traction, massage manipulation, local scald therapy and so on. One or manifold methods were adopted in non-operative group. The period of treatment depended on the locus and degree of lesions, and short-term was defined as before treatment or from 3 months to 2 years post-treatment by return visit, while long-term was defined as more than 2 years pest-treatment by teIephone interview. Curative effect： ①Excellent： All the symptoms were relieved, and the patients recovered to normal work and life;②Goed： Part of symptoms was relieved, but the patients did not recovered to normal levels. RESULTS： There were 996 patients lost in the long-term follow-up by telephone interviews. Comparison of short-and long-term curative effects： The cases who got excellent and good outcomes were significantly higher in operation group than in non-operative group [95.42%, 72.9%, （u=14.333 3, P〈0.01）], but no significant difference was found in the long-term curative effects between two treatment groups [92.65%, 88.0%, （u=0.458 6, P〉0.05）]. CONCLUSION： As for LIDH, the short-term curative effect of traditional Chinese medicine and western medicine integration treatment is better than that of conservative treatment, while the long-term curative effect is similar between integration treatment and conservative treatment, suggesting that conservative treatment and postoperative rehabilitative exercises are still crucial for LIDH patients after surgical treatment.