老年退变性腰椎管狭窄症的非手术治疗

Clinical outcome of non-surgical treatment of senile people with degenerative lumbar spinal canal stenosis

[目的]探讨老年退变性腰椎管狭窄症患者非手术治疗的疗效。[方法]2000年11月～2005年10月收治的60岁以上退变性腰椎管狭窄症患者176例,随机分为中医组、西医组及中西医结合组,组间性别、年龄、病程及并发症比较差异无统计学意义(P>0.05),具有可比性。分别予中医、西医及中西医结合非手术方法治疗并采用日本矫形外科协会JOA评分标准评定疗效。[结果]157例获2～7年随访,平均随访3.5年,三组患者治疗前JOA分值比较差异无统计学意义(P>0.05),出院及随访时中医组与西医组患者JOA分值比较差异无统计学意义(P>0.05),但中医组或西医组与中西医结合组间JOA分值以及疗效比较差异有统计学意义(P<0.05),中西医结合组疗效优于中医组和西医组。[结论]对于无急诊手术指征老年退变性腰椎管狭窄症患者,在积极治疗并存内科疾病的同时,选择合理的非手术治疗,可取得较好疗效,但中西医结合疗法与单纯中医或西医疗法比较,疗效更持久及稳定。

[ Objective ] To investigate the clinical effect of non-surgical treatment of senile people with degenerative lum- bar spinal canal stenosis. [ Method] Totally 176 cases of degenerative lumbar spinal canal stenosis from November 2000 to October 2005 were randomly divided into traditional Chinese medicine group （53 cases）, western medicine group （ 57 cases） , traditional Chinese medicine- western medicine group （ 66 cases） . And the treating effects were evaluatd by using JOA 29 grading system, and improving rate was analysed statistically. [ Result] Totally 157 cases acquired a follow - up of 2 - 7 years. The JOA score of cases in three groups had no obvious difference before treatment （P 〉 0.05 ）, the symptoms and activities of daily living were improved significantly in three groups after treatment （ P 〈 0. 05 ） , there was no obvious difference be- tween traditional Chinese medicine and western medicine group （ P 〉 0. 05 ） , but the clinical effect had obvious difference be- tween traditional Chinese medicine group and traditional Chinese medicine - western medicine group or western medicine group and traditional Chinese medicine - western medicine group （ P 〈 0. 05 ） . [ Conclusion ] In condition of controlling concomitant internal disease, degenerative lumbar canal stenosis cases were satisfied with nonoperation outcomes, comparing with other two groups, the traditional Chinese medicine - western medicine group guarrenteed better therapeutic effect.