脊髓型颈椎病围手术期血瘀证证候变化的临床观察

Clinical Observation of the Change of Blood Stasis Pattern in Patients with Cervical Spondylotic Myelopathy(CSM) during Perioperative Period

目的:研究血瘀证候在脊髓型颈椎病围手术期的变化特点,探讨手术对证候变化作用的机制。方法:选取2014年1月至2014年5月期间接受前路椎间盘髓核摘除+椎体间植骨融合钢板内固定术的30例脊髓型颈椎病患者,手术前后均按照血瘀证定量评分标准进行评分,并记录术前及术后7 d的血小板计数及纤维蛋白原数值并进行相关性分析。结果:术前血瘀证评分与颈椎椎体间隙受累数目有相关性;术前1 d、术后3 d及术后7 d的血瘀证评分经方差分析有差异,术后第7天,血小板计数及纤维蛋白原2组数值与术前1 d比较,差异有统计学意义。结论:初步推断通过手术干预治疗脊髓型颈椎病能改善脊髓受压所致的局限性缺血情况,从而促进改善患者全身血瘀证的表现。

Objective： To investigate the characteristics in blood-stasis pattern in perioperative period of cervical spondylotic myelopathy （CSM） and to discuss the mechanism of how the surgery impacts on the patterns changing in the perioperative period of CSM. Methods： Patient sample ： A total of 30 consecutive patients with cervical spondylotie myelopathy operated on during a 4-month period （January 2014 to May 2014） formed the study group. Methods： The participants in this study underwent anterior cervical discectomy and fusion （ ACDF ） for cervical spondylotic myelopathy before and after surgery. The scales of blood-stasis pattern were evaluated, the PLT and FIB were recorded, which were analyzed by SPSS 19. 0. The change of blood-stasis pattern before and after the surgeries, the relationship among the related indication can be understood, then draw the corresponding conclusion. Results： The relevance between the scales of bloodstasis pattern and the number of involved cord gaps, the platelet count and the fibrinogen content is present in this study. The difference of scales between 3 days after the surgery and 1 day before the surgery was also relevant with the course and the number of involved cord gaps. There was a significant difference in the scale of 1 day before the surgery and 3 days,7 days after the surgery, as well as 3 days after the surgery and 7 days after the surgery. There was also a significant correlation between the platelet count and fibrinogen content in 1 day before surgery and 7 days after the surgery. Conclusion ： This study indicates that the ischemia of spinal cord can be ameliorated by the intervention of operation for the treatment of CSM,which may eontibute to improve the performance of systemic blood-stasis pattern in patients.