倍他米松联合医用生物蛋白胶在腰椎管狭窄患者腰椎神经根减压术中的临床疗效研究

Effects of clinical efficacy of betamethasone combined with biomedical fibrin glue on lumbar nerve root decompression in patients with lumbar spinal stenosis

目的探讨倍他米松联合医用生物蛋白胶在腰椎管狭窄患者腰椎神经根减压术中的临床疗效。方法选取神经根型腰椎管狭窄患者120例,随机分为对照组(A)、倍他米松组(B)、医用生物蛋白胶组(C)、倍他米松联合医用生物蛋白胶组(D),每组30例。A组患者采用腰椎后路椎板间开窗减压间盘切除术,并给予阿司匹林肠溶片200 mg/次口服,1次/d治疗;B组在A组治疗基础上联合复方倍他米松注射液1 ml神经根周围注射;C组在A组基础上联合医用生物蛋白胶进行术中硬膜及神经根表面覆盖止血治疗;D组在A组基础上,采用倍他米松与医用生物蛋白胶组的联合应用,对患者进行抗炎抗粘连的治疗。4组均以28 d为1个疗程,共治疗4个疗程。治疗结束后,比较治疗前后四组患者改良日本骨科学会的下腰痛评估表(JOA评分)、Oswestry功能障碍指数评价系统评分(ODI评分)、视觉模拟评分(VAS评分)变化,引流量,术后感染率及临床疗效的变化。结果治疗后,与A组相比,其他三组总有效率升高(P<0.05),B、C两组有效率无统计学差异(P>0.05),D组有效率明显高于其他三组(P<0.05)。治疗后,四组患者直腿抬高试验角度增大,阳性反应发生率、VAS疼痛评分降低,JOA评分、脊柱ODI评分升高(P<0.05);与其他三组相比,D组患者治疗后VAS评分、直腿抬高试验角度增大,阳性反应发生率、术后48 h内引流量较低(P<0.05),JOA评分、脊柱ODI评分较高(P<0.05);四组患者术后感染发生率对比无统计学差异(P>0.05),B组、C组各项数值组间差异无统计学意义(P>0.05)。结论倍他米松联合医用生物蛋白胶治疗腰椎神经根减压术后的腰椎管狭窄患者临床疗效好,VAS疼痛评分、引流量降低,脊柱ODI评分、JOA评分升高。

Objective To investigate the effects of clinical efficacy of betamethasone combined with biomedical fibrin glue on lumbar nerve root decompression in patients with lumbar spinal stenosis. Methods A total of 120 patients with lumbar spinal stenosis from chengde medi- cal college affiliated hospital were collected and randomly divided into control group （A）, betamethasone group （B）, biomedical fibrin glue group （ C）, betamethasone combined with biomedical fibrin glue group （D）, 30 cases in each group. Patients in the control group were treated by lum- bar posterior decompression and decompression of lumbar intervertebral disc, and aspirin enteric - coated tablets 200 mg oral, 1 time/day treat- ment; patients in the betamethasone group were treated on the base of the control group with compound betamethasone injection 1 ml intra- articu- lar injections ; patients in the biomedical fibrin glue group were treated on the base of the control group with biomedical fibrin glue for intraoperative stopped bleeding treatment ; patients in the betamethasone combined with biomedical fibrin glue group were treated on the base of the control group with betamethasone and biomedical fibrin glue anti inflammation and anti adhesion treatment on the patients. Four groups with a 28 days period of treatment, a total of four courses of treatment. After treatment, compared the improved JOA, ODI, VAS scores changed, volume of drainage and postoperative infection rate and the changed of clinical efficacy of the four groups before and after treatment. Results After treatment, compared with control group, the total effective rate of other three groups increased （ P 〈 0. 05 ）, the effective rate compared between B and C groups had no statistical difference （ P 〉 0.05 ）, and the effective rate of D group was obvious higher than that of the other three groups （ P 〈 0. 05 ）. After treatment, the straight leg - raising test angle of the four groups increased, the incidence of positive reaction rate and VAS pain score decreased, JOA score and spinal ODI score increased （ P 〈 0. 05 ）. Compared with the other three groups, after treatment the VAS score and the straight leg - raising test angle of group D increased, the incidence of positive reaction rate and volume of drainage postoperative within 48 hours were lower （ P 〈 0.05 ）. JOA score and spinal ODI score were higher （ P 〈 0.05 ）. Four groups of patients with postoperative infection incidence rate had no statistical difference （ P 〉 0.05 ）, the indexes of group B and group C had no statistical significance difference （ P 〉 0.05 ）. Conclusion The clinical efficacy of betamethasone combined with biomedical fibrin glue on lumbar nerve root decompression in patients with lumbar spinal stenosis is good, VAS pain score and drainage decreased, spinal ODI score and JOA score increased.