椎管减压联合中药治疗脊髓型颈椎病的临床研究

Clinical study on spinal cord decompression combined with traditional Chinese medicine for the treatment of cervical spondylotic myelopathy

目的:比较椎管减压联合中药与单纯椎管减压治疗脊髓型颈椎病的临床疗效。方法 :2012年6月至2015年6月,收治脊髓型颈椎病患者73例,其中男42例,女31例,年龄29~73岁,平均50.9岁。根据患者意愿分为手术组和手术联合中药组,手术根据患者病情采用前路间盘摘除或椎体次全切钢板螺钉内固定术或后路单开门减压侧块螺钉内固定术,其中单纯手术组34例,手术联合中药组39例。比较两组患者术前和术后1周、1个月及末次随访的神经功能,通过日本骨科协会(JOA)17分法对所有患者神经功能进行评分,计算神经功能改善率,同时根据颈椎功能障碍指数量表(NDI)及根据JOA评分与《颈椎病临床评价量表》制定的督脉瘀阻证候积分对患者神经功能改善情况进行评定,术后通过X线片、CT、MRI观察内固定及脊髓减压情况。结果:所有患者手术顺利,术中均无硬膜、脊髓、神经根损伤,术后1例患者出现伤口感染,经抗感染治疗后得到控制,1例患者术后出现血肿,并伴有脊髓压迫,出现不全瘫表现,及时行二次手术清除血肿,患者未留下明显后遗症。两组患者术后均获得随访,随访12~24个月,单纯手术组平均(14.6±0.8)个月,手术联合中药组平均(13.5±0.7)个月,随访时间两组差异无统计学意义(P>0.05)。单纯手术组术前JOA评分、颈椎功能障碍指数(NDI)及督脉瘀阻证候积分分别为8.31±3.15、29.91±4.52、6.58±1.31,术后1周分别为10.21±2.58、18.67±4.31、8.24±1.18,术后1个月分别为11.38±2.85、16.11±3.18、8.91±2.11,末次随访分别为12.21±3.12、14.61±3.28、9.12±1.56,手术联合中药组术前JOA评分、颈椎功能障碍指数(NDI)及督脉瘀阻证候积分分别为8.29±3.47、30.83±4.14、6.38±1.81,术后1周分别为10.48±2.39、17.59±5.14、8.33±1.57,术后1个月分别为12.14±3.12、13.14±3.21、9.55±2.49,末次随访分别为13.85±3.34、12.11±2.51、10.33±1.95,两组患者术后JOA评分、颈椎功能障碍指数(NDI)及督脉瘀阻证候积分较术前明显提高(P<0.05);术后1周两组间差异无统计学意义(P>0.05),术后1个月及末次随访时,手术联合中药组较单纯单手术组脊髓功能改善更为明显(P<0.05),JOA改善率单纯手术组为(67.59±10.78)%,手术联合中药组为(66.88±12.15)%,两组差异无统计学意义(P>0.05)。两组患者术后均行X线、CT、MRI检查,未出现内固定松动断裂。结论:通过椎管减压治疗脊髓型颈椎病,可以扩大椎管,解除神经压迫,以疏通督脉,调节气血,振复阳气,配合中药活血祛瘀,温阳通络、补益肝肾能够达到较单纯手术治疗更佳的治疗效果。

Objective：To compare the clinical effect between spinal card decompression combined with traditional Chinese medicine and simple spinal card decompression for cervical spondylotic myelopathy. Methods：From June 2012 to June 2015,73 patients with cervical spondylotic myelopathy were treated,including 42 males and 31 females,aged from 29 to73 years old with a mean of 50.9 years old. The patients were divided into the simple operation group（34 cases） and the operation combined with traditional Chinese medicine group（39 cases） according to the idea of themselves. The anterior discectomy or subtotal corpectomy with internal fixation or posterior simple open-door decompression with lateral mass screw fixation were performed in the patients. Among them,39 cases were treated with traditional Chinese medicine after surgery. The Japanese orthopedic association（JOA） score of spinal cord function,the improvement rate of neural function,the neck dysfunction index（NDI） score and the governor vessel stasis syndrome score were compared between two groups preoperative and postoperative 1 week,1 month and the final follow-up respectively. The internal fixation and the condition of spinal cord decompression were observed by CT,MRI and X-rays before and after operation. Results：All the operations were successful,no injuries such as dura mater,spinal cord and nerve root were found. All the wounds were healed without infection except one patient had a superficial infection. It was solved after intermittent debridement and anti-infective therapy. Hematoma occurred in 1 case,complicated with spinal cord compression,caused incomplete paralysis,and promptly performed the reo-peration to remove the hematoma without any obvious sequelae. All the patients were followed up from 12 to 24 months,（14.6 ±0.8）months for simple operation group and（13.5±0.7） months for operation combined with traditional Chinese medicine group,and there was no significant difference（P〉0.05）. The scores of JOA,NDI and the governor＇s vessel stasis syndrome in simple operation group were 8.31 ±3.15,29.91 ±4.52,6.58 ±1.31 before operation,and 10.21 ±2.58,18.67 ±4.31,8.24 ±1.18 one week after operation,and 11.38±2.85,16.11±3.18,8.91±2.11 one month after operation,and 12.21±3.12,14.61±3.28,9.12±1.56 at final follow-up,respectively; and in operation combined with traditional Chinese medicine group were 8.29 ±3.47,30.83 ±4.14,6.38 ±1.81 before operation,and 10.48 ±2.39,17.59 ±5.14,8.33 ±1.57 one week after operation,and 12.14 ±3.12,13.14 ±3.21,9.55 ±2.49 one month after operation,and 13.85 ±3.34,12.11 ±2.51,10.33 ±1.95 at final follow-up,respectively.Postoperative JOA,NDI,and the governor vessel stasis syndrome score of two groups were significantly higher than preoperativee（P〈0.05）. There was no significant difference in JOA,NDI,and the governor vessel stasis syndrome score between two groups one week after operation（P〉0.05）. The above items in operation combined with traditional Chinese medicine group was better than that of simple operation group one month and final follow-up after operation（P〈0.05）. The improvement rate of neural function in simple operation group was（67.59 ±10.78）%,and in operation combined traditional Chinese medicine group was（66.88±12.15）%,there was no significant difference between two groups（P〉0.05）. There were no complications such as internal fixation failure or re-dislocation of atlas by postoperative CT,MRI and X-rays examination.Conclusion：Spinal card decompression for the treatment of cervical spondylotic myelopathy can extend the spinal canal,relieve the compression of nerve,achieve the deoppilation of governor vessel,the regulation of qi and blood,the restore of Yangqi,combined with traditional Chinese medicine of activating blood removing stasis,warming yang and activating meridians,reinforcing liver benefiting kidney,which may obtain better clinical effect.