全内窥镜下减压结合中药治疗退行性腰椎管狭窄症的中远期疗效

Full-endoscopic Minimally Invasive Decompression Combined with Chinese Medicine for Treating Degenerative Lumbar Spinal Stenosis:A 2-year Follow-up Report

目的:观察分析全内窥镜下减压结合中药治疗退行性腰椎管狭窄症的中远期临床疗效。方法:随访2010年1月至2014年12月间因退行性腰椎管狭窄症于本院进行手术并于术后服用中药的患者,手术方式为全内窥镜下经椎板间隙入路椎管减压术。分别于术前1天、术后3,6,12,24个月对患者使用疼痛视觉模拟量表评分(VAS)、ODI评分(Oswestry Disability Index,ODI)及改良的MacNab标准进行评价,同时记录诊疗过程中出现的并发症及不良反应。末次随访拍摄腰椎过伸过屈位片评估腰椎稳定性。结果:45例患者完成24个月的随访,男21例,女24例;年龄53~87岁,平均(72.35±9.24)岁。VAS评分由术前(6.96±0.95)分,下降到术后3个月(3.29±0.55)分,术后6个月(2.67±0.48)分,术后12个月(2.27±0.45)分,术后24个月(2.09±0.29)分。ODI评分由术前(87.60±6.15)分,下降到术后3个月(38.76±6.52)分,术后6个月(29.89±8.07)分,术后12个月(27.33±7.99)分,术后24个月(26.60±7.78)分。VAS及ODI评分术前术后差异有统计学意义(P<0.05),术后优良率达到88.89%.术后1例一过性感觉障碍及1例暂时性尿潴留,余无其他并发症发生,所有患者均未出现腰椎失稳。结论:全内窥镜下减压结合中药治疗退行性腰椎管狭窄症疗效满意,是安全有效的治疗方式,尤其针对老年患者,该方法充分发挥了现代先进技术和传统中医药结合的优势。

Objective：To observe and analyze the middle and long period clinical effect of minimally invasive decompression combined with traditional Chinese medicine on the treatment of degenerative lumbar spinal stenosis.Methods：All patients who underwent surgery for degenerative lumbar spinal stenosis were treated with traditional Chinese medicine after operation from January 2010 to December 2014.The patients were evaluated by pain visual analogue scale（VAS）,Oswestry disability index（ODI）score,and modified MacNab standard respectively at 1st day before operation,and 3,6,12 and 24 months after operation.At the same time,the complications and adverse reactions in the process of diagnosis and treatment were recorded.The lumbar hyperextension and flexion was taken at the last follow-up to evaluate the stability of the lumbar spine.Results：Forty-five patients were followed up for 24 months,including 21 males and 24 females,aged from 53 to 87 years（average 72.35±9.24 years）.The VAS score decreased from preoperative 6.96±0.95 to 3.29±0.55,2.67±0.48,2.27±0.45,2.09±0.29 respectively at 3,6,12 and 24 months after operation.The ODI score decreased from preoperative 87.60±6.15 to 38.76±6.52,29.89±8.07,27.33±7.99,26.60±7.78 respectively at 3,6,12 and 24 months after operation.There were significant differences between VAS and ODI scores before and after operation（P〈0.05）.The postoperative good rate was 88.89%.There were one cases of transient sexual dysfunction and one cases of temporary urinary retention after operation,and no other complications occurred.All patients had no lumbar instability.Conclusion：Minimally invasive decompression combined with traditional Chinese medicine is a safe and effective treatment for degenerative lumbar spinal stenosis,especially for elderly patients.This method has fully developed the advantages of modern advanced technology combined with traditional Chinese medicine.