微创经椎间孔椎间融合术联合引气归元针法治疗督脉瘀阻型腰椎椎管狭窄症的临床研究

Clinical Study of Minimally Invasive Transforaminal Lumbar Interbody Fusion Combined with Yingqiguiyuan Acupuncture for Treating Lumbar Spinal Stenosis of Du Meridian Stagnation Type

目的:探讨经皮Quadrant通道下微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)结合引气归元针法治疗督脉瘀阻型腰椎椎管狭窄症的临床疗效。方法:回顾性分析2015年6月至2016年6月本科室收治符合标准的督脉瘀阻型腰椎椎管狭窄症患者共61例,分为单纯手术组30例及手术结合针灸治疗组31例。分别比较术前、出院及末次随访时,两组患者JOA评分、VAS评分、腰部督脉瘀阻症候积分。结果:所有手术均顺利完成,术后两组患者督脉瘀阻积分及VAS评分均较术前明显降低,JOA评分均较术前明显提高,差异有统计学意义(P<0.05)。出院VAS评分及督脉瘀阻积分改善情况组间差异有统计学意义(P<0.05),JOA评分改善情况组间差异无统计学意义(P>0.05)。末次随访时3种指标评分改善情况组间对比差异无统计学意义(P>0.05),但针灸治疗组督脉瘀阻症候积分、VAS评分低于单纯手术组,JOA评分高于单纯手术组。结论:督脉瘀阻型腰椎椎管狭窄症行Quadrant通道下MIS-TLIF,能有效疏通督脉,术后瘀阻症状改善明显,体现了"督脉生病治督脉,治在骨上"的治病求本的中医思维。术后大部分患者仍残留少许瘀阻症候,运用引气归元针法能进一步疏通督脉,改善督脉瘀阻症候,缩短病程,促进早日康复,疗效优于单纯手术组。引气归元针法是中医的特色疗法,疗效确切,值得推广。

Objective：To explore the clinical effect of minimally invasive transforaminal lumbar interbody fusion（MISTLIF）through Mast Quadrant channel combined with Yingqiguiyuan acupuncture for treating lumbar spinal stenosis of Du meridian stagnation type.Methods：A retrospective analysis of 61 cases with the standard of lumbar spinal stenosis of Du meridian stagnation type collected from June 2015 to June 2016,were divided into surgery group（30 cases）and surgery combined with acupuncture group（31 cases）.Compared with the JOA score,VAS score and the Du meridian stagnation syndrome score of the patients in two groups respectively in preoperative,discharged and at the end of the follow-up.Results：All operations were completed successfully.After operation,the Du meridian stagnation syndrome score and the VAS score of the patients in two groups were significantly lower than those before operation,while the JOA score were significantly higher（P〈0.05）.The change of Du meridian stagnation syndrome score and the VAS score in operation and combined group were higher than those of operation group（P〈0.05）,while JOA score was not significantly different between the two groups at discharge（P〉0.05）.At the last follow-up,although there was no statistical difference in the Du meridian stagnation syndrome score,JOA score,VAS score between the two groups（P〉0.05）,the Du meridian stagnation syndrome score and the VAS score in operation and combined group were lower than operation group,and the JOA score were higher.Conclusion：MIS-TLIF through Mast Quadrant channel can dredge Du meridian stagnation effectively,significantly relief their symptoms after surgery.It reflects the thinking that＂supervising the pulse to be sick and supervising the pulse to be treated on the bone＂of Chinese medicine that medical treatment should seek for the intrinsic cause of disease.Most patients still remain a little postoperative stasis syndrome.The use of Yingqiguiyuan acupuncture which is one of the characteristics of traditional Chinese medicine therapy can further dredge Du meridian stagnation,relieve symptoms and short the course of disease to promote rehabilitation early.The clinical effect of operation combined group was better than the operation group.It is worthy to promote this therapeutic method.