腰椎后路减压固定融合术联合针刺治疗督脉瘀阻型老年性腰椎管狭窄症的临床疗效

Clinical Observation of Posterior Decompression and Fusion Surgery Combined with Acupuncture Treating Governor Vessel Stasis Type Lumbar Spinal Stenosis in the Elderly

目的探讨腰椎后路减压固定融合术联合针刺治疗督脉瘀阻型老年性腰椎管狭窄症的临床疗效。方法回顾性分析2013年1月至2015年6月北京中医药大学东方医院骨科收治的57例督脉瘀阻型老年性腰椎管狭窄症患者的临床资料。依据治疗方法不同分为两组:观察组36例,采用手术加针刺治疗;对照组21例,采用单纯手术治疗。术后随访2年,分别于术前、术后12 d(围术期)、术后2年(长期)行疼痛视觉模拟评分(VAS)、日本骨科协会评估治疗评分(JOA)以及中医症状评分。结果术后12 d,观察组总有效率高于对照组[86.1%(31/36)比61.9%(13/21)](P<0.05);术后2年,两组总有效率均为100.0%,差异无统计学意义(P>0.05);两组患者术前VAS评分比较差异统计学意义(P>0.05),术后12 d和术后2年两组VAS评分、中医症状评分呈下降趋势,且观察组低于对照组,而JOA评分呈上升趋势,且观察组高于对照组(P<0.05)。结论腰椎后路减压固定融合术治疗腰椎管狭窄症具有显著的临床疗效,针刺联合手术治疗可显著改善患者术后症状及功能,有助于患者术后康复。

Objective To investigate the clinical effects of lumbar posterior decompression and fixation surgery combined with acupuncture in treating governor vessel stasis type lumbar spinal stenosis in the elderly.Methods Retrospective analysis on 57 cases of governor vessel stasis type lumbar spinal stenosis in the elderly in Dongfang Hospital,Beijing University of Chinese Medicine from Jan. 2013 to Jun. 2015 was done.The patients were divided into two groups according to the treatment：an observation group of 36 cases treated with surgery plus acupuncture;a control group of 21 cases treated with only surtery.The patients were followed up for 2 years.Visual analogue score（VAS）,Japanese orthopedic association scores（JOA） and TCM symptom score comprehensive evaluation were performed before surgery,12 days after surgery（perioperative period） and 2 years （long term） to evaluate the treatment effect.Results Postoeprative 12 days,the total effective rate in the observation group was higher than that in the control group[86.1%（31/36） vs 61.9%（13/21）]（ P 〈0.05）;two years after operation,the total effective rate in both groups was 100.0%,there was no significant difference（ P 〉0.05）.The difference of preoperative VAS scores of the two groups was statistically significant（ P 〈0.05）. The VAS scores and TCM symptom scores of the two groups showed a decreasing trend after 12 days and 2 years after operation,and the observation group was lower than the control group.There was an upward trend in JOA and the observation group was higher than the control group（ P 〈0.05）. Conclusion The lumbar posterior decompression and fixation surgery has a significant therapeutic effect on the patients with lumbar spinal stenosis.Acupuncture combined with surgical treatment can significantly improve the postoperative symptoms and functions of the patients, which is helpful to the postoperative recovery.