杜仲腰痛丸联合椎管减压术治疗督脉瘀阻型退行性腰椎管狭窄症

Duzhong Yaotong Pill Combined with Spinal Canal Decompression Treating DLSS of Governor Vessel Obstruction

目的:对比研究杜仲腰痛丸联合椎管减压术与单纯手术治疗督脉瘀阻型退行性腰椎管狭窄症的临床疗效。方法:将2016年6月—2017年3月甘肃省中医院脊柱骨二科收治的72例退行性腰椎管狭窄症患者按随机数字表法分为两组,对照组行椎管减压术,治疗组在对照组基础上术后给予杜仲腰痛丸口服,8丸/次,2次/日,疗程为1个月。对比分析两组治疗后临床疗效,记录两组术前、术后1个月、末次随访时中医证候积分、腰部疼痛视觉模拟评分(VAS)和腰椎功能障碍指数(ODI)。结果:所有手术均顺利完成,术后平均随访7. 12个月,两组共失访3例,未按疗程服药而剔除2例,最终共67例纳入统计分析。治疗组临床总有效率为96. 97%,对照组总有效率为79. 41%,两组比较差异有统计学意义(P <0. 05);术前两组中医证候积分、VAS评分、ODI指数对比,差异无统计学意义(P> 0. 05);术后1个月两组中医证候积分、VAS评分、ODI指数较术前均有不同程度下降,治疗组下降较对照组显著,差异有统计学意义(P <0. 05);末次随访两组中医证候积分、VAS评分、ODI指数比较,差异无统计学意义(P>0. 05)。结论:通过椎管减压术治疗退行性腰椎管狭窄症,可解除脊髓的压迫与瘀阻,从解剖形态上疏通督脉,术后给予杜仲腰痛丸口服补益肝肾、化瘀通络,可改善微循环,预防血肿形成和抑制炎症反应,进一步疏通督脉,提高手术疗效。

Objective:To study the clinical effect of Duzhong Yaotong Pill combined with spinal canal decompression treating degenerative lumbar spinal stenosis(DLSS)of Governor Vessel obstruction.Methods:72DLSS cases were randomly divided into the control group and the treatment group.The control group was treated with spinal canal decompression;on which basis the treatmeal group was also treated with Duzhong Yaotong Pill(8pills/time,twice/day)for a month.TCM syndrome integral before the decompression,one month after the decompression,and at the time of the last follow-up was recorded,as well visual analogue scale(VAS)of lumbago and Oswestry disability index(ODI)were observed to compare the clinical curative effect between the two groups.Results:All the decompressions were completed successfully,with an average follow-up of7.12months.3cases were lost in the two groups,and2cases were excluded because of failing to take the medication as required;therefore67cases were included in the final statistical analysis.The total clinical efficiency of the treatment group was96.97%,which was significantly higher than79.41%of the control group(P<0.05).There were no statistical differences in TCM syndrome integral,VAS scores,and ODI before the decompression between the two groups(P>0.05);the above parameters were decreased to varying degrees one month after the decompression in the two groups;in which the treatment group improved more significantly than the control group(P<0.05).There were no statistical differences in TCM syndrome integral,VAS scores,and ODI at the time of last follow-up between the two groups(P>0.05).Conclusion:The vertebral canal decompression in the treatment of DLSS can remove the spinal cord compression and blood stasis,unclog Governor Vessel from anatomical morphology;the medication of Duzhong Yaotong Pill can reinforce Liver and Kidney,remove blood stasis from the collaterals.The medication can improve microcirculation,prevent hematoma formation and inhibit inflammatory reactions,further unclog Governor Vessel to improve the efficacy of the decompression.