椎间孔镜联合独活寄生汤治疗腰椎间盘突出症疗效观察

Observation of the therapeutic effect of percutaneous endoscopic lumbar discectomy combined with Duhuo Jisheng Decoction on lumbar disc herniation

目的观察椎间孔镜联合独活寄生汤治疗腰椎间盘突出症的临床效果。方法纳入2015年1月-2017年1月在陕西省咸阳市中心医院住院治疗的186例腰椎间盘突出症患者为研究对象,按照随机数表法将研究对象随机分为2组,对照组93例患者行经皮椎间孔镜髓核摘除术治疗,观察组93例患者行经皮椎间孔镜髓核摘除术后第2天给予独活寄生汤加减口服,连服6周。记录2组患者术前及术后1周、术后3个月、术后1年时疼痛视觉模拟评分(VAS评分)、Oswestry功能障碍指数量表评分(ODI评分)、改良JOA腰痛疾患评分(改良JOA评分),统计2组患者治疗6周后中医证候疗效及术后并发症发生情况、随访1年内复发情况。结果 2组患者术后1周、3个月、1年时VAS、ODI评分均较术前显著下降(P均<0.05),改良JOA评分均较术前显著升高(P均<0.05);与对照组比较,观察组术后各时间VAS、ODI评分更低(P均<0.05),改良JOA评分更高(P均<0.05)。术后6周时,观察组中医证候总有效率为91.40%(85/93),对照组为83.87%(78/93),2组比较差异有统计学意义(P<0.05)。2组患者术后均未发生脑脊液漏、椎间隙感染;随访发现观察组1例(1.08%)、对照组8例(8.60%)复发,观察组复发率明显低于对照组(P<0.05)。结论椎间孔镜联合独活寄生汤治疗腰椎间盘突出症能有效促进患者术后功能恢复,明显改善患者临床症状,且可降低复发率。

Objective It is to observe the clinical effect of percutaneous endoscopic lumbar discectomy combined with Duhuo Jisheng Decoction on lumbar disc herniation. Methods 186 patients with lumbar disc herniation who were hospitalized at Xianyang Central Hospital from January 2015 to January 2017 were included as the research subjects and were randomly divided into 2 groups according to the random number table method. 93 patients in the control group were treated with endoscopic transforaminal lumbar discectomy, 93 patients in the observation group was treated with Duhuo Jisheng Decoction by oral administration for 6 weeks from the second day after endoscopic transforaminal lumbar discectomy. The pain visual analogue scores(VAS scores), Oswestry Dysfunction Index scores(ODI scores), and modified JOA scores of low back pain were recorded at one week, 3 months, one years after the surgery, the efficacy of TCM syndromes and postoperative complications were calculated at 6 weeks after the surgery, and the recurrence within 1 year was followed-up in the two groups. Results The VAS scores and ODI scores of the two groups at 1 week, 3 months, and 1 year after surgery were significantly lower than those before surgery(P<0.05), and the modified JOA scores were significantly higher than those before surgery(P<0.05). Compared with the control group, the VAS scores and ODI scores were significantly lower and modified JOA scores were significantly higher in the observation group(P<0.05). At 6 weeks after surgery, the total effective rate of TCM syndromes in the observation group was 91.40%(85/93), and that in the control group was 83.87%(78/93), the difference in the rate between the two groups was statistically significant(P<0.05). No cerebrospinal fluid leakage and intervertebral space infection was found after the surgery in the two groups. There was one patient in the observation group(1.08%) and eight patients in the control group(8.60%) recurred. The recurrence rate in the observation group was significantly lower than that in the control group(P<0.05). Conclusion Percutaneous endoscopic lumbar discectomy combined with Duhuo Jisheng Decoction can effectively promote postoperative functional recovery, significantly improve the clinical symptoms of patients, and reduce the recurrence rate in the treatment of li,bar disc herniation.