EPS联合补肾活血汤治疗骨质疏松性老年腰椎管狭窄症的疗效及安全性研究

Efficacy and Safety of EPS Combined with Bushen Huoxue Decoction in the Treatment of Senile Lumbar Spinal Stenosis with Osteoporosis

目的观察膨胀式椎弓根螺钉(expanded pedicle screw, EPS)联合补肾活血汤治疗骨质疏松性老年腰椎管狭窄症的疗效及安全性。方法将骨质疏松性老年腰椎管狭窄症患者47例,完善术前评估和准备后,经后正中入路行椎管减压椎弓根螺钉内固定术,螺钉选用EPS,配合服用补肾活血汤治疗3个月。术后1个月、3个月、6个月及12个月观察患者临床疗效和并发症发生情况。结果所有患者均顺利完成手术,经过治疗患者的疼痛和生活质量均得到改善,术后1个月、3个月、6个月、12个月疼痛视觉模拟评分(visual analogue score, VAS)、Oswestry功能障碍指数(Oswestry disability index, ODI)均较治疗前明显改善(P<0.05),且术后6个月改善最显著。术后12个月时按日本骨科协会(Japanese orthopaedic association, JOA)评分标准,显效33例、有效9例,总有效率为89.4%(42/47)。在随访期间,所有患者的内置物椎弓根螺钉均未出现断裂,未出现感染以及其他的椎体骨折,无明显并发症发生。结论 EPS联合补肾活血汤治疗骨质疏松性老年腰椎管狭窄症患者疗效显著,可减轻患者腰部疼痛并改善腰椎功能,安全性较高,值得临床推广应用。

Objective To observe the efficacy and safety of expansive pedicle screw(EPS)combined with Bushen Huoxue Decoction in the treatment of senile lumbar spinal stenosis with osteoporosis.Methods A total of 47 elderly patients with lumbar spinal stenosis with osteoporosis were treated with internal fixation of pedicle screw through posterior median approach after improving preoperative evaluation and preparation.The screw selected EPS.The treatment was combined with Bushen Huoxue Decoction for 3 months.Clinical efficacy and complications were observed at 1,3,6 and 12 months after operation.Results All patients were successfully received operation.The pain and quality of life of the treated patients were improved after the operation,and the visual analogue scale(VAS)and Oswestry disability index(ODI)at 1,3,6 and 12 months after operation were improved compared with those before treatment(P<0.05),and the improvement was most obvious at 6 months after operation.At 12 months after operation according to Japanese Orthopaedic Association(JOA)scores,33 cases showed efficacy and 9 cases were effective,with a total effective rate of 89.4%(42/47).During follow-up,all patients had no rupture of the built-in pedicle screws,no infection and other vertebral fractures,and no obvious complications.Conclusion EPS combined with Bushen Huoxue Decoction can relieve pain in senile patients with osteoporosis and lumbar spinal stenosis pain and improve lumbar function.The safety is high,and it is worthy of clinical application.