中药腰突颗粒配合经皮全脊柱内镜治疗椎间盘源性马尾综合征的临床观察

Clinical Observation of Yaotu Granules Combined with Percutaneous Total Spinal Endoscopy in the Treatment of Discogenic Cauda Equina Syndrome

【目的】评估中药腰突颗粒配合经皮全脊柱内镜治疗椎间盘源性马尾综合征的有效性、安全性。【方法】采用回顾性分析方法,收集2014年5月至2019年5月在深圳市中医院住院治疗的42例椎间盘源性马尾综合征患者。所有患者均采用经皮全脊柱内镜髓核摘除术治疗,术后配合服用中药腰突颗粒3周。观察患者术前、术后7 d、21 d、3个月疼痛视觉模拟量表(VAS)评分、腰椎功能日本骨科学会(JOA)评分的变化情况,评估腰突颗粒配合经皮全脊柱内镜治疗椎间盘源性马尾综合征的有效性和安全性。【结果】(1)手术情况:所有患者均顺利完成手术,术后均服用腰突颗粒,手术时间平均为(51.8±14.2)min,术中出血量平均为(11.0±5.4)m L,术后均无并发症发生。(2)VAS评分情况:术后7 d、21 d、3个月的VAS评分分别为(1.73±0.41)分、(1.61±0.54)分和(1.42±0.35)分,均较术前的(8.18±2.19)分明显降低,差异均有统计学意义(P<0.01)。(3)JOA评分情况:术后7 d、21 d、3个月的JOA评分分别为(25.40±7.38)分、(26.50±8.27)分和(26.33±7.72)分,均较术前的(9.51±2.65)分明显提高,差异均有统计学意义(P<0.01)。(4)疗效情况:术后3个月,42例患者中,优32例,良7例,可3例,差0例,优良率为92.86%。【结论】腰突颗粒配合经皮全脊柱内镜治疗椎间盘源性马尾综合征疗效显著,表明结合正确的治疗策略能够较好地解决患者临床症状,安全有效。

Objective To evaluate the clinical efficacy and safety of Yaotu Granules combined with percutaneous total spinal endoscopy in the treatment of discogenic cauda equina syndrome(DCES). Methods A retrospective study was conducted in 42 patients with DCES hospitalized in Shenzhen Traditional Chinese Medicine Hospital from May 2014 to May 2019. All of the patients were treated with percutaneous lumbar discectomy under spinal endoscopy, and then were given oral use of Yaotu Granules for 3 weeks after operation. The changes of visual analogue scale(VAS)pain scores and Japanese Orthopaedic Association(JOA)scores of lumbar function were observed before surgery,7 days,21 days and 3 months after surgery. After treatment,the efficacy and safety of Yaotu Granules combined with percutaneous total spinal endoscopy in the treatment of DCES were evaluated.Results(1)All of the patients completed the operation successfully and then received oral use of Yaotu Granules after the operation. The average operation time was(51.8 ± 14.2)min,the average operative blood loss was(11.0 ±5.4)m L,and no postoperative complications occurred.(2)The VAS pain scores on the 7 th days,21 st days and3 rd month after surgery were(1.73 ± 0.41),(1.61 ± 0.54)and(1.42 ± 0.35)respectively,which were significantly decreased compared with those before surgery(8.18 ± 2.19),the differences being statistically significant(P <0.01).(3)JOA scores on the 7 th days,21 st days and 3 rd month after surgery were(25.40 ± 7.38),(26.50 ± 8.27)and(26.33 ± 7.72)respectively,which were significantly increased compared with those before surgery(9.51±2.65),the differences being statistically significant(P<0.01).(4)Three months after operation,the efficacy was excellent in 32 cases,good in 7 cases,common in 3 cases,and inferior in 0 case among the 42 patients,and the distinguished rate was 92.86%. Conclusion Yaotu Granules combined with percutaneous total spinal endoscopy exert significant efficacy in the treatment of DCES, which indicates that the combination of correct treatment strategy could safely and effectively relieve the clinical symptoms of patients.