颈前路减压融合联合通督舒脊方治疗脊髓型颈椎病的临床研究

ClinicalStudy on Anterior Cervical Decompression and Fusion Combined with Tongdu Shuji Formula on the Treatment of Cervical Spondylotic Myelopathy

目的:比较颈前路减压融合配合自拟通督舒脊方与颈前路减压融合治疗脊髓型颈椎病(CSM)的临床疗效。方法:2020年10月至2021年10月,收治CSM患者79例,试验组术后联合中药,对照组单纯手术治疗。记录术前、术后2周、术后1个月和术后3个月的两组患者的早期并发症发病率、督脉瘀阻症候积分、JOA评分、VAS评分、NDI并比较两组差异。结果:两组均完成术后3个月随访,结果显示手术加中药组(试验组)督脉瘀阻症候积分于术后1个月、术后3个月随访时高于手术组(对照组),VAS评分较对照组低,JOA评分术后1个月随访试验组组高于对照组、NDI术后3个月随访低于对照组,差异有统计学意义(P<0.05),上述指标两组在术后1周较术前均有改善,但差异无统计学意义(P>0.05),JOA评分在术后3个月、NDI术后1个月随访两组差异虽无统计学意义(P>0.05),但JOA评分试验组高于对照组、NDI明显低于对照组,提示手术联合中药疗效好于单纯手术治疗。结论:CSM可通过颈前路减压解除脊髓受压状态,术后采用自拟通督舒脊方益气、活血、通络,进一步改善微循环,消除炎性介质,有益于神经功能恢复,提高疗效。

Objective:To compare the clinical efficacy of anterior cervical decompression and fusion combined with self-made Tongdu Shuji formula and spinal canal decompression and fusion on the treatment of cervical spondylotic myelopathy(CSM).Methods:79 patients with CSM were treated from October 2020 to October 2021.The experimental group was on the treatment of traditional Chinese medicine after operation, and the control group was on the treatment of operation alone.The incidence rate of early complications, the scores of Du Meridian stasis syndrome, JOA scores, VAS scores and NDI of the two groups before and 2 weeks, 1 month, 3 months after operation were recorded and compared.The differences between the two groups were compared.Results:Both groups completed the follow-up of 3 months after operation.The results showed that the scores of Du Meridian stasis syndrome in the experimental group was higher than that in the control group at 1 month and 3 months after operation.The VAS scores were lower than that in the control group, and the difference was statistically significant(P<0.05).The JOA scores in the experimental group were higher than that in the control group at 1 month after operation, and the NDI was lower than that in the control group at 3 months after operation, and the difference was statistically significant(P<0.05).The above indexes of the two groups were improved one week after operation compared with those before operation, and the difference was not statistically significant(P>0.05).Although there was no statistically significant difference between the two groups in JOA scores at 3 months after operation and NDI at 1 month after operation(P>0.05),the JOA scores of the experimental group were higher than that of the control group, and the NDI was significantly lower than that of the control group, suggesting that the curative effect of operation combined with traditional Chinese medicine was better than that of simple operation.Conclusion:CSM can relieve spinal cord compression by anterior cervical decompression.Postoperative self-made Tongdu Shuji formula can replenish Qi, activate blood circulation and dredge collaterals, further improve microcirculation and eliminate inflammatory mediators, which is beneficial to nerve function recovery and improve curative efficacy.