壮骨活血方联合椎板切除减压术治疗胸腰脊柱爆裂骨折临床观察

Clinical observation on Zhuanggu Huoxue Decoction combined with laminectomy and decompression in patients with thoracolumbar spine burst fracture

目的观察壮骨活血方联合椎板切除减压术对胸腰脊柱爆裂骨折(TBF)腰椎功能和日常生活能力的影响。方法将我院80例TBF患者随机分为治疗组与对照组各40例。对照组行椎板切除减压术治疗,治疗组术后予壮骨活血方治疗。比较两组疼痛视觉模拟量表(VAS)、日本骨科学会(JOA)评分、日常活动能力Barthel指数(BI)评分,椎体前缘高度、椎间隙高度、矢状径、Cobb角,美国脊柱损伤协会(ASIA)评估神经功能。结果治疗后,治疗组总有效率显著高于对照组(P<0.05);与治疗前比较,两组患者ODI评分下降,JOA、BI评分增加(P<0.05),治疗组ODI评分均低于对照组,JOA、BI评分高于对照组(P<0.05);与治疗前比较,两组患者椎体前缘高度、椎间隙高度、矢状径均增加,Cobb角减少(P<0.05),治疗组患者椎体前缘高度、椎间隙高度、矢状径高于对照组,Cobb角低于对照组(P<0.05)。结论在椎板切除减压术的基础上,应用壮骨活血方显著改善TBF患者的椎体和椎管形态,改善胸腰椎功能和生活能力,有效促进术后神经功能恢复。

Objective To observe the effect of Zhuanggu Huoxue Decoction combined with laminectomy and decompression on lumbar spine function and daily living ability in patients with thoracolumbar burst fracture(TBF).Methods Eighty TBF patients were randomly divided into treatment group and a control group with 40 cases in each.Control group was treated with laminectomy and decompression,and treatment group was treated with Zhuanggu Huoxue Decoction after operation.Visual Analog Scale(VAS),Japanese Orthopaedic Association(JOA)score,Barthel Index(BI)score of daily activities,anterior vertebral body height,intervertebral space height,sagittal diameter,Cobb angle,American Spine Injury Association(ASIA)were compared for assessment of neurological function.Results After treatment,the total effective rate of treatment group was significantly higher than control group(P<0.05);compared with before treatment,the ODI scores of both groups decreased,while the JOA and BI scores increased(P<0.05),and the ODI scores of treatment group were all lower than control group,the JOA and BI scores were higher than control group(P<0.05);compared with before treatment,the anterior vertebral height,intervertebral space height and sagittal diameter increased in both groups,and were higher in treatment group than control group(P<0.05),and the Cobb angle decreased(P<0.05),and were lower in treatment group than control group(P<0.05).Conclusion On the basis of laminectomy and decompression,the application of Zhuanggu Huoxue Decoction can significantly improve the morphology of vertebral body and spinal canal in patients with TBF,improve the function and living ability of thoracolumbar spine,and effectively promote the recovery of postoperative neurological function.