地龙舒腰汤加味对腰椎间盘突出症后路术后残余根性腰腿痛(气滞血瘀型)临床疗效观察

Clinical Observation on the Therapeutic Effect of Modified Di Long ShuYao Tang on Residual Root Lower Back and Leg Pain(Qi Stagnation and Blood Stasis Type)after Posterior Surgery for Lumbar Disc Herniation

目的:观察地龙舒腰汤加味治疗腰椎间盘突出症(LDH)后路后残余神经根症状(气滞血瘀型)临床疗效。方法:选取2022年12月—2023年9月腰椎后路椎板减压植骨融合内固定术后残余根性症状(气滞血瘀型)患者60例,按照随机数字表法分为治疗组与对照组,每组30例。术后常规补液、换药预防感染,对照组在此基础上服用塞莱昔布胶囊与甲钴胺片,治疗组在对照组基础上服用地龙舒腰汤加味治疗,连续服用药物4周。比较2组患者在接受治疗后2周、4周、6周的视觉模拟评分法(Visual Analogue Scale,VAS),腰椎JOA(Japanese Orthopaedic Association scores)评分,分析手术单节段与多节段及年龄因素对患者疼痛(VAS)评分改善的影响判定地龙舒腰汤加味采用治法是否有效并评估有效率。结果:治疗后2周、4周、6周治疗组VAS评分明显低于对照组;腰椎JOA评分,治疗组的评分明显高于对照组;2组2周、4周、6周VAS评分,单节段低于多节段评分;治疗组2周、4周、6周,单节段与多节段的评分均低于对照组单节段与多节段的评分;年龄与VAS评分下降分值之间存在负相关,治疗后4周、6周,治疗组VAS下降分值高于对照组;治疗组有效率高于对照组,差异均有统计学意义。结论:地龙舒腰汤加味采用温经通络、活血化瘀兼以补益气血、补益肝肾法,能够有效改善LDH术后腰椎功能,缓解术后根性腰腿疼痛。

Objective:To observe the clinical efficacy of Dilong Shuyao Decoction plus other ingredients in the treatment of posterior residual nerve root symptoms(Qi stagnation and blood stasis type)of lumbar disc herniation(LDH).Methods:A total of 60 patients with residual root symptoms(Qi stagnation and blood stasis type)after posterior lumbar lamina decompression,bone grafting,fusion and internal fixation from December 2022 to September 2023 were selected and divided into a treatment group and a control group according to the random number table method,with 30 cases in each group.Routine fluid infusion and dressing change were performed after surgery to prevent infection.On this basis,the control group took Celecoxib capsules and methylcobalamin tablets.On the basis of the control group,the treatment group took Dilong Shuyao Decoction plus other ingredients for treatment,and the drugs were taken continuously for 4 weeks.The Visual Analogue Scale(VAS)and lumbar JOA(Japanese Orthopaedic Association scores)scores of the two groups of patients were compared at 2 weeks,4 weeks,and 6 weeks after treatment.The effects of single-segment and multi-segment surgery and age factors on the improvement of patients’pain(VAS)scores were analyzed to determine whether the treatment method of Dilong Shuyao Decoction with added ingredients was effective and to evaluate the effectiveness.Results:The VAS scores of the treatment group were significantly lower than those of the control group at 2 weeks,4 weeks,and 6 weeks after treatment;the lumbar JOA scores of the treatment group were significantly higher than those of the control group;the VAS scores of the two groups at 2 weeks,4 weeks,and 6 weeks were lower in single segment than in multiple segments;the scores of the treatment group at 2 weeks,4 weeks,and 6 weeks were lower in single segment and multiple segments than those of the control group;there was a negative correlation between age and the decrease in VAS scores.The decrease in VAS scores of the treatment group was higher than that of the control group at 4 weeks and 6 weeks after treatment;the effective rate of the treatment group was higher than that of the control group,and the differences were statistically significant.Conclusion:Dilong Shuyao Decoction with added ingredients adopts the methods of warming the meridians and dredging the collaterals,activating blood circulation and removing blood stasis,and replenishing Qi and blood,and replenishing the liver and kidney,which can effectively improve the lumbar function after LDH surgery and relieve postoperative radicular pain in the waist and legs.