腰椎管狭窄症内镜减压联合中药内服从督论治△

Endoscopic decompression combined with internal treatment of traditional Chinese medicine for lumbar spinal stenosis

摘要:

[目的] 探讨内镜减压联合中药内服从督论治治疗腰椎管狭窄症的临床疗效。[方法] 回顾性分析 2021 年 1 月— 2021 年 12 月本院内镜手术治疗的 45 例腰椎管狭窄症患者的临床资料。依据术前医患沟通结果，22 例采用内镜减压联合中药内服从督论治（联合组），23 例采用单纯内镜减压（单纯组）。比较两组围手术期、随访和影像资料。[结果]两组均顺利完成手术，两组手术时间、切口长度、术中透视次数、术中失血量、下地时间、切口愈合和住院时间的差异均无统计学意义 （P＞ 0.05）。两组患者均获随访 12 个月以上，末次随访时，两组中医证候积分、VAS 腰痛和腿痛评分、ODI 功能障碍指数均较术前显著改善（P＜0.05），术前两组间上述指标的差异均无统计学意义（P＞0.05），末次随访时，联合组中医证候积分 [(6.2±2.4) vs (11.5± 4.2), P＜0.05]、VAS 腰痛 [(0.9±0.7) vs (1.8±1.4), P＜0.05] 和腿痛 [(0.9±0.7) vs (1.0±0.9), P＜0.05] 评分、ODI 功能障碍指数 [(4.3±3.15) vs (6.9±4.2), P＜0.05] 均显著优于单纯组。影像方面，与术前相比，末次随访时，两组椎间隙高度、腰椎前凸角均无显著变化（P＞ 0.05），但椎管面积显著扩大（P＜0.05）。相应时间点，两组间上述影像指标的差异均无统计学意义（P＞0.05）。[结论] 腰椎管狭窄症内镜减压联合中药内服从督论治可解除神经压迫与疏通督脉瘀阻，显著改善神经功能，促进快速康复。

Abstract:

[Objective] To evaluate the clinical outcomes of endoscopic decompression combined with internal treatment of traditional Chinese medicine (TCM) for lumbar spinal stenosis. [Methods] A retrospective study was conducted on 45 patients who received endoscopic surgery for lumbar spinal stenosis in our hospital from January 2021 to December 2021. According to the results of preoperative doctor-pa- tient communication, 22 patients were treated with endoscopic decompression combined with traditional Chinese medicine (combination group), while the other 23 patients were treated with endoscopic decompression alone (simple group). The perioperative, follow-up and imag- ing data were compared between the two groups. [Results] The operation was successfully completed in both groups, without significant differ- ences in operation time, incision length, intraoperative fluoroscopy times, intraoperative blood loss, time to resume ambulation postoperative- ly, incision healing grade and hospital stay between the two groups (P＞0.05). At the latest follow-up lasted for more than 12 months the TCM symptom scores, VAS for lumbago and leg pain scores, as well as ODI score in both groups significantly improved compared with those before surgery (P＜0.05). Although there were no statistically significant differences in the above parameters between the two groups before surgery (P＞0.05), the combination group proved significantly superior to the simple group in terms of TCM symptom score [(6.2±2.4) vs (11.5± 4.2), P＜ 0.05], low back pain VAS [(0.9±0.7) vs (1.8±1.4), P＜0.05] and leg pain VAS [(0.9± 0.7) vs (1.0±0.9), P＜0.05] and ODI score [(4.3±3.15) vs (6.9±4.2), P＜0.05] at last follow-up. Radiographically, there were no significant changes in intervertebral height or lumbar lordotic angle be- tween the two groups at the last follow-up compared to the preoperative period (P＜0.05), whereas the spinal canal area was significantly en- larged in both groups (P＜0.05). At any corresponding time points, there was no significant difference in the above image indexes between the two groups (P＞0.05). [Conclusion] This endoscopic decompression combined with internal treatment of traditional Chinese medicine does re- lieve nerve compression and dredge the blockage of supervision vessel, significantly improve nerve function, and promote rapid recovery.