根型颈椎病前路椎间盘切除融合是否中药从督论治△

Anterior cervical discectomy and fusion with or without of traditional Chinese medicine decoction for cervical spondyloticradiculopathy

摘要:

[目的] 探讨经颈前路椎间盘切除融合（anterior cervical decompression and fusion, ACDF） 联合中药内服从督论治对神经根型颈椎病（cervical spondylotic radiculopathy, CSR） 的临床治疗疗效。[方法] 回顾性分析本院2022 年1 月—2022 年12月收治的43 例单节段CSR 患者行ACDF 治疗的临床资料。依据术前医患沟通结果，22 例采用ACDF 联合中药内服从督论治（联合组），21 例采用单纯ACDF（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、术中失血量、术中透视次数、下地时间及住院时间的差异均无统计学意义（P＞0.05）。与术前相比，末次随访时两组中医证候积分、VAS 评分、NDI 功能障碍指数、JOA 评分均显著改善（P＜0.05），末次随访时，联合组中医证候积分[(7.4±2.9) vs (11.6±5.2), P＜0.001]、VAS 评分[(0.9±0.4) vs (1.9±1.1), P＜0.001]、JOA 评分[(15.6±1.1) vs (14.4±0.9), P＜0.001]、NDI 评分[(25.4±4.2) vs (27.9±4.2), P=0.028] 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无显著变化（P＞0.05），但颈椎前凸角显著增大（P＜0.05），颈椎ROM 显著减小（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] CSR 采用ACDF 联合中药内服从督论治可解除神经根压迫且疏通督脉瘀阻，显著改善神经功能，促进患者快速康复。

Abstract:

[Objective] To compare the clinical outcome of anterior cervical discectomy and fusion (ACDF) combined with or withoutChinese medicine decoction for cervical spondylotic radiculopathy (CSR). [Methods] A retrospective study was conducted on 43 patientswho had single-segment CSR treated by ACDF in our hospital from January 2022 to December 2022. According to the preoperative doctorpatientcommunication, 22 patients were treated with ACDF combined with traditional Chinese medicine decoction (the combined group),while other 21 patients were treated with ACDF alone (the simple group). The perioperative period, follow-up and imaging data of the twogroups were compared. [Results] All patients in both groups had operation performed successfully, and there were no significant differencesin operation time, incision length, intraoperative blood loss, intraoperative fluoroscopy times, ambulation time and hospital stay between thetwo groups (P＞0.05). The TCM syndrome score, VAS score, NDI score and JOA score were significantly improved in both groups at the lastfollow-up compared with those preoperatively (P＜0.05). The combined group proved significantly superior to the simple group in terms ofTCM syndrome score [(7.4±2.9) vs (11.6±5.2), P＜0.001], VAS score [(0.9±0.4) vs (1.9±1.1), P＜0.001], JOA score [(15.6±1.1) vs (14.4±0.9),P＜0.001], NDI score [(25.4±4.2) vs (27.9±4.2), P=0.028] at the latest follow-up. As for imaging, there was no significant change in theheight of intervertebral space (P＞0.05), but the cervical lordosis angle was significantly increased (P＜0.05), and the cervical ROM was sig-nificantly decreased in both group at the latest follow-up compared with those preoperatively (P＜0.05). At any corresponding time points,there were no significant differences in the above image indicators between the two groups (P＞0.05). [Conclusion] The ACDF combinedwith Chinese medicine decoction for cervical spondylotic radiculopathy (CSR) does relieve nerve root compression and dredge the blockageof the supervision vein, significantly improve nerve function and promote rapid recovery.