倍他米松与医用生物蛋白胶在腰椎神经根减压术中的联合应用评价

目的：评价在神经根减压术中联合应用倍他米松和医用生物蛋白胶的疗效。方法：观察对象为腰椎神经根减压术术后的120例患者，根据术后处理方式的不同将患者分为4组：A组单纯手术组，B组单纯应用倍他米松组，C组单纯应用医用生物蛋白胶组，D组倍他米松联合应用医用生物蛋白胶组。观察各组术后直腿抬高试验角度、改良JOA评分、ODI评分、VAS评分、术后48 h内引流量，分析各组检查结果的差异。结果：术前患者年龄、病史时程、男女比例、直腿抬高试验角度、改良JOA评分、ODI评分、VAS评分、术后48 h内引流量均无统计学意义。术后各组患者直腿抬高试验角度在不同时期均有明显改善，差异有统计学意义（P<0.05）。术后4周，D组患者髋关节运动角度显著高于其他3组，差异有统计学意义[（75±23）°vs.（54±19）°，vs.（62±20）°，vs.（64±21）°，（P<0.05）]；术后4周，D组患者膝关节运动角度显著低于其他3组，差异有统计学意义[（11±4）° vs.（16±6）°，vs.（13±5）°，vs.（14±5）°，（P<0.05）]；术后4周，D组患者髋关节运动角度显著高于A组，差异有统计学意义[（74±21）° vs.（54±19）°，（P<0.05）]。术后患者症状也有显著改善：术后4周，D组患者改良JOA评分显著高于其他3组，差异有统计学意义[（22±7）vs.（16±6），vs.（18±5），vs.（18±5），（P<0.05）]。术后4周，D组患者ODI评分显著低于其他3组，差异有统计学意义[（9±2）vs.（18±3），vs.（13±2），vs.（15±3），（P<0.05）]。D组患者VAS评分显著低于其他3组，差异有统计学意义[（3.3±0.6）vs.（5.4±0.8），vs.（4.3±0.7），vs.（4.2±0.7），（P<0.05）]。D组患者术后48 h内引流量明显低于其他3组，差异有统计学意义[（316±41）vs.（457±51），vs.（420±56），vs.（391±48），（P<0.05）]。结论：联合应用倍他米松和医用生物蛋白胶能够在神经根减压术中收获比单用药物更好的疗效。

Evaluation of combined application in lumbar nerve root decompression in betamethasone and fibrin glue

OBJECTIVE To evaluate the effect of the nerve root decompression combined with betamethasone and fibrin glue. METHODS To observe the object for the 120 patients after lumbar nerve root decompression surgery, according to the postoperative treatment and were divided into 4 groups:group a surgery alone group, group B simple application of betamethasone group, group C simple application of fibrin glue group, group D betamethasone combined application of medical biological protein gum group. The straight leg raising test angle, modified JOA score, ODI score, VAS score, 48 hours after operation were observed and analyzed. The difference between the two groups was analyzed. RESULTS Preoperative patient's age, duration of history, male and female ratio, straight leg raising test angle, modified JOA score, ODI score, VAS score, 48 hours volume of drainage after surgery were not statistically significant. The straight leg raising test angle of each group was significantly improved in different stages, and the difference was statistically significant (P<0.05). After 4 weeks, group D patients with hip joint movement angle was significantly higher than other three groups, the difference was statistically significant[(75±23)°vs.(54±19)°,vs.(62±20)°,vs.(64±21)°,(P<0.05)]. Postoperative 4 weeks, D group of patients with knee joint movement angle was significantly lower than the other three groups, the difference was statistically significant[(11±4)° vs.(16±6)°,vs.(13±5)°,vs.(14±5)°,(P<0.05)]. Postoperative 4 weeks, D group patients with hip joint movement angle was significantly higher than that in a group, the difference was statistically significant[(74±21)° vs.(54±19)°,(P<0.05)]. Postoperative symptoms also significantly improved:4 weeks after operation, patients in group D improved JOA score was significantly higher than that of other three groups, the difference was statistically significant[(22±7)°vs.(16±6)°,vs.(18±5)°,vs.(18±5)°,(P<0.05)]. At 4 weeks after operation, the ODI score of D group was significantly lower than that of the other 3 groups, the difference was statistically significant[(9±2)°vs.(18±3), vs.(13±2)°,vs.(15±3)°,(P<0.05)]. VAS score of D group was significantly lower than the other 3 groups, the difference was statistically significant[(3.3±0.6)°vs.(5.4±0.8)°,vs.(4.3±0.7)°,vs.(4.2±0.7)°,(P<0.05)]. In patients with D group, 48 hours after operation was significantly lower than the other 3 groups, the difference was statistically significant[(316±41) vs. (457±51), vs. (420±56), vs. (391±48), (P<0.05)]. CONCLUSION Combined with betamethasone and fibrin glue can in the nerve root decompression in harvest than the single drugs better curative effect.