椎管减压联合补阳还五汤治疗脊髓型颈椎病的临床研究

目的比较椎管减压联合补阳还五汤与单纯椎管减压治疗脊髓型颈椎病的临床疗效。方法回顾性分析2009年6月-2015年6月中日友好医院脊柱外科收治脊髓型颈椎病患者77例,其中男41例,女36例,年龄29~76岁,平均50.07岁。根据患者意愿分为椎管减压联合补阳还五汤组(观察组)和单纯椎管减压手术组(对照组),其中观察组42例,对照组35例。手术方式根据患者病情采用前路间盘摘除或椎体次全切钢板螺钉内固定术或后路单开门减压侧块螺钉内固定术。观察组在此基础上给予补阳还五汤中药汤剂治疗。对照组行单纯椎管减压手术治疗。比较两组患者术前和术后1周、1个月及末次随访的日本骨科协会脊髓功能评分(JOA)、颈椎疼痛视觉模拟评分(VAS)、颈椎功能障碍指数评分(NDI)及根据JOA评分与《颈椎病临床评价量表》制定的督脉瘀阻证候积分。术后(治疗后)通过X线片、CT、MRI观察内固定及脊髓减压情况、治疗后脊髓压迫情况。结果所有患者手术顺利,术中均无硬膜、脊髓、神经根损伤,术后1例患者出现伤口感染,经抗感染治疗后得到控制,1例患者术后出现血肿,并伴有脊髓压迫,出现不全瘫表现,及时行二次手术清除血肿,患者未留下明显后遗症。所有观察组患者均遵医嘱服用补阳还五汤中药汤剂。两组患者术后均获得随访,随访12~24个月,观察组平均(13.52±0.87)个月,对照组平均(13.52±0.56)个月,随访时间两组差异无统计学意义(P>0.05)。观察组术前JOA评分、VAS评分、NDI评分及督脉瘀阻证候积分分别为(8.35±3.21)、(6.15±1.63)、(31.93±4.32)、(6.48±3.42);术后1周分别为(10.41±3.25)、(4.32±2.13)、(17.69±4.28)、(8.81±1.32);术后1个月分别为(12.52±2.34)、(2.71±1.42)、(15.65±3.46)、(9.82±2.43);末次随访分别为(14.16±3.13)、(1.02±0.55)、(12.24±3.22)、(10.85±2.88)。对照组术前JOA评分、VAS评分、NDI评分及督脉瘀阻证候积分分别为(8.28±3.58)、(6.24±1.81)、(30.89±4.21)、(6.77±2.13);术后1周分别为(10.13±2.17)、(4.69±2.52)、(18.68±5.34)、(8.39±3.52);术后1个月分别为(10.48±5.12)、(3.87±1.82)、(17.43±3.97)、(8.57±2.45);末次随访分别为(12.35±4.41)、(1.71±0.42)、(14.31±4.25)、(9.43±3.07)。两组患者术后JOA评分、VAS评分、NDI评分及督脉瘀阻证候积分较术前明显提高(P<0.05);术后1周两组间差异无统计学意义(P>0.05);术后1个月及末次随访时,观察组较对照组脊髓功能改善更为明显(P<0.05),JOA改善率观察组为(68.31±11.24)%,对照组为(69.92±12.82)%,两组差异无统计学意义(P>0.05)。两组患者术后(治疗后)均行X线、CT、MRI检查,均未出现内固定松动断裂。结论通过椎管减压外科手术治疗脊髓型颈椎病,直接从解剖学上解除对神经的压迫,以达到疏通督脉的作用,联合补阳还五汤补气、活血、通络较单纯外科手术治疗效果更佳。

Clinical Study on Treatment of Cervical Spondylotic Myelopathy with Spinal Canal Decompression Combined with Buyang Huanwu Decoction

Objective To compare the clinical effects of treating cervical spondylotic myelopathy with spinal decompression combined with Buyang Huanwu Decoction and single spinal decompression.Methods A retrospective analysis was performed on 77 cases of cervical spondylotic myelopathy admitted by the spinal surgery department of China-Japan Friendship Hospital from June 2009 to June 2015,including 41 male patients and 36 female patients,aged 29 to 76 years,with an average age of 50.07 years old.According to the patients’wishes,the patients were divided into the group of spinal decompression combined with Buyang Huanwu Decoction(observation group)and the group of spinal decompression surgery alone(control group),in which 42 cases were observed and 35 cases were controlled.Surgical methods:anterior intercostal dissection or subtotal vertebral plate and screw fixation or posterior single door decompression lateral screw fixation were performed according to the patients’condition.The observation group was treated with Buyang Huanwu Decoction.The control group was treated with pure decompression.The Japanese orthopaedic association spinal function score(JOA),visual analogue score of cervical pain(VAS),cervical dysfunction index score(NDI)and the score of ductus stasis syndrome based on JOA score and clinical evaluation scale of cervical spondylosis were compared between the two groups.After operation(after treatment),internal fixation,spinal decompressionand spinal compression were observed by X-ray,CT and MRI.Results All patients had surgery smoothly,and there was no epidural,spinal cord or nerve root injury during the operation.One case had postoperative wound infection and was under controlafter anti-infection treatment.One case had the postoperative hematomawith spinal cord compression.There was no complete paralysis.Timely surgical removal of hematoma left no obvious sequelae.All the patients in the observation group took Buyang Huanwu Decoction.Patients in both groups were followed up for 12 to 24 months postoperatively,with the mean of the observation group(13.52±0.87)months and the mean of the control group(13.52±0.56)months.There was no significant difference in the follow-up time between the two groups(P>0.05).Before operation,JOA score,VAS score,NDI score and score of syndromes in the observation group were respectively(8.35±3.21),(6.15±1.63),(31.93±4.32),(6.48±3.42).One week after operation,the scores were(10.41±3.25),(4.32±2.13),(17.69±4.28),(8.81±1.32),respectively.One month after operation,the scores were(12.52±2.34),(2.71±1.42),(15.65±3.46),(9.82±2.43),respectively.The scores after the final follow-up were(14.16±3.13),(1.02±0.55),(12.24±3.22)and(10.85±2.88).In the control group,the scores of JOA,VAS,NDI and main vein stasis were respectively(8.28±3.58),(6.24±1.81),(30.89±4.21)and(6.77±2.13).One week after operation,the scores were(10.13±2.17),(4.69±2.52),(18.68±5.34)and(8.39±3.52)respectively.One month after operation,the scores were(10.48±5.12),(3.87±1.82),(17.43±3.97),(8.57±2.45),respectively.The scores of the last follow-up were(12.35±4.41),(1.71±-0.42),(14.31±-4.25)and(9.43±3.07).Postoperative JOA score,VAS score,NDI score and score of blood stasis syndrome were significantly improved in the two groups(P<0.05).There was no significant difference between the two groups one week after surgery(P>0.05).After 1 month and the last follow-up,the improvement of spinal function in the observation group was more significantly than that in the control group(P<0.05).JOA improvement rate was(68.31±11.24)%in the observation group and the control group’s JOA improvement rate was(69.92±12.82)%,showing no significant difference(P>0.05).Postoperative(post-treatment)X-ray,CT and MRI examinations were performed in both groups.Conclusion Treating cervical spondylotic myelopathy by decompressive surgery can relieve the pressure on nerve directly from the anatomical point of viewso as to achieve the function of regulating the pulse.