脊柱内镜下联合独活寄生汤行椎板减压治疗退变性腰椎管狭窄症的临床效果观察

Clinical effect of Duhuo Jisheng decoction combined with spinal endoscope in treatment of degenerative lumbar spinal stenosis

摘要:

目的 探讨脊柱内镜下联合独活寄生汤行椎板减压治疗退变性腰椎管狭窄症（DLSS）的临床效果。方法 回顾性分析2014年1月－2019年1月该院收治的105例DLSS患者的临床资料，按照治疗方式分为对照组（n = 52）和观察组（n = 53）。对照组采用脊柱内镜下行椎板减压术+安慰剂治疗，观察组采用脊柱内镜下行椎板减压术+独活寄生汤治疗，比较两组患者手术时间、切口长度、出血量、下床活动时间和术后住院时间；采用日本骨科协会（JOA）评分标准评估疗效；比较两组患者Oswestry功能障碍指数（ODI）评分、血清白细胞介素-1α（IL-1α）、肿瘤坏死因子-α（TNF-α）和单核细胞趋化蛋白-1（MCP-1）的变化情况。结果 观察组下床活动时间和术后住院时间均较对照组短（P < 0.05）；观察组术后6个月JOA优良率为92.45%，高于对照组的75.00%（P < 0.05）；观察组术后1、3和6个月ODI评分均低于对照组（P < 0.05）；观察组术后IL-1α、TNF-α和MCP-1水平均低于对照组（P < 0.05）。结论 脊柱内镜下联合独活寄生汤行椎板减压治疗DLSS能够促进患者术后恢复、提高疗效，且有利于改善腰椎功能、减轻炎症反应，值得临床推广。

Abstract:

Objective To investigate the clinical effect of Duhuo Jisheng decoction combined with spinal endoscope in treatment of degenerative lumbar spinal stenosis (DLSS).Methods Clinical data of 105 patients with DLSS from January 2014 to January 2019 were retrospectively analyzed. According to the treatment method, they were divided into control group (n = 52) and observation group (n = 53). The control group was treated with spinal endoscopic laminectomy + placebo, and the observation group was treated with spinal endoscopic laminectomy+Duhuo Jisheng decoction. The operation time, incision length, blood loss, ambulation time and postoperative hospital stay were compared between the two groups; The curative effect was evaluated by Japanese Orthopaedic Association (JOA) Score; Oswestry disability index (ODI) score, serum interleukin-1α (IL-1α), tumor necrosis factor-α (TNF α) and monocyte chemoattractant protein-1 (MCP-1) were compared between the two groups.Results The ambulation time and postoperative hospital stay of the observation group were shorter than those of the control group (P < 0.05); The excellent and good rate of JOA was 92.45% in observation group 6 months after operation, which was higher than 75.00% in control group (P < 0.05); The ODI scores in observation group were lower than those in control group (P < 0.05) at 1, 3 and 6 months after operation; The levels of IL-1 α, TNF-α and MCP-1 level in observation group were lower than those in control group (P < 0.05).Conclusion The treatment of degenerative lumbar spinal stenosis with the combination of Duhuo Jisheng decoction and spinal endoscopic laminectomy can promote the postoperative recovery, improve the curative effect, improve the lumbar function and reduce the inflammatory reaction, which is worth popularizing.