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[1]韓松,俞鵬飛,戴宇祥,等.消髓化核湯防治經(jīng)皮椎間孔鏡下腰椎間盤(pán)摘除術(shù)后早期腰臀部疼痛的臨床研究[J].中醫(yī)正骨,2020,32(12):11-16.
　HAN Song,YU Pengfei,DAI Yuxiang,et al.A clinical study of Xiaosui Huahe Tang(消髓化核湯)for prevention and treatment of early low back and hip pains after percutaneous endoscopic lumbar discectomy[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(12):11-16.
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消髓化核湯防治經(jīng)皮椎間孔鏡下腰椎間盤(pán)摘除術(shù)后早期腰臀部疼痛的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期數(shù):
2020年12期
頁(yè)碼:
11-16
欄目:
臨床研究
出版日期:
2020-12-20

文章信息/Info

Title:
A clinical study of Xiaosui Huahe Tang(消髓化核湯)for prevention and treatment of early low back and hip pains after percutaneous endoscopic lumbar discectomy
作者:
韓松; 俞鵬飛; 戴宇祥; 姜宏; 王宇鋮; 李紅衛(wèi); 李宇衛(wèi)
(南京中醫(yī)藥大學(xué)附屬蘇州市中醫(yī)醫(yī)院,江蘇 蘇州 215009)
Author(s):
HAN Song; YU Pengfei; DAI Yuxiang; JIANG Hong; WANG Yucheng; LI Hongwei; LI Yuwei
Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine,Suzhou 215009,Jiangsu,China
關(guān)鍵詞:
腰椎;  椎間盤(pán)移位;  消髓化核湯;  椎間孔鏡;  椎間盤(pán)切除術(shù); 經(jīng)皮;  疼痛;  臨床試驗(yàn)
Keywords:
lumbar vertebrae;  intervertebral disc displacement;  Xiaosui Huahe Tang;  transforaminal endoscope;  diskectomy; percutaneous;  pain;  clinical trial
摘要:
目的:觀察消髓化核湯防治經(jīng)皮椎間孔鏡下腰椎間盤(pán)摘除術(shù)后早期腰臀部疼痛的臨床療效,并初步探討其作用機(jī)制。方法:選取100例單節(jié)段腰椎間盤(pán)突出癥患者,隨機(jī)分為2組,每組50例。2組患者均采用經(jīng)皮椎間孔鏡下椎間盤(pán)摘除術(shù)治療。消髓化核湯組術(shù)后第1天開(kāi)始口服消髓化核湯,連續(xù)服用30 d; 常規(guī)處理組僅行經(jīng)皮椎間孔鏡下椎間盤(pán)摘除術(shù)。隨訪觀察患者腰臀部疼痛改善情況,記錄患者手術(shù)前后的腰臀部疼痛視覺(jué)模擬量表(visual analogue scale,VAS)評(píng)分、Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)。術(shù)后3個(gè)月隨訪時(shí)進(jìn)行MRI檢查,計(jì)算突出物體積。結(jié)果:①總體情況。術(shù)后3個(gè)月時(shí),消髓化核湯組2例腰痛未緩解、1例腰痛較術(shù)前加重、2例出現(xiàn)新發(fā)腰痛,常規(guī)處理組9例術(shù)后腰痛未緩解、3例腰痛較術(shù)前加重、1例出現(xiàn)新發(fā)腰痛、2例出現(xiàn)新發(fā)臀部疼痛。術(shù)后常規(guī)處理組腰臀部疼痛未改善的比例高于消髓化核湯組(χ2=6.250,P=0.012)。②腰臀部疼痛VAS評(píng)分。時(shí)間因素和分組因素存在交互效應(yīng)(F=9.051,P=0.000)。2組患者腰臀部疼痛VAS評(píng)分總體比較,組間差異無(wú)統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=0.180,P=0.671)。手術(shù)前后不同時(shí)間點(diǎn)腰臀部疼痛VAS評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=204.471,P=0.000)。2組腰臀部疼痛VAS評(píng)分均呈下降趨勢(shì)[(5.46±1.48)分,(2.92±1.25)分,(2.51±1.24)分,(1.16±0.79)分,F=125.367,P=0.000;(5.02±1.59)分,(2.48±1.19)分,(3.14±1.29)分,(1.74±1.04)分,F=88.226,P=0.000]; 術(shù)前、術(shù)后1 d時(shí)2組腰臀部疼痛VAS評(píng)分比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(t=1.426,P=0.157; t=1.789,P=0.077); 術(shù)后1個(gè)月、3個(gè)月時(shí)消髓化核湯組的腰臀部疼痛VAS評(píng)分均低于常規(guī)處理組(t=-2.468,P=0.015; t=-3.126,P=0.020)。③ODI。時(shí)間因素和分組因素存在交互效應(yīng)(F=12.527,P=0.000)。2組患者ODI總體比較,組間差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=10.441,P=0.001)。手術(shù)前后不同時(shí)間點(diǎn)ODI的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=375.457,P=0.000)。2組患者的ODI均呈下降趨勢(shì)[(53.08±13.02)%,(32.37±7.87)%,(20.00±6.00)%,F=222.671,P=0.000;(53.29±10.97)%,(41.17±6.39)%,(27.81±6.51)%,F=157.023,P=0.000]; 術(shù)前2組ODI比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=-0.087,P=0.931); 術(shù)后1個(gè)月、3個(gè)月時(shí)消髓化核湯組的ODI均低于常規(guī)處理組(t=-6.135,P=0.000; t=-6.234,P=0.000)。④突出物體積。術(shù)后3個(gè)月時(shí)MRI檢查顯示,消髓化核湯組殘存突出物體積小于常規(guī)處理組[(161.07±192.99)mm3,(275.84±255.34)mm3,t=-2.535,P=0.013]。結(jié)論:經(jīng)皮椎間孔鏡下腰椎間盤(pán)摘除術(shù)后口服消髓化核湯,可有效緩解和減少術(shù)后早期腰臀部疼痛,改善腰椎功能,其作用機(jī)制可能與消髓化核湯能促進(jìn)突出椎間盤(pán)重吸收有關(guān)。
Abstract:
To observe the clinical curative effects of Xiaosui Huahe Tang(消髓化核湯,XSHHT)for prevention and treatment of early low back and hip pains after percutaneous endoscopic lumbar discectomy(PELD)and to explore its mechanism of action.Methods:One hundred patients with single-segment lumbar disc herniation were selected and randomly divided into XSHHT group and conventional therapy group,50 cases in each group.All patients in the 2 groups were treated with PELD.Moreover,the patients in XSHHT group were treated with oral application of XSHHT since the postoperative day 1 for consecutive 30 days.The patients were followed up.The improvement of low back and hip pains were observed and compared between the 2 groups,and the low back and hip pains visual analogue scale(VAS)scores and Oswestry disability index(ODI)were recorded and compared between the 2 groups before and after the surgery.The MRI examination was performed and the volume of lumbar intervertebral disc protrusion(LIDP)was calculated at 3 months after the surgery.Results:At 3 months after the surgery,non-remission(NR)of low back pain(2 cases),aggravation of low back pain(1 case)and new low back pain(2 cases)were found in XSHHT group,while NR of low back pain(9 cases),aggravation of low back pain(3 cases),new low back pain(1 case)and new hip pain(2 cases)were found in conventional therapy group.The proportion of NR of low back and hip pains was higher in conventional therapy group compared to XSHHT group after the surgery(χ2=6.250,P=0.012).There was interaction between time factor and group factor in low back and hip pains VAS scores(F=9.051,P=0.000).There was no statistical difference in low back and hip pains VAS scores between the 2 groups in general,in other words,there was no group effect(F=0.180,P=0.671).There was statistical difference in low back and hip pains VAS scores between different timepoints before and after the surgery,in other words,there was time effect(F=204.471,P=0.000).The low back and hip pains VAS scores presented a time-dependent decreasing trend in the 2 groups(5.46+/-1.48,2.92+/-1.25,2.51+/-1.24,1.16+/-0.79 points,F=125.367,P=0.000; 5.02+/-1.59,2.48+/-1.19,3.14+/-1.29,1.74+/-1.04 points,F=88.226,P=0.000).There was no statistical difference in low back and hip pains VAS scores between the 2 groups before the surgery and at 1 day after the surgery(t=1.426,P=0.157; t=1.789,P=0.077).The low back and hip pains VAS scores were lower in XSHHT group compared to conventional therapy group at 1 and 3 months after the surgery(t=-2.468,P=0.015; t=-3.126,P=0.020).There was interaction between time factor and group factor in ODI(F=12.527,P=0.000).There was statistical difference in ODI between the 2 groups in general,in other words,there was group effect(F=10.441,P=0.001).There was statistical difference in ODI between different timepoints before and after the surgery,in other words,there was time effect(F=375.457,P=0.000).The ODI presented a time-dependent decreasing trend in the 2 groups(53.08+/-13.02,32.37+/-7.87,20.00+/-6.00%,F=222.671,P=0.000; 53.29+/-10.97,41.17+/-6.39,27.81+/-6.51%,F=157.023,P=0.000).There was no statistical difference in ODI between the 2 groups before the surgery(t=-0.087,P=0.931).The ODI was lower in XSHHT group compared to conventional therapy group at 1 and 3 months after the surgery(t=-6.135,P=0.000; t=-6.234,P=0.000).The results of MRI examination demonstrated that the volume of residual LIDP was smaller in XSHHT group compared to conventional therapy group at 3 months after the surgery(161.07+/-192.99 vs 275.84+/-255.34 mm(3),t=-2.535,P=0.013).Conclusion:Oral application of XSHHT can effectively alleviate and reduce early low back and hip pains and improve lumbar function after PELD.Its mechanisms of action may be that it can promote the reabsorption of herniated intervertebral discs.

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備注/Memo

備注/Memo:
基金項(xiàng)目:江蘇省自然科學(xué)基金項(xiàng)目(BK20190191); 江蘇省青年醫(yī)學(xué)重點(diǎn)人才培養(yǎng)項(xiàng)目(QNRC2016253)
通訊作者:俞鵬飛 E-mail:[email protected]
更新日期/Last Update: 2020-12-20