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[1]楊子情,豆賁,謝義松,等.微創(chuàng)經(jīng)椎間孔腰椎間融合術(shù)聯(lián)合中藥封包療法治療腰椎滑脫癥的臨床研究[J].中醫(yī)正骨,2016,28(07):28-37.
　YANG Ziqing,DOU Ben,XIE Yisong,et al.A clinical comparison of three kinds of fixation for treatment of type C distal radius fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(07):28-37.
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微創(chuàng)經(jīng)椎間孔腰椎間融合術(shù)聯(lián)合中藥封包療法治療腰椎滑脫癥的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期數(shù):
2016年07期
頁碼:
28-37
欄目:
臨床研究
出版日期:
2016-07-20

文章信息/Info

Title:
A clinical comparison of three kinds of fixation for treatment of type C distal radius fractures
作者:
楊子情; 豆賁; 謝義松; 徐無忌; 孫國榮; 吳小輝; 袁萬福; 劉曉嵐
湖南中醫(yī)藥大學第二附屬醫(yī)院,湖南 長沙 410005
Author(s):
YANG Ziqing; DOU Ben; XIE Yisong; XU Wuji; SUN Guorong; WU Xiaohui; YUAN Wanfu; LIU Xiaolan
The Second Affiliated Hospital of Hunan University of Traditional Chinese Medicine,Changsha 410005,Hunan,China
關(guān)鍵詞:
脊椎滑脫;  腰椎;  脊柱融合術(shù);  椎間孔;  外科手術(shù); 微創(chuàng)性;  熱敷;  臨床試驗
Keywords:
spondylolysis;  lumbar vertebrae;  spinal fusion;  intervertebral foramen;  surgical procedures; minimally invasive;  hot compress;  clinical trial
摘要:
目的:觀察微創(chuàng)經(jīng)椎間孔腰椎間融合術(shù)(transforaminal lumbar interbody fusion,TLIF)聯(lián)合中藥封包療法治療腰椎滑脫癥的臨床療效和安全性。方法:回顧性分析116例手術(shù)治療的腰椎滑脫癥患者的病例資料。28例采用開放TLIF治療(TLIF組)、31例采用開放TLIF聯(lián)合中藥封包治療(TLIF聯(lián)合組)、27例采用微創(chuàng)TLIF治療(MIS-TLIF組)、30例采用微創(chuàng)TLIF聯(lián)合中藥封包治療(MIS-TLIF聯(lián)合組)。微創(chuàng)TLIF采用CN12M009 Quadrant系統(tǒng)進行手術(shù),中藥封包療法所用藥物為消炎散。比較各組的并發(fā)癥發(fā)生情況、手術(shù)時間、術(shù)中出血量、術(shù)后引流量、住院時間、疼痛視覺模擬量表(visual analogue scale,VAS)評分、Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)評分、外周靜脈血肌酸激酶(creatine kinase,CK)含量及多裂肌橫截面積和灰度值。多裂肌橫截面積和灰度值采用Image J v2.1軟件在腰椎T2WI MRI上進行測量。結(jié)果:所有患者均獲得隨訪,隨訪時間12～24個月。術(shù)后TLIF組2例患者出現(xiàn)神經(jīng)損傷表現(xiàn),使用神經(jīng)營養(yǎng)藥物治療后逐漸好轉(zhuǎn); 各組均未發(fā)生椎間隙感染、腦脊液漏、下肢深靜脈血栓、內(nèi)固定材料斷裂或松動、椎間隙高度丟失、椎體間Cage下陷及移位等并發(fā)癥。至末次隨訪時,所有患者腰椎滑脫均已復位,融合椎體均已獲得骨性愈合。TLIF組和TLIF聯(lián)合組手術(shù)時間比較,MIS-TLIF組和MIS-TLIF聯(lián)合組手術(shù)時間比較,組間差異均無統(tǒng)計學意義; TLIF組和TLIF聯(lián)合組手術(shù)時間均比MIS-TLIF組和MIS-TLIF聯(lián)合組長(P=0.000,P=0.000; P=0.000,P=0.000)。TLIF組和TLIF聯(lián)合組術(shù)中出血量比較,MIS-TLIF組和MIS-TLIF聯(lián)合組術(shù)中出血量比較,組間差異均無統(tǒng)計學意義; TLIF組和TLIF聯(lián)合組術(shù)中出血量均比MIS-TLIF組和MIS-TLIF聯(lián)合組多(P=0.000,P=0.000; P=0.000,P=0.000)。TLIF組和TLIF聯(lián)合組術(shù)后引流量比較,MIS-TLIF組和MIS-TLIF聯(lián)合組術(shù)后引流量比較,組間差異均無統(tǒng)計學意義; TLIF組和TLIF聯(lián)合組術(shù)后引流量均比MIS-TLIF組和MIS-TLIF聯(lián)合組多(P=0.000,P=0.000; P=0.000,P=0.000)。TLIF組比TLIF聯(lián)合組住院時間長(P=0.013),MIS-TLIF組比MIS-TLIF聯(lián)合組住院時間長(P=0.024),TLIF組和TLIF聯(lián)合組住院時間均比MIS-TLIF組和MIS-TLIF聯(lián)合組長(P=0.000,P=0.000; P=0.000,P=0.000)。手術(shù)前后不同時間VAS評分的差異有統(tǒng)計學意義,即存在時間效應(F=1 635.341,P=0.000)。與術(shù)前相比,4組患者術(shù)后2 d、7 d、14 d、6個月、12個月時的VAS評分均減小(P=0.004,P=0.000,P=0.000,P=0.001; P=0.002,P=0.000,P=0.000,P=0.000; P=0.001,P=0.000,P=0.000,P=0.000; P=0.008,P=0.000,P=0.000,P=0.000; P=0.000,P=0.000,P=0.000,P=0.004)。4組VAS評分總體上比較,組間差異有統(tǒng)計學意義,即存在分組效應(F=129.520,P=0.000)。術(shù)前4組VAS評分比較,差異無統(tǒng)計學意義; 術(shù)后2 d時,MIS-TLIF組和MIS-TLIF聯(lián)合組VAS評分均小于TLIF組和TLIF聯(lián)合組(P=0.000,P=0.000; P=0.000,P=0.000); TLIF組與TLIF聯(lián)合組比較、MIS-TLIF組與MIS-TLIF聯(lián)合組比較,組間差異均無統(tǒng)計學意義; 術(shù)后7 d、14 d、6個月、12個月時,MIS-TLIF聯(lián)合組VAS評分均小于MIS-TLIF組(P=0.000; P=0.000; P=0.000; P=0.000),MIS-TLIF組VAS評分均小于TLIF聯(lián)合組(P=0.000; P=0.000; P=0.000; P=0.003),TLIF聯(lián)合組的VAS評分均小于TLIF組(P=0.000; P=0.000; P=0.000; P=0.006); 時間因素與分組因素存在交互效應(F=18.500,P=0.000)。手術(shù)前后不同時間ODI評分的差異有統(tǒng)計學意義,即存在時間效應(F=2 857.334,P=0.000)。與術(shù)前相比,4組患者術(shù)后2 d、7 d、14 d、6個月、12個月時的ODI評分均減小(P=0.013,P=0.000,P=0.000,P=0.003; P=0.008,P=0.000,P=0.000,P=0.001; P=0.003,P=0.000,P=0.000,P=0.002; P=0.005,P=0.000,P=0.000,P=0.000; P=0.000,P=0.000,P=0.000,P=0.031)。4組ODI評分總體上比較,組間差異有統(tǒng)計學意義,即存在分組效應(F=173.869,P=0.000)。術(shù)前4組ODI評分比較,差異無統(tǒng)計學意義; 術(shù)后2 d時,MIS-TLIF組和MIS-TLIF聯(lián)合組的ODI評分均小于TLIF組和TLIF聯(lián)合組(P=0.000,P=0.003; P=0.000,P=0.000); TLIF組與TLIF聯(lián)合組比較、MIS-TLIF組與MIS-TLIF聯(lián)合組比較,組間差異均無統(tǒng)計學意義; 術(shù)后7 d、14 d、6個月、12個月時,MIS-TLIF聯(lián)合組ODI評分均小于MIS-TLIF組(P=0.000; P=0.000; P=0.003; P=0.000),MIS-TLIF組ODI評分均小于TLIF聯(lián)合組(P=0.000; P=0.000; P=0.006; P=0.000),TLIF聯(lián)合組的ODI評分均小于TLIF組(P=0.004; P=0.000; P=0.002; P=0.000)。時間因素與分組因素存在交互效應(F=23.108,P=0.000)。手術(shù)前后不同時間外周靜脈血CK含量的差異有統(tǒng)計學意義,即存在-----------------------------------------------
Abstract:
Objective:To observe the clinical curative effects and safety of minimally invasive transforaminal lumbar interbody fusion(TLIF)combined with traditional Chinese medicine(TCM)packet therapy in the treatment of lumbar spondylolisthesis.Methods:The medical records of 116 patients with lumbar spondylolisthesis were analyzed retrospectively.Twenty-eight patients were treated with open TLIF(TLIF group),thirty-one patients were treated with open TLIF combined with TCM packet therapy(TLIF combined-treatment group),twenty-seven patients were treated with minimally invasive TLIF(MIS-TLIF group),while the others were treated with MIS-TLIF combined with TCM packet therapy(MIS-TLIF combined-treatment group).CN12M009 Quadrant system was used for MIS-TLIF surgery,and Xiaoyan San(消炎散)was used for TCM packet therapy.The complications,operative times,intraoperatve blood loss,postoperative drainage,hospital stay,pain visual analogue scale(VAS)scores,Oswestry disability index(ODI)scores,peripheral venous blood creatine kinase(CK)contents and cross sectional areas(CSA)and gray values of multifidus were compared between the 4 groups.The CSA and gray values of multifidus were measured by using Image J v2.1 software on T2-weighted MRI of lumbar spine.Results:All patients in the 4 groups were followed up for 12-24 months.Nerve injuries were found in 2 patients in TLIF group after surgery,and the patients improved gradually after treatment with neurotrophic drugs.No complications such as intervertebral space infection,cerebrospinal fluid leakage,lower extremity deep venous thrombosis,breakage or loosening of internal fixators,loss of interspace height loss and sag and displacement of intervertebral cage were found in all of the groups.All patients obtained reduction of lumbar spondylolisthesis and bone union of fused vertebra at last follow-up.There was no statistical difference in operative time between TLIF group and TLIF combined-treatment group and between MIS-TLIF group and MIS-TLIF combined-treatment group.The operative time was longer in TLIF group and TLIF combined-treatment group compared to MIS-TLIF group and MIS-TLIF combined-treatment group(P=0.000,P=0.000; P=0.000,P=0.000).There was no statistical difference in intraoperatve blood loss between TLIF group and TLIF combined-treatment group and between MIS-TLIF group and MIS-TLIF combined-treatment group.The intraoperatve blood loss were more in TLIF group and TLIF combined-treatment group compared to MIS-TLIF group and MIS-TLIF combined-treatment group(P=0.000,P=0.000; P=0.000,P=0.000).There was no statistical difference in postoperative drainage between TLIF group and TLIF combined-treatment group and between MIS-TLIF group and MIS-TLIF combined-treatment group.The postoperative drainage were more in TLIF group and TLIF combined-treatment group compared to MIS-TLIF group and MIS-TLIF combined-treatment group(P=0.000,P=0.000; P=0.000,P=0.000).The hospital stay was longer in TLIF group compared to TLIF combined-treatment group(P=0.013)and was longer in MIS-TLIF group compared to MIS-TLIF combined-treatment group(P=0.024),and was longer in TLIF group and TLIF combined-treatment group compared to MIS-TLIF group and MIS-TLIF combined-treatment group(P=0.000,P=0.000; P=0.000,P=0.000).There was statistical difference in VAS scores between different timepoints before and after the surgery,in other words,there was time effect(F=1 635.341,P=0.000).The VAS scores decreased in all of the 4 groups at 2,7,14 days and 6 and 12 months after the surgery compared to pre-surgery(P=0.004,P=0.000,P=0.000,P=0.001; P=0.002,P=0.000,P=0.000,P=0.000; P=0.001,P=0.000,P=0.000,P=0.000; P=0.008,P=0.000,P=0.000,P=0.000; P=0.000,P=0.000,P=0.000,P=0.004).There was statistical difference in VAS scores between the 4 groups in general,in other words,there was group effect(F=129.520,P=0.000).There was no statistical difference in VAS scores between the 4 groups before surgery.The VAS scores were lower in MIS-TLIF group and MIS-TLIF combined-treatment group compared to TLIF group and TLIF combined-treatment group at 2 days after the surgery(P=0.000,P=0.000; P=0.000,P=0.000).There was no statistical difference in VAS scores between TLIF group and TLIF combined-treatment group and between MIS-TLIF group and MIS-TLIF combined-treatment group.At 7,14 days and 6 and 12 months after the surgery,the VAS scores were lower in MIS-TLIF combined-treatment group compared to MIS-TLIF group(P=0.000; P=0.000; P=0.000; P=0.000),and were lower in MIS-TLIF group compared to TLIF combined-treatment group(P=0.000; P=0.000; P=0.000; P=0.003),and were lower in TLIF combined-treatment group compared to TLIF group(P=0.000; P=0.000; P=0.000; P=0.006).There was interaction between time factor and grouping factor(F=18.500,P=0.000).There was statistical difference in ODI scores between different timepoints before and after the surgery,in other words,there was time effect(F=2 857.334,P=0.000).The ODI scores decreased in all of the 4 groups at 2,7,14 days and 6 and 12 months after the surgery compared to pre-surgery(P=0.013,P=0.000,P=0.000,P=0.003; P=0.008,P=0.000,P=0.000,P=0.001; P=0.003,P=0.000,P=0.000,P=0.002; P=0.005,P=0.000,P=0.000,P=0.000; P=0.000,P=0.000,P=0.000,P=0.031).There was statistical difference in ODI scores between the 4 groups in general,in other words,there was group effect(F=173.869,P=0.000).There was no statistical difference in ODI scores between the 4 groups before surgery.At 2 days after the surgery,the ODI scores were lower in MIS-TLIF group and MIS-TLIF combined-treatment group compared to TLIF group and TLIF combined-treatment group(P=0.000,P=0.003; P=0.000,P=0.000),and there was no statistical difference in ODI scores between TLIF group and TLIF combined-treatment group and between MIS-TLIF group and MIS-TLIF combined-treatment group.At 7,14 days and 6 and 12 months after the surgery,the ODI scores were lower in MIS-TLIF combined-treatment group compared to MIS-TLIF group(P=0.000; P=0.000; P=0.003; P=0.000),and were lower in MIS-TLIF group compared to TLIF combined-treatment group(P=0.000; P=0.000; P=0.006; P=0.000),and were lower in TLIF combined-treatment group compared to TLIF group(P=0.004; P=0.000; P=0.002; P=0.000).There was interaction between time factor and grouping factor(F=23.108,P=0.000).There was statistical difference in peripheral venous blood CK contents between different timepoints before and after the surgery,in other words,there was time effect(F=5 355.427,P=0.000).The peripheral venous blood CK contents increased in all of the 4 groups at 2,7,14 days and 6 months after the surgery compared to pre-surgery(P=0.002,P=0.000,P=0.000,P=0.000; P=0.002,P=0.000,P=0.000,P=0.007; P=0.000,P=0.000,P=0.000,P=0.012; P=0.008,P=0.000,P=0.000,P=0.000).There was statistical difference in peripheral venous blood CK contents between the 4 groups in general,in other words,there was group effect(F=662.238,P=0.000).There was no statistical difference in peripheral venous blood CK contents between the 4 groups before surgery and at 6 months after the surgery.At 2 days after the surgery,the peripheral venous blood CK contents were lower in MIS-TLIF group and MIS-TLIF combined-treatment group compared to TLIF group and TLIF combined-treatment group(P=0.002,P=0.006; P=0.000,P=0.000)and there was no statistical difference between TLIF group and TLIF combined-treatment group and between MIS-TLIF group and MIS-TLIF combined-treatment group.At 7 and 14 days after the surgery,the peripheral venous blood CK contents were lower in MIS-TLIF combined-treatment group compared to MIS-TLIF group(P=0.000; P=0.000),and were lower in MIS-TLIF group compared to TLIF combined-treatment(P=0.000; P=0.009),and were lower in TLIF combined-treatment group compared to TLIF group(P=0.008; P=0.000).There was interaction between time factor and grouping factor(F=133.581,P=0.000).There was statistical difference in the CSA of multifidus between different timepoints before and after the surgery,in other words,there was time effect(F=4 633.716,P=0.000).The CSA of multifidus decreased in all of the 4 groups at 14 days and 6 and 12 months after the surgery compared to pre-surgery(P=0.002,P=0.000,P=0.000,P=0.000; P=0.001,P=0.000,P=0.000,P=0.025; P=0.001,P=0.000,P=0.000,P=0.000).There was statistical difference in the CSA of multifidus between the 4 groups in general,in other words,there was group effect(F=849.382,P=0.000).There was no statistical difference in the CSA of multifidus between the 4 groups before surgery.At 14 days and 6 and 12 months after the surgery,the CSA of multifidus were greater in MIS-TLIF combined-treatment group compared to MIS-TLIF group(P=0.006; P=0.000; P=0.000),and were greater in MIS-TLIF group compared to TLIF combined-treatment group(P=0.000; P=0.000; P=0.000),and were greater in TLIF combined-treatment compared to TLIF group(P=0.000; P=0.000; P=0.000).There was interaction between time factor and grouping factor(F=155.619,P=0.000).There was statistical difference in the gray values of multifidus between different timepoints before and after the surgery,in other words,there was time effect(F=2 679.510,P=0.000).The gray values of multifidus decreased in all of the 4 groups at 14 days and 6 and 12 months after the surgery compared to pre-surgery(P=0.009,P=0.000,P=0.000,P=0.000; P=0.008,P=0.000,P=0.000,P=0.000; P=0.004,P=0.000,P=0.000,P=0.024).There was statistical difference in the gray values of multifidus between the 4 groups in general,in other words,there was group effect(F=453.201,P=0.000).There was no statistical difference in the gray values of multifidus between the 4 groups before surgery.At 14 days and 6 and 12 months after the surgery,the gray values of multifidus were greater in MIS-TLIF combined-treatment group compared to MIS-TLIF group(P=0.002; P=0.000; P=0.000),and were greater in MIS-TLIF group compared to TLIF combined-treatment group(P=0.000; P=0.000; P=0.000),and were greater in TLIF combined-treatment group compared to TLIF group(P=0.000; P=0.000; P=0.000).There was interaction between time factor and grouping factor(F=56.039,P=0.000).Conclusion:The combination therapy of minimally invasive TLIF and TCM packet therapy has such advantages as high safety,less trauma,short hospital stay,less postoperative pain and fast recovery in treatment of lumbar spondylolisthesis,so it is worthy of popularizing in clinic.

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備注/Memo

備注/Memo:
2016-04-03收稿 2016-06-03修回
劉曉嵐 E-mail:[email protected]

更新日期/Last Update: 1900-01-01