[1]韩松,俞鹏飞,戴宇祥,等.消髓化核汤防治经皮椎间孔镜下腰椎间盘摘除术后早期腰臀部疼痛的临床研究[J].中医正骨,2020,32(12):11-16.
　HAN Song,YU Pengfei,DAI Yuxiang,et al.A clinical study of Xiaosui Huahe Tang(消髓化核汤)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.
点击复制

消髓化核汤防治经皮椎间孔镜下腰椎间盘摘除术后早期腰臀部疼痛的临床研究()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期数:
2020年12期
页码:
11-16
栏目:
临床研究
出版日期:
2020-12-20

文章信息/Info

Title:
A clinical study of Xiaosui Huahe Tang(消髓化核汤)for prevention and treatment of early low back and hip pains after percutaneous endoscopic lumbar discectomy
作者:
韩松; 俞鹏飞; 戴宇祥; 姜宏; 王宇铖; 李红卫; 李宇卫
(南京中医药大学附属苏州市中医医院,江苏 苏州 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
关键词:
腰椎;  椎间盘移位;  消髓化核汤;  椎间孔镜;  椎间盘切除术; 经皮;  疼痛;  临床试验
Keywords:
lumbar vertebrae;  intervertebral disc displacement;  Xiaosui Huahe Tang;  transforaminal endoscope;  diskectomy; percutaneous;  pain;  clinical trial
摘要:
目的:观察消髓化核汤防治经皮椎间孔镜下腰椎间盘摘除术后早期腰臀部疼痛的临床疗效,并初步探讨其作用机制。方法:选取100例单节段腰椎间盘突出症患者,随机分为2组,每组50例。2组患者均采用经皮椎间孔镜下椎间盘摘除术治疗。消髓化核汤组术后第1天开始口服消髓化核汤,连续服用30 d; 常规处理组仅行经皮椎间孔镜下椎间盘摘除术。随访观察患者腰臀部疼痛改善情况,记录患者手术前后的腰臀部疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)。术后3个月随访时进行MRI检查,计算突出物体积。结果:①总体情况。术后3个月时,消髓化核汤组2例腰痛未缓解、1例腰痛较术前加重、2例出现新发腰痛,常规处理组9例术后腰痛未缓解、3例腰痛较术前加重、1例出现新发腰痛、2例出现新发臀部疼痛。术后常规处理组腰臀部疼痛未改善的比例高于消髓化核汤组(χ2=6.250,P=0.012)。②腰臀部疼痛VAS评分。时间因素和分组因素存在交互效应(F=9.051,P=0.000)。2组患者腰臀部疼痛VAS评分总体比较,组间差异无统计学意义,即不存在分组效应(F=0.180,P=0.671)。手术前后不同时间点腰臀部疼痛VAS评分的差异有统计学意义,即存在时间效应(F=204.471,P=0.000)。2组腰臀部疼痛VAS评分均呈下降趋势[(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]; 术前、术后1 d时2组腰臀部疼痛VAS评分比较,差异均无统计学意义(t=1.426,P=0.157; t=1.789,P=0.077); 术后1个月、3个月时消髓化核汤组的腰臀部疼痛VAS评分均低于常规处理组(t=-2.468,P=0.015; t=-3.126,P=0.020)。③ODI。时间因素和分组因素存在交互效应(F=12.527,P=0.000)。2组患者ODI总体比较,组间差异有统计学意义,即存在分组效应(F=10.441,P=0.001)。手术前后不同时间点ODI的差异有统计学意义,即存在时间效应(F=375.457,P=0.000)。2组患者的ODI均呈下降趋势[(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]; 术前2组ODI比较,差异无统计学意义(t=-0.087,P=0.931); 术后1个月、3个月时消髓化核汤组的ODI均低于常规处理组(t=-6.135,P=0.000; t=-6.234,P=0.000)。④突出物体积。术后3个月时MRI检查显示,消髓化核汤组残存突出物体积小于常规处理组[(161.07±192.99)mm3,(275.84±255.34)mm3,t=-2.535,P=0.013]。结论:经皮椎间孔镜下腰椎间盘摘除术后口服消髓化核汤,可有效缓解和减少术后早期腰臀部疼痛,改善腰椎功能,其作用机制可能与消髓化核汤能促进突出椎间盘重吸收有关。
Abstract:
To observe the clinical curative effects of Xiaosui Huahe Tang(消髓化核汤,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.

参考文献/References:

[1] 王大巍,邵滨,邢建强,等.椎间孔镜技术治疗腰椎间盘突出症2年以上随访的疗效[J].中国微创外科杂志,2020,20(4):326-329.
[2] 郑泉鑫,皮安平,潘锰,等.后路脊柱内镜下椎间盘髓核摘除术联合身痛逐瘀汤口服治疗腰椎间盘突出症[J].中医正骨,2019,31(6):67-69.
[3] JASPER G P,FRANCISCO G M,TELFEIAN A E.A retrospective evaluation of the clinical success of transforaminal endoscopic discectomy with foraminotomy in geriatric patients[J].Pain Physician,2013,16(3):225-229.
[4] DAGISTAN Y,CUKUR S,DAGISTAN E,et al.Role of expression of inflammatory mediators in primary and recurrent lumbar disc herniation[J].J Korean Neurosurg Soc,2017,60(1):40-46.
[5] 邓亚典,杨勇,陈曦.补阳还五汤口服联合浮针疗法治疗腰椎间盘突出症椎间孔镜术后残余神经症状[J].中医正骨,2017,29(10):64-65.
[6] MOHAMED ALI A E,MOHAMED A A,SALMAN O H,et al.Immediate post-discectomy percutaneous facet nerve continuous and nerve root pulsed radiofrequency and intraluminal injection of steroid with hyaluronidase improved outcome of surgery for lumbar disk herniation[J].Egypt J Anaesth,2017,33(1):21-28.
[7] 涂源源,刘亦恒,邢晓伟.经皮椎间孔镜术联合复方倍他米松治疗腰椎间盘突出症的疗效及对疼痛症状的影响[J].中华骨与关节外科杂志,2020,13(5):385-389.
[8] 胡有谷.腰椎间盘突出症[M].4版.北京:人民卫生出版社,2011:370.
[9] 国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:202.
[10] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:119-121.
[11] 俞鹏飞,姜宏,刘锦涛.破裂型腰椎间盘突出症非手术治疗后的转归[J].中国脊柱脊髓杂志,2015,25(2):109-114.
[12] 胡德新,郑琦,朱博,等.经皮椎间孔镜下选择性减压治疗老年性腰椎管狭窄症的疗效分析[J].中国骨伤,2014,27(3):194-198.
[13] 孙建民,丁永国,李昌隆,等.经皮脊柱内镜下腰椎间盘切除术后复发因素及治疗方案[J].中国疼痛医学杂志,2020,26(5):362-367.
[14] 董江,王智权,苏军强,等.腰椎经皮内镜手术术后疗效不佳的相关因素分析[J].医学综述,2020,26(7):1390-1395.
[15] 甄瑞鑫,刘士波,曹雪峰,等.椎间孔镜术后副损伤导致腰臀部疼痛原因分析[J].医学研究杂志,2018,47(11):146-150.
[16] 钱军,董福龙,张银顺,等.经皮内镜下腰椎间盘摘除术后早期腰痛及大腿后方痛的临床观察及预后[J].中华医学杂志,2019,99(31):2445-2449.
[17] 黄克伦,滕红林,朱旻宇,等.经皮椎间孔镜下腰椎间盘摘除术并发症分析[J].中国骨伤,2017,30(2):121-124.
[18] AHN Y,LEE H Y,LEE S H,et al.Dural tears in percutaneous endoscopic lumbar discectomy[J].Eur Spine J,2011,20(1):58-64.
[19] KIM J E,KIM K H.Piriformis syndrome after percutaneous endoscopic lumbar discectomy via the posterolateral approach[J].Eur Spine J,2011,20(10):1663-1668.
[20] 王剑锋,杨林.腰椎间孔镜术后复发的原因分析及对策[J].武警医学,2017,28(4):366-368.
[21] 钱军,余水生,刘建军,等.全脊柱内镜下椎间孔成型对腰椎生物力学的影响[J].中华医学杂志,2018,98(13):1013-1018.
[22] 张隆,时莉芳,陈佳,等.两种术式治疗腰椎间盘突出症的临床对比研究[J].中国矫形外科杂志,2020,28(1):10-14.
[23] 中华医学会疼痛学分会脊柱源性疼痛学组.腰椎间盘突出症诊疗中国疼痛专家共识[J].中国疼痛医学杂志,2020,26(1):2-6.
[24] 马智佳,姜宏,俞鹏飞,等.消髓化核汤保守治疗130例巨大型腰椎间盘突出症的疗效分析[J].中国骨伤,2019,32(3):239-243.
[25] 刘锦涛,姜宏,王拥军,等.大鼠破裂型椎间盘突出模型的建立及突出物重吸收机制的研究[J].中国骨伤,2010,23(5):370-372.
[26] 姜宏,刘锦涛,惠礽华,等.黄芪对破裂型椎间盘突出重吸收动物模型的影响[J].中国骨伤,2009,22(3):205-207.

相似文献/References:

[1]吴青坡,孙国绍,王林杰.后路椎管减压联合腰椎椎弓根钉动态稳定装置内固定 治疗单节段腰椎退行性疾病[J].中医正骨,2015,27(10):42.
[2]李林军.应用膨胀式椎弓根螺钉内固定治疗合并骨质疏松的 胸腰椎退行性疾病[J].中医正骨,2015,27(08):49.
[3]孙广江,崔海舰.络病理论指导下应用独活寄生汤加减治疗腰椎间盘突出症[J].中医正骨,2015,27(12):37.
　SUN Guangjiang,CUI Haijian.Clinical study on oral application of Duhuo Jisheng Tang Jiajian(独活寄生汤加减)under the guidance of collaterals disease theory for treatment of lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(12):37.
[4]陈冠军,陈扬,庄汝杰.可灌注骨水泥椎弓根螺钉系统 在老年腰椎疾患手术中的应用[J].中医正骨,2015,27(02):40.
[5]万宏波,马海燕,蒋云霞,等.口服益气化瘀汤联合功能锻炼治疗腰椎退行性疾病 术后残留腰腿痛的临床研究[J].中医正骨,2015,27(06):1.
　WAN Hongbo,MA Haiyan,JIANG Yunxia,et al.Clinical study on oral application of Yiqi Huayu Tang(益气化瘀汤)combined with functional exercise for the treatment of postoperative residual lumbocrural pain in patients with lumbar degenerative disease[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(12):1.
[6]王世龙.腰椎椎管内外痛风石1例[J].中医正骨,2012,24(02):69.
[7]秦杰,李振宇.三法十式手法配合中药腰痹汤治疗腰椎间盘突出症[J].中医正骨,2011,23(02):71.
[8]颜 峰.椎间融合术配合中药外敷治疗退行性腰椎滑脱症[J].中医正骨,2016,28(01):38.
[9]喻秋萍,唐萌芽,王峥峰,等.身痛逐瘀汤治疗腰椎间盘突出症的系统评价[J].中医正骨,2016,28(06):24.
　YU Qiuping,TANG Mengya,WANG Zhengfeng,et al.Efficacy of Shentong Zhuyu Tang(身痛逐瘀汤)for treatment of lumbar disc herniation:a systematic review[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(12):24.
[10]董永强,何鑫东,张伟伟,等.经皮椎间孔镜髓核摘除术联合McKenzie疗法治疗腰椎间盘突出症的临床研究[J].中医正骨,2016,28(07):38.
　DONG Yongqiang,HE Xindong,ZHANG Weiwei,et al.Observation on the curative effect of fire-needle therapy for treatment of supraspinal and interspinal ligament injuries[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(12):38.
[11]刘彦璐,林耐球,李绍旦,等.正骨手法结合中药外敷治疗腰椎间盘突出症[J].中医正骨,2015,27(02):26.
[12]邵礼晖,潘浩.Coflex棘突间动态稳定系统治疗腰椎退变性疾病40例[J].中医正骨,2015,27(02):37.
[13]郭新军,朱卉敏,王衡,等.一次性纤维环缝合器在腰椎间盘突出症髓核摘除术中的应用[J].中医正骨,2015,27(03):59.
[14]林斌,黎秋生,何勇,等.椎弓根螺钉单侧固定与双侧固定治疗腰椎间盘突出症 对邻近节段退变的影响[J].中医正骨,2015,27(01):16.
　LIN Bin,LI Qiusheng,HE Yong,et al.Effect of unilateral versus bilateral fixation with pedicle screws on adjacent segment degeneration in patients with lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(12):16.
[15]贾龙,张华.“治未病”思想指导下腰椎间盘突出症的辨证防治[J].中医正骨,2017,29(01):36.
[16]聂富祥,贺海怿,朱文辉,等.一次性可扩张通道下微创经椎间孔入路腰椎间融合术治疗单节段腰椎退行性疾病[J].中医正骨,2017,29(05):34.
[17]宋仁谦,周英杰,赵刚.经皮可灌注骨水泥椎弓根螺钉固定治疗合并严重骨质疏松症的腰椎退行性疾病[J].中医正骨,2017,29(05):37.
[18]张史飞,任绍东,屠永刚,等.椎弓根螺钉双皮质固定治疗合并骨质疏松的腰椎不稳症[J].中医正骨,2017,29(09):73.
[19]邓罗义,孙红,宁旭.神经根沉降征及其在腰椎退行性疾病诊断中的应用价值[J].中医正骨,2018,30(08):50.
[20]李智斐,李嘉琅,张翼升,等.医用臭氧治疗腰椎间盘突出症的作用机制及应用进展[J].中医正骨,2018,30(10):59.

备注/Memo

备注/Memo:
基金项目:江苏省自然科学基金项目(BK20190191); 江苏省青年医学重点人才培养项目(QNRC2016253)
通讯作者:俞鹏飞 E-mail:yupengfei86@163.com
更新日期/Last Update: 2020-12-20