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
|
摘要
目的:探讨保守治疗巨大型腰椎间盘突出症的临床疗效并分析影响其重吸收的因素。方法:2013年1月至2016年12月收集130例巨大型腰椎间盘突出症患者,按Iwabuchi位移、"牛眼征"改变特点分类,给予消髓化核汤为主的中医药保守治疗。其中男93例,女37例,年龄15～64(37.11±13.96)岁;病程1d～8年,平均(11.82±20.45)个月。观察并比较椎间盘突出率变化、症状改变情况,突出率采用富田庄司法测量,疗效评价采用腰椎JOA评分。结果:所有患者获得随访,时间13～48(21.45±11.87)个月,不同影像学类型患者随访时间差异无统计学意义(P>0.05);95例持续保守治疗患者吸收率为(44.08±35.70)%,Iwabuchi位移阳性组、"牛眼征"阳性组患者吸收率明显高于平均值(P<0.05);95例患者治疗后3、6、12个月JOA评分优良率分别为78.95%、81.05%、85.26%,JOA评分与治疗前比较,差异均有统计学意义(P<0.05);35例(26.92%)选择了手术治疗,治疗后3、6、12个月JOA评分优良率均为100%(P<0.05)。结论:消髓化核汤保守治疗巨大型腰椎间盘突出症的临床疗效满意,Iwabuchi位移阳性、"牛眼征"阳性改变患者发生了明显的突出物重吸收现象。
Objective:To explore the clinical effect of conservative treatment for giant lumbar intervertebral disc herniation and analyze the factors affecting its resorption. Methods:From January 2013 to December 2016,the clinical data of 130 patients with giant lumbar intervertebral disc herniation were collected. The patients were classified according to the characteristics of Iwabuchi displacement and "bull eye sign",Xiaosui Huahe(消髓化核)decoction of traditional Chinese medicine conservative treatment was used in the patients. There were 93 males and 37 females,aged from 15 to 64 years old with an average of(37.11±13.96) years old;with the disease duration ranging from 1 day to 8 years with an average of(11.82±20.45) months. Rate of intervertebral disc herniation was measured by Futian's method,and clinical effect was evaluated by JOA score. Results:All the patients were followed up from 13 to 48 months with an average of(21.45±11.87) months,and there were no significant differences in follow-up time between different imaging types(P>0.05). The absorption rate 95 patients with persistent conservative treatment was(44.08±35.70)%. The absorption rate of Iwabuchi displacement positive group and "bull eye sign" positive group was significantly higher than the average value(P<0.05). The rate of excellent and good JOA scores in 95 patients was 78.95%,81.05% and 78.95% at 3,6 and 12 months after treatment,respectively(P<0.05). Finally 35 patients accepted surgical treatment,the rate of excellent and good JOA scores was 100% at 3,6,12 months after treatment(P<0.05). Conclusion:The clinical effect of Xiaosui Huahe(消髓化核) decoction conservative treatment is satisfactory for giant lumbar intervertebral disc herniation. Patients with Iwabuchi displacement and "bull's eye sign" had significant herniation resorption.
Objective:To explore the clinical effect of conservative treatment for giant lumbar intervertebral disc herniation and analyze the factors affecting its resorption. Methods:From January 2013 to December 2016,the clinical data of 130 patients with giant lumbar intervertebral disc herniation were collected. The patients were classified according to the characteristics of Iwabuchi displacement and "bull eye sign",Xiaosui Huahe(消髓化核)decoction of traditional Chinese medicine conservative treatment was used in the patients. There were 93 males and 37 females,aged from 15 to 64 years old with an average of(37.11±13.96) years old;with the disease duration ranging from 1 day to 8 years with an average of(11.82±20.45) months. Rate of intervertebral disc herniation was measured by Futian's method,and clinical effect was evaluated by JOA score. Results:All the patients were followed up from 13 to 48 months with an average of(21.45±11.87) months,and there were no significant differences in follow-up time between different imaging types(P>0.05). The absorption rate 95 patients with persistent conservative treatment was(44.08±35.70)%. The absorption rate of Iwabuchi displacement positive group and "bull eye sign" positive group was significantly higher than the average value(P<0.05). The rate of excellent and good JOA scores in 95 patients was 78.95%,81.05% and 78.95% at 3,6 and 12 months after treatment,respectively(P<0.05). Finally 35 patients accepted surgical treatment,the rate of excellent and good JOA scores was 100% at 3,6,12 months after treatment(P<0.05). Conclusion:The clinical effect of Xiaosui Huahe(消髓化核) decoction conservative treatment is satisfactory for giant lumbar intervertebral disc herniation. Patients with Iwabuchi displacement and "bull's eye sign" had significant herniation resorption.
引文
[1]#12
[2]姜宏,施杞,郑清波.腰椎间盘突出后的自然吸收及其临床意义[J].中华骨科杂志,1998,18(12):755-757.JIANG H,SHI Q,ZHENG QB. The resorption and clinical significance of lumbar disc herniation[J]. Zhonghua Gu Ke Za Zhi, 1998,18(12):755-757. Chinese.
[3]俞鹏飞,姜宏,刘锦涛.消髓化核汤对腰椎间盘突出后重吸收影响的临床研究[J].长春中医药大学学报,2012,28(2):221-223,225.YU PF, JIANG H,LIU JT. Clinical study on the effect of the resorption of lumbar intervertebral disc herniation with"Xiaosui Huahe"decoction[J]. Chang Chun Zhong Yi Yao Da Xue Xue Bao,2012,28(2):221-223,225. Chinese.
[4]俞鹏飞.益气逐瘀利水方对腰椎间盘突出后重吸收影响的MRI观察及临床相关研究[D].南京:南京中医药大学,2011:13-34.YU PF. The MRI obsernation and clinical related research of"Yiqi Zhuyu and Lishui Decoction"on the resorption of lumbar disc herniation[D]. Nanjing:Nanjing University of Chinese Medicine,2011:13-34. Chinese.
[5]Atlas SJ,Tosteson TD, Blood EA,et al. The impact of workers'compensation on outcomes of surgical and nonoperative therapy for patients with a lumbar disc herniation:SPORT[J]. Spine(Phila Pa1976),2010,35(1):89-97.
[6]姜宏.腰椎间盘突出症——重吸收现象与诊疗研究[M].第4版.南京:江苏科学技术出版社,2016:197.JIANG H. Resorption of Lumbar Disc Herniation Diagnosis and Management[M]. 4th. Edition. Nanjing:Jiangsu Science and Technology Publishing House,2016:197. Chinese.
[7] Toyone T,Takahashi K,Kitahara H,et al. Visualisation of symptomatic nerve roots. Prospective study of contrast-enhanced MRI in patients with lumbar disc herniation[J]. J Bone Joint Surg Br, 1993,75(4):529-533.
[8]Iwabuchi M,Murakami K, Ara F,et al. The predictive factors for the resorption of a lumbar disc herniation on plain MRI[J]. Fukushima J Med Sci,2010,56(2):91-97.
[9]姜宏,俞鹏飞,刘锦涛.破裂型腰椎间盘突出症——MRI分析/临床转归预测/治疗策略[M].南京:江苏科学技术出版社,2017:91.JIANG H,YU PF,LIU JT. Clinical outcomes of patients with ruptured lumbar disc herniation, predication and treatment strategies based on MRI[M]. Nanjing:Jiangsu Science and Technology Publishing House, 2017:91. Chinese.
[10]吉万波,陆爱清,陶帅,等.“消髓化核汤”促进腰椎间盘突出症术后康复30例临床研究[J].江苏中医药,2013,12:30-31.JI WB,LU AQ,TAO S,et al. Clinical study on the 30 cases of postoperative rehabilitation for lumbar intervertebral disc herniation with"Xiaosui Huahe"decoction[J]. Jiang Su Zhong Yi Yao,2013,12:30-31. Chinese.
[11]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.LIU JT,JIANG H,WANG YJ,et al. A study of a rat lumbar disc herniation model and the mechanism spontaneous of resorption[J].Zhongguo Gu Shang/China J Orthop Trauma,2010,23(5):370-372. Chinese with abstract in English.
[12]姜宏,刘锦涛,惠扔华,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.JIANG H,LIU JT,HUI RH,et al. An experimental study on the influence of radix astragali on the ressorption of ruptured disc herniation[J]. Zhongguo Gu Shang/China J Orthop Trauma, 2009,22(3):205-207. Chinese with abstract in English.
[13]金今,邱贵兴,王以朋,等.经皮穿刺木瓜凝乳蛋白酶化学溶核术治疗腰椎间盘突出症[J].中国脊柱脊髓杂志,1998,8(4):39-41.JIN J,QIU GX,WANG YP,et al. The treatment of lumbar intervertebral disc herniation by percutaneous puncture with chymopapain chemonucleolysis[J]. Zhongguo Ji Zhu Ji Sui Za Zhi,1998,8(4):39-41. Chinese.
[14]姜宏.腰椎间盘突出症——重吸收现象与诊疗研究[M].第4版.南京:江苏科学技术出版社,2016:224-226.JIANG H. Resorption of Lumbar Disc Herniation Diagnosis and Management[M]. 4th. Edition. Nanjing:Jiangsu Science and Technology Publishing House,2016:224-226. Chinese.
[15] Hong J,Ball PA. Images in clinical medicine.Resolution of lumbar disc herniation without surgery[J]. N Engl J Med,2016,374(16):1564.
[16] Ming Z,Jin TL,Hong J,et al. Incidence of spontaneous resorption of lumbar disc herniation:A Meta analysis[J]. Pain Physician,2017,20:E45-E52.
[17] Panagopoulos J,Hush J, Steffens D,et al. Do MRI findings change over a period of up to one year in patients with low back pain and/or sciatica? A systematic review[J]. Spine(Phila Pa 1976),2017,42(7):504-512.
[18] Robert G,Marek S. Lumbar Disc Herniation[M]. Lippincott Williams&Wilkins:2002:84-91.
[19] Citisli V,Ibrahimoglu M. Spontaneous remission of a big subligamentous extruded disc herniation:case report and review of the literature[J]. Korean J Spine,2015,12(1):19-21.
[20]俞鹏飞,刘锦涛,马智佳,等.破裂型腰椎间盘突出症转归预测因素的Logistic回归分析[J].中国骨伤,2018,31(6):522-527.YU PF,LIU JT,MA ZJ,et al. Logistic regression analysis on the outcome predictive factors of ruptured lumbar disc herniation[J].Zhongguo Gu Shang/China J Orthop Trauma,2018,31(6):522-527. Chinese with abstract in English.
[21] Juergen Kraemer主编,张佐伦,孙慧译.椎间盘疾病[M].第3版.济南:山东科学技术出版社,2014:294-297.Juergen K,editor. Translated by ZHANG ZL,SUN H. Intervertebral Disk Disease[M]. 3rd Edition. Jinan:Shandong Science and Technology Publishing,2014:294-297. Chinese.
[22] Macki M, Hernandez-Hermann M,Bydon M,et al. Spontaneous regression of sequestrated lumbar disc herniations:literature review[J]. Clin Neurol Neurosurg,2014,120:136-141.
[23] Kawaji Y,Uchiyama S,Yagi E,et al. Three-dimensional evaluation of disc hernia and predicition of absorption by enhanced MRI[J].J Orthop Sci,2001,6(6):498-502.
[2]姜宏,施杞,郑清波.腰椎间盘突出后的自然吸收及其临床意义[J].中华骨科杂志,1998,18(12):755-757.JIANG H,SHI Q,ZHENG QB. The resorption and clinical significance of lumbar disc herniation[J]. Zhonghua Gu Ke Za Zhi, 1998,18(12):755-757. Chinese.
[3]俞鹏飞,姜宏,刘锦涛.消髓化核汤对腰椎间盘突出后重吸收影响的临床研究[J].长春中医药大学学报,2012,28(2):221-223,225.YU PF, JIANG H,LIU JT. Clinical study on the effect of the resorption of lumbar intervertebral disc herniation with"Xiaosui Huahe"decoction[J]. Chang Chun Zhong Yi Yao Da Xue Xue Bao,2012,28(2):221-223,225. Chinese.
[4]俞鹏飞.益气逐瘀利水方对腰椎间盘突出后重吸收影响的MRI观察及临床相关研究[D].南京:南京中医药大学,2011:13-34.YU PF. The MRI obsernation and clinical related research of"Yiqi Zhuyu and Lishui Decoction"on the resorption of lumbar disc herniation[D]. Nanjing:Nanjing University of Chinese Medicine,2011:13-34. Chinese.
[5]Atlas SJ,Tosteson TD, Blood EA,et al. The impact of workers'compensation on outcomes of surgical and nonoperative therapy for patients with a lumbar disc herniation:SPORT[J]. Spine(Phila Pa1976),2010,35(1):89-97.
[6]姜宏.腰椎间盘突出症——重吸收现象与诊疗研究[M].第4版.南京:江苏科学技术出版社,2016:197.JIANG H. Resorption of Lumbar Disc Herniation Diagnosis and Management[M]. 4th. Edition. Nanjing:Jiangsu Science and Technology Publishing House,2016:197. Chinese.
[7] Toyone T,Takahashi K,Kitahara H,et al. Visualisation of symptomatic nerve roots. Prospective study of contrast-enhanced MRI in patients with lumbar disc herniation[J]. J Bone Joint Surg Br, 1993,75(4):529-533.
[8]Iwabuchi M,Murakami K, Ara F,et al. The predictive factors for the resorption of a lumbar disc herniation on plain MRI[J]. Fukushima J Med Sci,2010,56(2):91-97.
[9]姜宏,俞鹏飞,刘锦涛.破裂型腰椎间盘突出症——MRI分析/临床转归预测/治疗策略[M].南京:江苏科学技术出版社,2017:91.JIANG H,YU PF,LIU JT. Clinical outcomes of patients with ruptured lumbar disc herniation, predication and treatment strategies based on MRI[M]. Nanjing:Jiangsu Science and Technology Publishing House, 2017:91. Chinese.
[10]吉万波,陆爱清,陶帅,等.“消髓化核汤”促进腰椎间盘突出症术后康复30例临床研究[J].江苏中医药,2013,12:30-31.JI WB,LU AQ,TAO S,et al. Clinical study on the 30 cases of postoperative rehabilitation for lumbar intervertebral disc herniation with"Xiaosui Huahe"decoction[J]. Jiang Su Zhong Yi Yao,2013,12:30-31. Chinese.
[11]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.LIU JT,JIANG H,WANG YJ,et al. A study of a rat lumbar disc herniation model and the mechanism spontaneous of resorption[J].Zhongguo Gu Shang/China J Orthop Trauma,2010,23(5):370-372. Chinese with abstract in English.
[12]姜宏,刘锦涛,惠扔华,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.JIANG H,LIU JT,HUI RH,et al. An experimental study on the influence of radix astragali on the ressorption of ruptured disc herniation[J]. Zhongguo Gu Shang/China J Orthop Trauma, 2009,22(3):205-207. Chinese with abstract in English.
[13]金今,邱贵兴,王以朋,等.经皮穿刺木瓜凝乳蛋白酶化学溶核术治疗腰椎间盘突出症[J].中国脊柱脊髓杂志,1998,8(4):39-41.JIN J,QIU GX,WANG YP,et al. The treatment of lumbar intervertebral disc herniation by percutaneous puncture with chymopapain chemonucleolysis[J]. Zhongguo Ji Zhu Ji Sui Za Zhi,1998,8(4):39-41. Chinese.
[14]姜宏.腰椎间盘突出症——重吸收现象与诊疗研究[M].第4版.南京:江苏科学技术出版社,2016:224-226.JIANG H. Resorption of Lumbar Disc Herniation Diagnosis and Management[M]. 4th. Edition. Nanjing:Jiangsu Science and Technology Publishing House,2016:224-226. Chinese.
[15] Hong J,Ball PA. Images in clinical medicine.Resolution of lumbar disc herniation without surgery[J]. N Engl J Med,2016,374(16):1564.
[16] Ming Z,Jin TL,Hong J,et al. Incidence of spontaneous resorption of lumbar disc herniation:A Meta analysis[J]. Pain Physician,2017,20:E45-E52.
[17] Panagopoulos J,Hush J, Steffens D,et al. Do MRI findings change over a period of up to one year in patients with low back pain and/or sciatica? A systematic review[J]. Spine(Phila Pa 1976),2017,42(7):504-512.
[18] Robert G,Marek S. Lumbar Disc Herniation[M]. Lippincott Williams&Wilkins:2002:84-91.
[19] Citisli V,Ibrahimoglu M. Spontaneous remission of a big subligamentous extruded disc herniation:case report and review of the literature[J]. Korean J Spine,2015,12(1):19-21.
[20]俞鹏飞,刘锦涛,马智佳,等.破裂型腰椎间盘突出症转归预测因素的Logistic回归分析[J].中国骨伤,2018,31(6):522-527.YU PF,LIU JT,MA ZJ,et al. Logistic regression analysis on the outcome predictive factors of ruptured lumbar disc herniation[J].Zhongguo Gu Shang/China J Orthop Trauma,2018,31(6):522-527. Chinese with abstract in English.
[21] Juergen Kraemer主编,张佐伦,孙慧译.椎间盘疾病[M].第3版.济南:山东科学技术出版社,2014:294-297.Juergen K,editor. Translated by ZHANG ZL,SUN H. Intervertebral Disk Disease[M]. 3rd Edition. Jinan:Shandong Science and Technology Publishing,2014:294-297. Chinese.
[22] Macki M, Hernandez-Hermann M,Bydon M,et al. Spontaneous regression of sequestrated lumbar disc herniations:literature review[J]. Clin Neurol Neurosurg,2014,120:136-141.
[23] Kawaji Y,Uchiyama S,Yagi E,et al. Three-dimensional evaluation of disc hernia and predicition of absorption by enhanced MRI[J].J Orthop Sci,2001,6(6):498-502.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |