督脉瘀阻型寰枢椎脱位手术联合中药治疗的临床研究  

Clinical Research on Operation Combined with Traditional Chinese Medicine for Treating Atlantoaxial Dislocation of Governor Vessel Stasis

作　　者：移平[1] 谭明生[1] 吕国华[2] 杨峰[1] 唐向盛[1] 郝庆英[1] 周英杰[3] 张恩忠[4] 姜良海[1] 刘楚吟[1] 齐英娜 YI Ping TAN Mingsheng L Guohua YANG Feng TANG Xiangsheng HAO Qingying ZHOU Yingjie ZHANG Enzhong JIANG Lianghai LIU Chuyin QI Yingna(China-Japan Friendship Hospital, Beijing 100029, China Xiangya Hospital Central South University,Changsha 410008 ,China Luoyang Orthopedic Traumatological Hospital, Luoyang 471002, Henan China Wendeng Osteopath Hospital, Wendeng 264400,Shandong China.)

机构地区：[1]中日友好医院,北京100029 [2]中南大学湘雅医院 [3]河南洛阳正骨医院 [4]山东文登整骨医院

出　　处：《中国中医骨伤科杂志》2017年第1期14-18,22,共6页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：国家自然科学基金(81173423)

摘　　要：目的:比较手术联合补阳还五汤与单纯手术治疗督脉瘀阻型寰枢椎脱位的临床疗效。方法:自2005年1月至2014年1月,寰枢椎脱位的患者351例,分为单纯手术组及手术联合补阳还五汤治疗的手术中药组。分别比较术前、术后1个月及末次随访时,两组患者的日本骨科协会脊髓功能(JOA)评分、颈部疼痛视觉模拟评分(VAS)、颈椎功能障碍指数评分(NDI)和督脉瘀阻证候积分。结果:所有手术均顺利完成,患者随访时间6~13个月。术后两组患者督脉瘀阻证候积分、JOA评分均较术前明显提高,VAS,NDI评分均较术前明显降低,差异均有统计学意义(P<0.05)。两组患者术前督脉瘀阻证候积分,JOA,VAS,NDI评分差异无统计学意义(P>0.05);术后1个月时,手术中药组的督脉瘀阻证候积分和JOA评分高于手术组,VAS和NDI评分低于手术组,差异均有统计学意义(P<0.05);至末次随访时,两组的督脉瘀阻证候积分,JOA,VAS,NDI评分虽然差异无统计学意义(P>0.05),但手术中药组的督脉瘀阻证候积分和JOA评分高于手术组,VAS和NDI评分低于手术组,提示手术中药组疗效较单纯手术组好。结论:通过手术复位和椎管减压治疗寰枢椎脱位,可解除督脉(脊髓)的瘀阻和压迫,解剖形态结构上疏通督脉。围手术期采用中药活血化瘀、补益肝肾、益气活络,可改善微循环、消除炎症介质和保护神经细胞,进一步疏通督脉,促进恢复神经功能。Objective：To compare the clinical effect between operation combined with Buyanghuanwu decoction（BYHWD）and only operation for treating atlantoaxial dislocation of governor vessel stasis.Methods：From January 2005 to June 2015,351 cases with atlantoaxial dislocation were included.The patients were divided into the only operation group and the operation combined with BYHWD group.The Japanese orthopedic association spinal cord function（JOA）score,the visual analogue scale of neck pain（VAS）,the neck dysfunction index（NDI）score and the governor vessel stasis syndrome score of the patients in two groups were compared preoperative and postoperative 1month and the last follow-up respectively.Results：All operations were completed successfully.Patients were followed up for 6to 13 months.After operation,the governor vessel stasis syndrome score and the JOA score of the patients in two groups were significantly higher than those before operation,while the VAS and NDI score were significantly lower（P〈0.05）.There was no statistically significant difference in the governor vessel stasis syndrome score,JOA,VAS and NDI score between the two groups before operation（P〈0.05）.The governor vessel stasis syndrome score and the JOA score in operation and combined group were higher than those of operation group,while the VAS and NDI score were lower（P〈0.05）.At the last follow-up,although there was no statistical difference in the governor vessel stasis syndrome score,JOA,VAS and NDI score between the two groups（P〈0.05）,the governor vessel stasis syndrome score and the JOA score in operation and combined group were higher than operation group,and the VAS and NDI score were lower,which meant the clinical effect of operation and traditional Chinese medicine group was better than the operation group.Conclusion：In the treatment of atlantoaxial dislocation,surgical reduction and spinal canal decompression can remove governor vessel（spinal cord）stasis and oppression,clear the governor pulse in an

关 键 词：寰枢椎脱位 督脉 补阳还五汤 手术治疗 

分 类 号：R684.7[医药卫生—骨科学]