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  

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[1] 戴宇祥 姜宏[1] 王宇铖 李红卫[1] 李宇卫[1] HAN Song;YU Pengfei;DAI Yuxiang;JIANG Hong;WANG Yucheng;LI Hongwei;LI Yuwei(Suzhou TCM Hospital Affiliated to Nanjig University of Chinese Medicine,Suzhou 215009,Jiangsu,China)

机构地区：[1]南京中医药大学附属苏州市中医医院,江苏苏州215009

出　　处：《中医正骨》2020年第12期11-16,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：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)。

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30d;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(visualanaloguescale,VAS)评分、Oswestry功能障碍指数(Oswestrydisabilityindex,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1d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�Objective: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( χ~2= 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

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 

分 类 号：R687.3[医药卫生—骨科学]