中西医并重治疗经皮椎间孔镜下腰椎间盘摘除术并发类脊髓高压综合征  

Spinal Hypertensive Syndrome Complicated by Percutaneous Foraminal Disc Excision Treatment with Traditional Chinese and Western Medcine

作　　者：戈阳华[1] 李华南[1] 李勇[1] 戈思 GE Yang-hua;LI Hua-nan;LI Yong;GE Si(The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine,Nanchang 330006,China)

机构地区：[1]江西中医药大学附属医院,南昌330006

出　　处：《江西中医药大学学报》2021年第2期25-28,共4页Journal of Jiangxi University of Chinese Medicine

基　　金：国家中医药管理局第四批全国中医(临床、基础)优秀人才研修项目(国中医药人教发[2017]24号);国家中医药管理局全国名老中医药专家传承工作室建设项目(国中医药人教函〔2012〕149号);江西省中医药科研基金项目(2019A197)。

摘　　要：目的:回顾与总结经皮椎间孔镜下腰椎间盘摘除术(Percutaneous transforaminal endoscopic lumbar discectomy PTELD)危急并发症--类脊髓高压综合征(Myeloid hypertension-like syndrome,MHL)的原因与处置措施。方法:通过病例总结与文献复习,对我院2018年1月至2020年5月间268例PTELD术中3例MHL的诱因、症状、体征及治疗过程进行了回顾,总结了MHL的病因病机和治疗方案。结果:MHL辨证属寒凝督脉,气虚血瘀之痿躄病,作者术中以稳定生命体征、迅速缓解临床症状为先,术后予补阳五汤加减温阳通督,益气活血,保护脊髓和神经功能为要。本组MHL患者感觉及运动功能均完全恢复,取得了良好的疗效。结论:PTELD有疏通督脉,清理粘连,椎管减压的作用,但学习曲线长,操作要求高。MHL是PTELD危急并发症,中西医并重治疗MHL及时有效保护了脊髓及神经功能,疗效可期。Objective:To review and summarize the causes and treatment measures of the critical complication—Myeloid hypertensionlike syndrome(MHL)inPercutaneous transforaminal endoscopic lumbar discectomy(PTELD).Methods:With the case summary and literature review,There were 3 MHL cases in 268 cases of PTELD in our hospital from January 2018 to May 2020,who had been reviewed by the causes,symptoms,signs and medical measures,therefore the etiology and pathogenesis and treatment plan of MHL were concluded.Result:MHL syndrome was differentiated in type of cold coagulation of Governor channel,deficiency of Qi and blood stasis.It was the top priority to stabilizethe vital signs,relief clinical symptoms rapidly and protect the spinal cord and nerve functions during PTELD.Modified Buyang Huanwu Decoction was given to warm Yang and dredge the Governor channel,promote blood circulation,invigorate qi and promote blood circulation,and protect spinal cord and nerve functions postoperatively.This group of MHL cases was recovered completely in sensory and motor functions,and then achieved good results.Conclusion:PTELD has functions of dredging the supervisory channels,clearing adhesions,and decompressing the spinal canal,but it needs a long learning curve and high operation requirements.MHL is a critical complication of PTELD.Treating MHL with both Chinese and Western medicine can effectively protect the spinal cord and nerve functions timely and effectively.

关 键 词：腰椎间盘摘除术 腰椎间盘突出 类脊髓高压综合征 补阳还五汤 临床观察 

分 类 号：R473.6[医药卫生—护理学]