微创经椎间孔腰椎间融合术联合中医康复治疗高龄腰椎滑脱症临床观察  

Clinical observation on minimally invasive lumbar interbody fusion combined with rehabilitation of TCM in treatment of senile lumbar spondylolisthesis

作　　者：陈思思[2] 刘沛[1] 张麟 CHEN Sisi;LIU Pei;ZHANG Lin(Wuhan No.1 Hospital,Wuhan 430022)

机构地区：[1]武汉市第一医院,湖北武汉430022 [2]武汉市第一医院体检中心,湖北武汉430022

出　　处：《湖北中医药大学学报》2021年第5期92-95,共4页Journal of Hubei University of Chinese Medicine

基　　金：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[2018]134号)。

摘　　要：目的观察显微镜辅助下微创经椎间孔腰椎间融合术(MIS-TLIF)联合围手术期中医康复治疗高龄腰椎滑脱症临床疗效。方法将我院脊柱外科行显微镜辅助下MIS-TLIF的高龄(70岁以上)单节段腰椎滑脱症患者153例随机分为观察组(76例)与对照组(77例)。观察组MIS-TLIF术后联合围手术期中医康复治疗,对照组仅行MIS-TLIF术。术后根据改良Macnab法进行疗效评定;于术前、术后3d、术后3个月、术后6个月观察两组患者视觉模拟评分法(VAS)评分、腰椎Oswestry功能障碍指数(ODI)评分、日本骨科协会评分法(JOA)评分、椎间隙高度、矢状面Cobb角,观察两组不良反应及预后并进行疗效比较。结果根据改良Macnab疗效评定,观察组优良率显著高于对照组(P<0.05);两组术后3d、3个月、6个月随访时的VAS、ODI评分较术前明显降低(P<0.05),JOA评分均较术前明显提高(P<0.05),两组VAS、ODI、JOA评分比较差异有统计学意义(P<0.05);两组术后3d、术后3个月、术后6个月在滑脱节段椎间隙高度、滑脱节段Cobb角较术前均有显著性差异(P<0.05),而两组间在各时间点对比无明显差异(P>0.05);两组在手术时间、出血量、出院时间、死亡率和手术并发症无显著性差异(P>0.05),均未出现严重并发症。结论微创经椎间孔腰椎间融合术联合中医康复治疗高龄腰椎滑脱症患者疗效较好,能在短期缓解疼痛,快速康复,但两组远期疗效比较差异不大。Objective To observe the clinical effect of microscope assisted minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)combined with perioperative TCM rehabilitation in treatment of senile lumbar spondylolisthesis.Methods A total of 153 elderly patients(over 70 years old)with single level lumbar spondylolisthesis were randomly divided into observation group(76 cases)and control group(77 cases).Observation group was treated with MIS-TLIF combined with perioperative TCM rehabilitation,while control group was only treated with MIS-TLIF.The curative effect was evaluated according to the modified macnab method;Visual analogue scale(VAS)score,lumbar Oswestry disability index(ODI)score,Japanese Orthopaedic Association(JOA)score,intervertebral space height and sagittal Cobb angle were observed before operation,3 days,3 months and 6 months after operation.The adverse reactions and prognosis of the two groups were observed and compared.Results According to the Modified Macnab efficacy evaluation,the excellent and good rate of observation group was higher than control group(P<0.05),the VAS and ODI scores of both groups 3 days,3 months and 6 months after operation were significantly lower than those before operation(P<0.05),and the JOA scores were significantly higher than those before operation(P<0.05),there were significant differences in VAS,ODI and JOA scores between the two groups 3 days,3 months and 6 months after operation(P<0.05),there were significant differences in intervertebral space height and Cobb angle of spondylolisthesis segment between the two groups 3 days,3 months and 6 months after operation(P<0.05),but there was no significant difference between the two groups at each time point(P>0.05),there was no significant difference in operation time,blood loss,discharge time,mortality and complications between the two groups(P>0.05);there were no serious complications.Conclusion MIS-TLIF combined with TCM rehabilitation has a good effect in treatment of senile lumbar spondylolisthesis,which can reliev

关 键 词：腰椎滑脱 高龄 经椎间孔腰椎间融合术 显微镜 微创 中医康复 

分 类 号：R274.2[医药卫生—中医骨伤科学]