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  

Analysis of clinical effect of Xiaosui Huahe(消髓化核)decoction for the treatment of 130 patients with giant lumbar intervertebral disc herniation

作　　者：马智佳 姜宏[2] 俞鹏飞[2] 刘锦涛[2] 李晓春 MA Zhi-jia;JIANG Hong;YU Peng-fei;LIU Jin-tao;LI Xiao-chun(Suzhou Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Traditional Chinese Medicine,Suzhou 215009,Jiangsu,China)

机构地区：[1]南京中医药大学,江苏南京210023 [2]南京中医药大学附属苏州市中医医院,江苏苏州215009

出　　处：《中国骨伤》2019年第3期239-243,共5页China Journal of Orthopaedics and Traumatology

基　　金：国家自然科学基金项目(编号:81473691);江苏省卫计委青年医学重点人才项目(编号:QNRC2016253);苏州市卫计委青年基金项目(编号:KJXW2016036)~~

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.

关 键 词：保守治疗 椎间盘移位 重吸收 

分 类 号：R274.9[医药卫生—中西医结合]