【作者】 詹柱享；

【导师】 晋大祥；

【作者基本信息】 广州中医药大学 ， 中医学， 2011， 硕士

【摘要】 [目的]观察中药制剂补气通络胶囊结合髓核摘除术治疗腰痛伴根性痛的腰椎间盘突出症患者的疗效,探讨手术前后腰痛及根性痛的转归并对相关因素进行分析。[方法]采用前瞻性研究的方法,收集从2010年6月至2010年11月因椎间盘突出症导致腰腿痛入院手术治疗的患者57例,随机分为治疗组(28例)及对照组(27例),治疗组除了接受手术治疗外,还加服补气通络胶囊(主要由人参、当归、丹参、川芎等中药组成)治疗,观察患者术前及术后6个月腰痛及腿痛的VAS评分、ODI评分以及SF-36评分的变化,评价单纯髓核摘除术的疗效以及髓核摘除术后配合补气通络胶囊的效果,探讨手术前后腰痛及根性痛的转归并对相关因素进行分析。[结果]与患者术前腰痛相关的因素：椎间盘突出面积(P=0.041)、椎间盘退变程度(P=0.046)、椎间高度(P=0.047)、腰椎稳定性(P=0.042)；与术前腿痛相关因素：椎间盘突出临床分型(P=0.045)、椎间盘突出面积(P=0.031)；与术后6月腰痛相关因素：腰椎稳定性(P=0.009)。两组患者术后6个月的腰痛和下肢根性痛以及功能障碍均较术前明显改善,与术前比较有显著性差异(均P<0.01),且治疗组术后6个月的腰痛和下肢根性痛以及功能障碍均较对照组有明显提高(均P<0.05),两组比较,术后6个月治疗组的疗效优于对照组。所有患者术后ODI功能障碍指数评定,优31例,良24例,可2例,优良率为96.5%。患者手术后生活质量各维度均较术前有显著提高(P<0.01)。对比一般人群,术后PCS:PF、RP、BP、GH和一般人群存在显著性差异(P<0.05),分别降低19.78%、22.50%、12.19%、25.37%；术后MCS:MH、RE与一般人群相比无明显差异(P>0.05), VT、SF分别降低：15.49%、11.76%。术后MCS改善程度大于PCS程度(P<0.05)。[结论]①患者术前的腰痛情况跟椎间盘突出面积大小、椎间盘退变程度、椎间隙高度及腰椎稳定性具有相关性；术前根性痛跟椎间盘突出的临床分型、突出面积大小具有相关性。②患者术后的腰痛情况跟术前腰椎稳定性具有相关性；术后腿痛情况恢复理想,无明显相关因素。③髓核摘除术后配合中药制剂补气通络胶囊治疗对疗效有强化作用,有利于患者康复。④髓核摘除术能对患者的腰痛及根性痛产生有意义的缓解,其中根性痛缓解较理想,对于长期患有腰痛且腰椎退行性变严重的患者,术后可能腰痛缓解不彻底。⑤髓核摘除术能有效改善患者的功能障碍及提高患者的生存质量,其中对患者心理健康的改善大于生理健康。更多还原

【Abstract】 ObjectiveTo observe the efficacy of use traditional Chinese medicine preparation Bu Qi Tong Luo Capsule combination of scectomy in the treatment of disc herniation, researched the transition of low back pain and radicular pain before and after surgery, and analyzed the related factors.MethodsA prospective study.57 patients who got lumbar disc herniation with back pain and leg pain and need to take operation were observed from June 2010 to November 2010, all patients were randomly divided into treatment group (28 cases) and control group (27 cases), the treatment group not in add to surgery, but also took Bu Qi Tong Luo Capsules (mainly composed of ginseng, angelica, red sage root, Chuanxiong, etc), to observe the diversification of preoperative and postoperative six months VAS scores、ODI scores、SF-36 scores. Assessed the efficacy of discectomy and Bu Qi Tong Luo Capsule, research the transition of low back pain and radicular pain before and after surgery, and analyzed the related factors.ResultsPreoperative factors associated with low back pain:disc’s herniation area (P=0.041), disc’s degeneration (P=0.046), disc’s height (P=0.047), the stability of lumbar spine (P=0.042); preoperative factors associated with leg pain:disc’s clinical type (P=0.045), disc’s area (P=0.031); factors associated with low back pain in postoperative 6 months:the stability of lumbar spine (P=0.009). After 6 months, the patients’ low back pain and radicular pain and dysfunction in the two groups were significantly improved compared with preoperative patients, there were significant differences (all P<0.01), after 6 months,patients who got low back pain and Lower extremity radicular pain and dysfunction in the treatment group were significantly improved compared with the control group (all P<0.05), between the two groups, after 6 months, the efficacy of treatment group was better than the control group. All patients were assessed with ODI dysfunction, excellent in 31 cases, good in 24 cases, general in 2 cases, the fine rate was 96.5%. Compared the patients in preoperative and postoperative, the various dimensions of quality of life in patients were significant differences (P<0.01). Comparison whit the general population, postoperative PCS:PF、RP、BP、GH were significant differences (P<0.05), decreased by 19.78%、22.50%、12.19% and 25.37%; postoperative MCS:compared with the general population, the MH and RE were no significant difference (P>0.05), VT、SF were reduced:15.49%、11.76%. Postoperative MCS was greater improved than PCS (P<0.05)Conclusion①Patients who got low back pain before surgery were related to the following factors:disc’s area、disc’s degeneration、disc’s height、the stability of lumbar spine; patients who got leg pain before surgery were related to the following factors:disc’s clinical type、disc’s area.②Patients who got low back pain after surgery were related to the following factors:the stability of lumbar spine;patients’leg pain were good recovery after surgery, no significant correlationfactors.③After discectomy, patients who took traditional Chinese medicine preparations Bu Qi Tong Luo Capsule to treat lumbar disc herniation can got the strengthening effect on the efficacy, it is good for patients to recover.④Discectomy could alleviate low back pain and leg pain, it were significantly, especially radicular pain, but patients who got chronic low back pain and lumbar degenerative severe cases, surgery may not completely alleviate back pain.⑤Discectomy can effectively improve the patients’dysfunction and improve their quality of life, the improvement of mental health was more significantly than physical health.更多还原