發(fā)布時間：2018-04-25 07:18

  本文選題：痹癥 + Hybrid術　； 參考：《北京中醫(yī)藥大學》2016年碩士論文

【摘要】：背景脊髓型頸椎病(CSM)是頸椎病中的一種常見且嚴重的臨床類型,它以頸椎間盤及小關節(jié)的退行性病變?yōu)榛静±砘A,形成椎體緣骨贅,繼而壓迫脊髓、神經(jīng)根及營養(yǎng)脊髓的血管,造成壓迫頸椎節(jié)段的頸椎管管腔狹窄。脊髓的慢性壓迫及血供障礙,最終導致了與受損節(jié)段相關的脊髓功能障礙。據(jù)全球調查結果顯示在50歲以上脊髓功能損傷的成年人中,脊髓型頸椎病在占首要原因。臨床上CSM主要以頸脊髓損害為主要表現(xiàn),可伴有頸痛、上肢痛及麻木等,影像學檢查CT、MRI可輔助診斷。1955年,Robinsion和Smith首次開創(chuàng)頸椎前路減壓植骨融合術,因其術中入路簡便、暴露良好、出血較少,且能徹底去除受壓脊髓前方的致壓物,椎間植骨及加用鋼板內(nèi)固定后使頸椎更為穩(wěn)固等特點,是臨床治療脊髓型頸椎病的“標準術式”。然而脊椎減壓融合手術治療頸椎退變性疾病雖療效確切,仍存在有并發(fā)癥如臨近節(jié)段退行性病變(ASD)、生理活動丟失、繼發(fā)性失穩(wěn),部分患者甚至需要再次手術。頸椎前路經(jīng)椎間隙減壓植骨融合(ACDF)聯(lián)合人工椎間盤置換(CADR)術,即頸椎前路融合與非融合“混搭”手術(Hybrid Surgery)。該術式在保證脊髓充分減壓和融合的同時,也盡量減少了脊椎的生理活動的丟失,有效延緩了ASD的發(fā)生。中醫(yī)理論認為,脊髓型頸椎病屬于“痿證”、“痹證”范疇。運用中藥、針灸、推拿手法等傳統(tǒng)中醫(yī)手段治療輕、中度脊髓型頸椎病療效確切,目前臨床多主張采用中醫(yī)綜合療法治療脊髓型頸椎病。本研究通過分析本組病例短期臨床療效的結果,探論中醫(yī)與西醫(yī)治療脊髓型頸椎病的各自優(yōu)勢及存在的問題,探討中西醫(yī)結合治療CSM的優(yōu)勢。目的通過對比觀察中藥聯(lián)合Hybrid Surgery術式(中西醫(yī)結合組)與單純Hybrid Surgery術式(單純手術組)治療頸椎病的臨床療效,探討中西醫(yī)結合治療頸椎病的優(yōu)勢及存在的問題。方法對自2013年9月至2015年10月的36例頸椎病患者進行回顧性研究,其中采用中西醫(yī)結合組患者17例,單純手術組患者19例。術前、術后1、3、6、12個月分別行脊髓功能JOA評分(17分法)、頸椎殘障功能指數(shù)評分(NDI)評定臨床癥狀的改善情況及日常生活狀態(tài)、疼痛視覺模擬評分(VAS)、神經(jīng)功能Odom標準評級術后的療效優(yōu)良率、頸椎活動度(頸椎活動度評估：用Cobb法測量動力位X線片C2-C7整體活動度以及手術上位及下位相鄰節(jié)段活動度)結果兩組患者手術均順利完成,傷口均I期愈合。圍手術期未出現(xiàn)血管、神經(jīng)損傷、硬脊膜撕裂,未出現(xiàn)切口血腫和感染及脊髓功能損傷加重等并發(fā)癥。患者術后脊髓性及神經(jīng)性癥狀明顯改善,感覺和肌力均有不同程度的好轉。從數(shù)據(jù)分析中可以看出,中西醫(yī)結合組術后JOA評分略高于單純手術組,但不具有統(tǒng)計學差異(p0.05)。術后第12月,Odom標準分級方法,結合組優(yōu)良率分別為94.1%、89.4%。兩組術后神經(jīng)功能恢復情況良好,結合組在數(shù)據(jù)上顯示要高于單純手術組,但差異未出現(xiàn)統(tǒng)計學差異(p0.05)。頸椎活動度Cobb角兩組比較未見明顯統(tǒng)計學差異(p0.05)。VAS評分及頸椎殘障功能指數(shù)評分(NDI)中西醫(yī)結合組略低于單純手術組,兩組具有明顯統(tǒng)計學差異(p0.05)。結論治療頸椎病,中藥聯(lián)合Hybrid術式(中西醫(yī)結合方法)較單純西醫(yī)Hybrid術不僅能改善術后活動度,而且可以更加滿意的改善患者的神經(jīng)功能和脊髓癥狀。
[Abstract]:Background cervical spondylotic myelopathy (CSM) is a common and serious clinical type of cervical spondylosis. It is based on the degenerative lesion of the cervical intervertebral disc and the small joint as the basic pathological basis, forming the vertebral marginal osteophyte, then pressing the spinal cord, nerve root and the vascular of the nutrient spinal cord, causing the stenosis of the cervical spinal canal and the chronic compression of the spinal cord. The result of global survey shows that cervical spondylotic myelopathy is the primary cause of spinal cord injury in adults over 50 years of age. The main clinical manifestation of CSM is cervical spinal cord injury, including neck pain, upper limb pain and numbness, imaging examination of CT, MRI For the first time in the diagnosis of.1955, Robinsion and Smith first pioneered anterior cervical decompression and fusion for the first time because of its simple operation, good exposure, less bleeding, and a thorough removal of pressure in front of the compressed spinal cord, intervertebral bone graft and the fixation of the plate with steel plate to make the cervical spine more stable, which is the "standard" for the clinical treatment of cervical spondylotic myelopathy. Although spinal decompression and fusion is effective in the treatment of cervical degenerative disease, there are still complications such as adjacent segment degenerative disease (ASD), physiological activity loss, secondary instability, and some patients need reoperation. Anterior cervical intervertebral space decompression, bone fusion (ACDF) combined with artificial disc replacement (CADR) It is the anterior cervical fusion and the non fusion "Hybrid Surgery". The operation can reduce the loss of the physiological activity of the spine as much as possible while guaranteeing the full decompression and fusion of the spinal cord, and effectively postpone the occurrence of ASD. The theory of Chinese medicine holds that the spinal cervical spondylosis belongs to "flaccid syndrome", "arthralgia syndrome" category. The treatment of mild and moderate myelopathy with traditional Chinese medicine and other traditional Chinese medicine is effective in the treatment of cervical spondylotic myelopathy with traditional Chinese medicine. This study is to discuss the advantages and problems of traditional Chinese medicine and Western medicine in the treatment of spinal cervical spondylosis by analyzing the results of short term clinical effect in this group. The advantages of combination of traditional Chinese medicine combined with Hybrid Surgery (combination of traditional Chinese medicine and Western Medicine) and simple Hybrid Surgery (simple operation group) in the treatment of cervical spondylosis were compared, and the advantages and problems of the combination of traditional Chinese and Western medicine in the treatment of cervical spondylosis were compared and observed in 36 cases of cervical vertebra from September 2013 to October 2015. A retrospective study was carried out in the patients, including 17 patients with integrated traditional Chinese and Western medicine and 19 patients in simple operation group. Before operation, the spinal function JOA score (17 points) was performed 1,3,6,12 months after operation, and the cervical disability functional index score (NDI) was used to evaluate the improvement of clinical symptoms and daily living condition, pain visual analogue score (VAS) and nerve work. The good rate of curative effect after the Odom standard rating, the activity of cervical vertebra (evaluation of cervical vertebra activity), the results of two groups of patients were successfully completed with Cobb method to measure the overall activity degree of the power position X-ray film and the activity degree of adjacent segments of the upper and lower segments of the operation. All the wounds healed at I stage. No blood vessels, nerve injuries, and tulle of the spinal cord were found in the perioperative period. There were no complications such as incision hematoma and infection and aggravation of spinal cord function injury. The patients with spinal and neurogenic symptoms improved significantly after operation, and the sensation and muscle strength were improved in different degrees. From the data analysis, the JOA score of the combined Chinese and Western medicine group was slightly higher than that of the simple operation group, but there was no statistical difference (P0.05). Twelfth months, Odom standard classification method, combined group excellent rate of 94.1%, 89.4%. two groups after the recovery of nerve function good, the combination group on the data showed that the group was higher than the simple operation group, but the difference was not statistically significant (P0.05). There was no significant statistical difference (P0.05).VAS score and cervical disability in the two groups of cervical activity degree (P0.05). The barrier function index score (NDI) was slightly lower than that of the simple operation group, and the two groups had significant difference (P0.05). Conclusion the treatment of cervical spondylosis, the combination of traditional Chinese medicine and traditional Chinese medicine (combined traditional Chinese and Western Medicine) can not only improve the postoperative activity, but also improve the nerve function and spinal cord of the patients more satisfactorily. Symptom.

【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R687.3

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