【摘要】：目的:對(duì)后柱重建治療中央型腰椎間盤突出癥的術(shù)式評(píng)價(jià),圍手術(shù)期聯(lián)合使用甘肅省中醫(yī)院“損傷膠囊”(治療組)與傳統(tǒng)全椎板減壓椎間盤切除組(對(duì)照組)治療中央型腰椎間盤突出癥的指標(biāo)及療效進(jìn)行對(duì)比研究,以期探討后柱重建治療中央型椎間盤突出癥的臨床療效。旨在較大限度地保持脊柱的生物力學(xué)穩(wěn)定,預(yù)防傳統(tǒng)的椎板切除減壓手術(shù)引起的不良綜合癥,為此術(shù)式治療中央型椎間盤突出癥提供臨床依據(jù)。并在治療過(guò)程中給予中藥制劑損傷膠囊干預(yù),對(duì)中藥聯(lián)合手術(shù)治療中央型腰椎間盤突出癥進(jìn)行臨床研究。方法:嚴(yán)格按照中央型腰椎間盤突出癥的納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn),入選2012年1月~2014年1月甘肅省中醫(yī)院中央型腰椎間盤突出癥患者78例,將符合入選的中央型腰椎間盤突出癥核患者38例采用后柱重建術(shù)式聯(lián)合圍手術(shù)期損傷膠囊干預(yù)作為治療組。并將另40例患者采用傳統(tǒng)全椎板減壓椎間盤切除組作為對(duì)照組,分別從腰椎JOA標(biāo)準(zhǔn)及功能障礙指數(shù)(ODI)對(duì)術(shù)前、術(shù)后腰椎及下肢功能恢復(fù)情況進(jìn)行對(duì)比分析,結(jié)合患者術(shù)后實(shí)際臨床癥狀緩解情況、重建后柱的骨性愈合情況以及是否存在術(shù)后腰椎不穩(wěn)定等方面,評(píng)價(jià)后柱重建術(shù)對(duì)治療中央型椎間盤突出癥患者的療效,并作統(tǒng)計(jì)學(xué)分析。結(jié)果:后柱重建治療中央型腰椎間盤突出癥在解除脊髓壓迫、保證脊柱的穩(wěn)定性等有顯著優(yōu)越性。臨床研究顯示,后柱重建術(shù)式聯(lián)合損傷膠囊治療中央型腰椎間盤突出癥較對(duì)照組在腰椎JOA標(biāo)準(zhǔn)及功能障礙指數(shù)(ODI)、術(shù)后腰椎的穩(wěn)定性及下肢功能恢復(fù)情況等方面有顯著優(yōu)勢(shì),均存在統(tǒng)計(jì)學(xué)意義。結(jié)論:后柱重建術(shù)治療中央型腰椎間盤突出癥不僅能徹底解除脊髓壓迫,大大縮短手術(shù)時(shí)間,充分解決了椎管狹窄、椎管內(nèi)硬膜及神經(jīng)根受壓。對(duì)脊柱整體結(jié)構(gòu)的破壞較小,后柱重建內(nèi)固定又可以同時(shí)實(shí)現(xiàn)脊柱的牢固融合。
[Abstract]:Objective: to evaluate the method of posterior column reconstruction in the treatment of central lumbar disc herniation. The index and effect of central lumbar disc herniation treated by combined use of "injury capsule" in Gansu Provincial traditional Chinese Medicine Hospital (treatment group) and traditional total laminectomy discectomy group (control group) during perioperative period were compared. To explore the clinical effect of posterior column reconstruction in the treatment of central disc herniation. The aim is to maintain the biomechanical stability of the spine to prevent the adverse syndrome caused by the traditional laminectomy and decompression surgery and to provide the clinical basis for the treatment of central disc herniation. The treatment of central lumbar disc herniation with traditional Chinese medicine combined with surgery was studied. Methods: 78 patients with central lumbar disc herniation were selected from January 2012 to January 2014 according to the inclusion and exclusion criteria of central lumbar disc herniation. Thirty-eight patients with central lumbar disc herniation were treated with post reconstruction combined with perioperative injury capsule intervention. Another 40 patients were treated with traditional total lamina decompression discectomy group as control group. The recovery of lumbar vertebrae and lower extremities were compared and analyzed from JOA criteria and dysfunction index (ODI) before and after operation. To evaluate the efficacy of post reconstruction in the treatment of central disc herniation, the clinical symptoms were alleviated, the bone healing of the reconstructed post column and the instability of lumbar vertebrae were evaluated. Statistical analysis was made. Results: posterior column reconstruction in the treatment of central lumbar disc herniation has significant advantages in relieving spinal cord compression and ensuring spinal stability. Clinical study showed that posterior column reconstruction combined with injury capsule in the treatment of central lumbar disc herniation compared with the control group in lumbar JOA standards and dysfunction index (ODI), The stability of lumbar vertebrae and the recovery of lower limb function were significant. Conclusion: reconstruction of posterior column in the treatment of central lumbar disc herniation can not only completely relieve spinal cord compression, greatly shorten the operation time, but also fully solve the spinal canal stenosis, spinal canal dural and nerve root compression. The damage to the whole structure of the spine is small, and the posterior column reconstruction and internal fixation can also realize the solid fusion of the spine at the same time.
【學(xué)位授予單位】：甘肅中醫(yī)藥大學(xué)(原名：甘肅中醫(yī)學(xué)院)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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