【摘要】：目的：本研究是針對腰椎開窗術后局部血腫形成,不能及時吸收,導致大量瘢痕組織形成的研究。通過試驗研究及臨床應用觀察丹參注射液對血腫吸收的影響,期望達到減少硬膜外疤痕粘連的形成,提高腰椎手術療效。方法：采用前瞻性研究方法,收集2014年8月至2015年6月,因腰椎間盤突出癥(血瘀型)需行腰椎手術治療患者40例,按照入院時間隨機分為丹參組和生理鹽水組,最后納入數據統(tǒng)計的有40例,即試驗組(丹參注射液+膠原蛋白組,20例)、對照組(生理鹽水+膠原蛋白組,20例)。觀察隨訪期限6個月。術后兩天內觀察引流量并計量,采用VAS、ODI評分法于術前1天及術后3、6個月評價臨床癥狀改善情況,并行腰椎術后MRI檢查,觀察瘢痕變化情況,所有數據采用SPSS20.0軟件進行比較分析。結果：臨床中患者有40例,均得到隨訪,且術后都恢復效果好。比較兩組患者術前基線特征(年齡),均未見顯著性差異(P0.05),具有可比性。兩組患者均獲得6個月的隨訪,無椎管狹窄、神經、血管損傷等并發(fā)癥發(fā)生。兩組VAS不同時間比較,丹參組術后3、6個月VAS評分低于生理鹽水組,差異有統(tǒng)計學意義(P0.05)。兩組在術后3、6個月各觀察點ODI評分均有顯著差異(P0.05),且丹參組的臨床療效優(yōu)于生理鹽水組。MRI檢查示丹參組瘢痕形成及突入椎管情況明顯小于生理鹽水組,差異具有統(tǒng)計學意義(P0.05)。結論：局部應用丹參注射液可有效促進局部血腫吸收與清除,減少瘢痕形成,減輕硬膜外粘連。術后隨訪發(fā)現(xiàn)術后粘連引起的并發(fā)癥減少。
[Abstract]:Objective: this study is aimed at the formation of local hematoma after lumbar fenestration, which can not be absorbed in time, resulting in a large number of scar tissue formation. The effect of Salvia miltiorrhiza injection on hematoma absorption was observed in order to reduce the formation of epidural scar adhesion and improve the effect of lumbar surgery. Methods: from August 2014 to June 2015, 40 patients with lumbar disc herniation (blood stasis type) were randomly divided into Salvia miltiorrhiza group and saline group according to their admission time. Finally, 40 cases were included in the data, that is, the experimental group (20 cases of Danshen injection collagen group) and the control group (20 cases of normal saline collagen group). The follow-up period was 6 months. The drainage flow was observed and measured within two days after operation. The improvement of clinical symptoms was evaluated 1 day before operation and 3 months and 6 months after operation by VAS,ODI score. The changes of scar were observed by MRI examination after lumbar vertebra operation. All the data were compared and analyzed by SPSS20.0 software. Results: 40 patients were followed up and recovered well after operation. The baseline characteristics (age) of the two groups were not significantly different (P0.05). The patients in both groups were followed up for 6 months without complications such as spinal canal stenosis, nerve and vascular injury. Compared with VAS in two groups, the VAS score of salvia miltiorrhiza group was significantly lower than that of saline group at 3 and 6 months after operation (P0.05). There were significant differences in ODI scores between the two groups at 3 and 6 months after operation (P0.05), and the clinical efficacy of salvia miltiorrhiza group was better than that of normal saline group. MRI examination showed that the scar formation and the process of spinal canal in Salvia miltiorrhiza group were significantly lower than those in saline group. The difference was statistically significant (P0.05). Conclusion: local application of Salvia miltiorrhiza injection can effectively promote the absorption and clearance of local hematoma, reduce scar formation and reduce epidural adhesion. The postoperative follow-up showed that the complications caused by postoperative adhesions were reduced.
【學位授予單位】：福建中醫(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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