恒古骨傷愈合劑促進腰椎板開窗微小骨粒回植骨重建的研究
發(fā)布時間：2019-04-09 09:23
【摘要】：目的：觀察恒古骨傷愈合劑對腰椎板開窗術后微小骨�；刂补侵亟ǖ膶嶒炑芯考俺醪脚R床應用,探討恒古骨傷愈合劑促進椎板開窗處自體微小骨粒骨重建的療效及作用機制。方法：(1)動物實驗研究：選取清潔級健康雄性新西蘭大白兔22只,隨機分為3組,A組(治療組,n=9)；B組(對照組,n=9)；C組(正常組,n=4)。A組建立兔腰椎板開窗術后微小骨�；刂驳哪Ｐ�,給予恒古骨傷愈合劑治療,(按經(jīng)由人與兔體表面積用藥量換算計算出的劑量,兔用藥量為1.30ml/kg)灌胃,1次／2d,服用3個月；B組建立模型后,服用相同劑量的生理鹽水,C組未進行手術處理,相同劑量的生理鹽水灌服,治療后4、8、12周分別行大體標本粘連組織觀察、羥脯氨酸(hydroxyproline, Hyp)測定、CT檢查及組織形態(tài)學觀察。(2)初步臨床應用：采用前瞻性研究方法,收集2013年10月至2014年8月,因腰椎間盤突出癥(血瘀型)需行腰椎手術治療患者50例,按照入院時間隨機分為治療組和對照組,最后因隨訪問題納入數(shù)據(jù)統(tǒng)計的有41例(41/50),即治療組(常規(guī)治療+恒古骨傷愈合劑組,21例)、對照組(常規(guī)治療組,20例),觀察隨訪期限6個月。采用VAS、ODI評分法于術前1天及術后1、3、6月評價臨床癥狀改善情況,并行腰椎術后CT檢查,觀察骨重建變化情況,所有數(shù)據(jù)采用SPSS18.0軟件進行比較分析。結果：(1)實驗部分：大體觀察及組織學發(fā)現(xiàn),A組的粘連程度Rydell分級及組織學分級要遠低于B組(P0.05)。羥脯氨酸濃度分析結果顯示A組瘢痕組織中羥脯氨酸濃度要明顯低于B組(P0.05)。CT檢查示術后12周A組微小骨粒形成骨板與開窗椎板骨質(zhì)相連、骨梁連續(xù),無明顯界限,椎管形態(tài)及容積無明顯變化,未見脊髓受壓；B組對照節(jié)段椎板缺損,少量瘢痕突入椎管內(nèi),椎管重建未完成。(2)臨床中患者有41例(41/50)獲隨訪(隨訪率為82.0%)。比較兩組患者基線特征(年齡、病程、突出節(jié)段、腰椎間盤突出類型、術前VAS、ODI評分及術后3天CT值),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(jīng)、血管損傷等并發(fā)癥發(fā)生。兩組VAS不同時間比較,治療組術后1、3、6個月VAS評分低于對照組,差異有統(tǒng)計學意義(P0.05)。兩組在術后1、6個月各觀察點ODI評分均有顯著差異(P0.05),且治療組的臨床療效優(yōu)于對照組。CT檢查示治療組微小骨粒植骨區(qū)CT值在術后3、6個月較對照組均明顯增高,差異具有統(tǒng)計學意義(P0.05)。結論：(1)恒古骨傷愈合劑可有效促進兔椎板開窗處再植自體微小骨粒的骨重建,形成的骨板可遮擋疤痕侵入椎管,減少椎管內(nèi)粘連。(2)恒古骨傷愈合劑聯(lián)合腰椎后路髓核摘除微小骨�；刂矐糜谘甸g盤突出癥手術治療,回植微小骨粒重建椎管(骨性結構)效果好,術后隨訪發(fā)現(xiàn)術后粘連引起的并發(fā)癥減少。
[Abstract]:Aim: to observe the experimental study and preliminary clinical application of Henggu Gushangyu mixture (HGJM) in the reconstruction of small bone granule bone graft after lumbar laminar fenestration, and to explore the therapeutic effect and mechanism of Henggu Gu Shuangyu mixture on autogenous small bone particle bone reconstruction at lamina fenestration. Methods: (1) Animal experiment: 22 healthy male New Zealand rabbits of clean grade were randomly divided into 3 groups: group A (treatment group, n = 9); B); Group C (normal group, n = 4). A) was used to establish the model of small bone particle reimplantation after fenestration of lumbar lamina in rabbits and treated with Henggu Gushangyu mixture (according to the dose calculated by the amount of drugs used in the conversion between human and rabbit body surface area). The dosage of 1.30ml/kg was given to rabbits once a day for 3 months. After the model was established in group B, the rats in group B were treated with the same dose of saline, while the group C was not treated surgically. The same dose of saline was administered in group C. After 4, 8 and 12 weeks of treatment, the adhesive tissues of gross specimens were observed and the hydroxyproline (hydroxyproline, Hyp) was measured. CT examination and histomorphology observation. (2) preliminary clinical application: from October 2013 to August 2014, 50 patients with lumbar disc herniation (blood stasis type) who needed lumbar spine surgery were collected by prospective study method. According to the admission time, 41 cases (41 cases) were randomly divided into the treatment group and the control group according to the time of admission. The treatment group (21 cases) and the control group (routine treatment group, 21 cases) and the control group (routine treatment group) were included in the data statistics according to the follow-up problem. The follow-up period was 6 months. VAS,ODI scoring method was used to evaluate the improvement of clinical symptoms 1 day before operation and 1, 3 and 6 months after operation. The changes of bone reconstruction were observed by CT after lumbar surgery. All the data were compared and analyzed with SPSS18.0 software. Results: (1) the experimental part: gross observation and histology showed that the adhesion degree of group A was significantly lower than that of group B (P 0.05). The Rydell grade and histological grade of group A were significantly lower than those of group B (P0.05). The results of hydroxyproline concentration analysis showed that the concentration of hydroxyproline in scar tissue of group A was significantly lower than that of group B (P0.05). Ct examination showed that the bone plate of group A was connected with the bony of fenestrated lamina at 12 weeks after operation, the bone beam was continuous, and there was no obvious limit. There were no significant changes in the shape and volume of spinal canal and no compression of spinal cord. (2) 41 patients (41 / 50) were followed up (follow-up rate was 82.0%) in group B compared with segmental laminae defect, a small number of cicatricial processes entered the spinal canal, and the spinal canal reconstruction was not completed. (2) in the clinic, 41 cases (41%) were followed up. There was no significant difference in baseline characteristics (age, course of disease, herniation segment, type of lumbar disc herniation, preoperative VAS,ODI score and CT value 3 days after operation) between the two groups (P0.05). The patients in both groups were followed up for 6 months without complications such as spinal canal stenosis, nerve and vascular injury. The VAS scores in the treatment group were significantly lower than those in the control group at 1, 3 and 6 months after operation (P0.05). The VAS scores of the two groups were significantly lower than those of the control group at different time (P0.05). There were significant differences in ODI scores between the two groups at 1 and 6 months after operation (P0.05), and the clinical efficacy of the treatment group was better than that of the control group. Ct examination showed that the CT value of the minimal bone graft area in the treatment group was significantly higher than that in the control group at 3 and 6 months after operation. The difference was statistically significant (P0.05). Conclusion: (1) Henggu Guishuangyu mixture can effectively promote the reconstruction of autogenous tiny bone particles at the fenestration of lamina in rabbits, and the resulting bone plate can occlude scar and invade the spinal canal. (2) Henggu Gu Shuangyu mixture combined with posterior lumbar nucleus pulposus implantation for lumbar disc herniation was applied to the surgical treatment of lumbar intervertebral disc herniation, and the reconstruction of spinal canal (bony structure) with small bone particle was good, and the effect of reconstruction of spinal canal (bony structure) was good. Postoperative follow-up showed that complications caused by postoperative adhesion decreased.
【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】：2015
【分類號】：R687.3
本文編號：2455049
[Abstract]:Aim: to observe the experimental study and preliminary clinical application of Henggu Gushangyu mixture (HGJM) in the reconstruction of small bone granule bone graft after lumbar laminar fenestration, and to explore the therapeutic effect and mechanism of Henggu Gu Shuangyu mixture on autogenous small bone particle bone reconstruction at lamina fenestration. Methods: (1) Animal experiment: 22 healthy male New Zealand rabbits of clean grade were randomly divided into 3 groups: group A (treatment group, n = 9); B); Group C (normal group, n = 4). A) was used to establish the model of small bone particle reimplantation after fenestration of lumbar lamina in rabbits and treated with Henggu Gushangyu mixture (according to the dose calculated by the amount of drugs used in the conversion between human and rabbit body surface area). The dosage of 1.30ml/kg was given to rabbits once a day for 3 months. After the model was established in group B, the rats in group B were treated with the same dose of saline, while the group C was not treated surgically. The same dose of saline was administered in group C. After 4, 8 and 12 weeks of treatment, the adhesive tissues of gross specimens were observed and the hydroxyproline (hydroxyproline, Hyp) was measured. CT examination and histomorphology observation. (2) preliminary clinical application: from October 2013 to August 2014, 50 patients with lumbar disc herniation (blood stasis type) who needed lumbar spine surgery were collected by prospective study method. According to the admission time, 41 cases (41 cases) were randomly divided into the treatment group and the control group according to the time of admission. The treatment group (21 cases) and the control group (routine treatment group, 21 cases) and the control group (routine treatment group) were included in the data statistics according to the follow-up problem. The follow-up period was 6 months. VAS,ODI scoring method was used to evaluate the improvement of clinical symptoms 1 day before operation and 1, 3 and 6 months after operation. The changes of bone reconstruction were observed by CT after lumbar surgery. All the data were compared and analyzed with SPSS18.0 software. Results: (1) the experimental part: gross observation and histology showed that the adhesion degree of group A was significantly lower than that of group B (P 0.05). The Rydell grade and histological grade of group A were significantly lower than those of group B (P0.05). The results of hydroxyproline concentration analysis showed that the concentration of hydroxyproline in scar tissue of group A was significantly lower than that of group B (P0.05). Ct examination showed that the bone plate of group A was connected with the bony of fenestrated lamina at 12 weeks after operation, the bone beam was continuous, and there was no obvious limit. There were no significant changes in the shape and volume of spinal canal and no compression of spinal cord. (2) 41 patients (41 / 50) were followed up (follow-up rate was 82.0%) in group B compared with segmental laminae defect, a small number of cicatricial processes entered the spinal canal, and the spinal canal reconstruction was not completed. (2) in the clinic, 41 cases (41%) were followed up. There was no significant difference in baseline characteristics (age, course of disease, herniation segment, type of lumbar disc herniation, preoperative VAS,ODI score and CT value 3 days after operation) between the two groups (P0.05). The patients in both groups were followed up for 6 months without complications such as spinal canal stenosis, nerve and vascular injury. The VAS scores in the treatment group were significantly lower than those in the control group at 1, 3 and 6 months after operation (P0.05). The VAS scores of the two groups were significantly lower than those of the control group at different time (P0.05). There were significant differences in ODI scores between the two groups at 1 and 6 months after operation (P0.05), and the clinical efficacy of the treatment group was better than that of the control group. Ct examination showed that the CT value of the minimal bone graft area in the treatment group was significantly higher than that in the control group at 3 and 6 months after operation. The difference was statistically significant (P0.05). Conclusion: (1) Henggu Guishuangyu mixture can effectively promote the reconstruction of autogenous tiny bone particles at the fenestration of lamina in rabbits, and the resulting bone plate can occlude scar and invade the spinal canal. (2) Henggu Gu Shuangyu mixture combined with posterior lumbar nucleus pulposus implantation for lumbar disc herniation was applied to the surgical treatment of lumbar intervertebral disc herniation, and the reconstruction of spinal canal (bony structure) with small bone particle was good, and the effect of reconstruction of spinal canal (bony structure) was good. Postoperative follow-up showed that complications caused by postoperative adhesion decreased.
【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】：2015
【分類號】：R687.3
【引證文獻】
相關會議論文 前1條
1 喻贛鵬;李剛;荊浩;周岳;胡寧敏;;自體微小顆粒骨復合萬古霉素治療感染性骨缺損的實驗研究[A];寧夏醫(yī)學會第八屆骨科學術會議論文匯編[C];2013年
，本文編號：2455049
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