椎间盘镜下髓核摘除术配合独活寄生汤加减治疗肝肾亏虚型腰椎间盘突出症临床观察.docVIP

椎间盘镜下髓核摘除术配合独活寄生汤加减治疗肝肾亏虚型腰椎间盘突出症临床观察 　　【摘 要】目的：观察椎间盘镜下髓核摘除术配合独活寄生汤加减治疗肝肾亏虚型腰椎间盘突出症的临床疗效。方法：将60例肝肾亏虚型腰椎间盘突出症患者随机分为治疗组和对照组，每组30例。对照组采用椎间盘镜下髓核摘除术治疗，治疗组在对照组的基础上配合独活寄生汤加减治疗，两组均以4周为1个疗程。观察两组临床疗效及术前、术后6个月及术后12个月随访时JOA下腰痛评分。结果：所有患者均获得随访，随访时间6～12个月，平均（7.50±1.32）个月。治疗组显效25例，有效4例，无效1例，总有效率为96.67%；对照组显效20例，有效7例，无效3例，总有效率为90.00%。两组比较，差异有统计学意义（P 0.05）。两组术后6个月及末次随访时，JOA评分较治疗前均有改善（P 0.05），且治疗组优于对照组（P 0.05）。两组治疗后腰腿痛症状均明显减轻，腰椎功能改善，但治疗组优于对照组（P 0.05）。两组均无椎间隙感染、脑脊液漏、神经根损伤等并发症发生，结论：辨证分型口服独活寄生汤加减治疗肝肾亏虚型腰椎间盘突出症，能够减轻或消除神经水肿，改善微循环，促进炎性介质及致痛物的清除，促进神经功能恢复，有效提高临床疗效，较单纯椎间盘镜下髓核摘除术具有优势，值得推广运用。 　　【关键词】 腰椎间盘突出症；肝肾亏虚型；独活寄生汤；髓核摘除术；椎间盘镜 　　doi：10.3969/j.issn.2095-4174.2015.10.008 　　【ABSTRACT】Objective：To observe the clinical curative effect of microendoscopic discectomy combined with modified Duhuo Jisheng Tang （独活寄生汤） in the treatment of liver-kidney-deficiency-type lumbar disc herniation.Methods：60 cases of liver-kidney-deficiency-type lumbar disc herniation were randomly divided into a treatment group and a control group，30 cases in each.Patients in the control group were treated by microendoscopic discectomy，while those in the treatment group were treated by microendoscopic discectomy combined with modified Duhuo Jisheng Tang，4 months for a course.The JOA low back pain scores and efficacy of the two groups were observed before operation and 6 and 12 months[average（7.50±1.32）months] after operation.Results：All the patients were followed up for 6 to 12 months.In the treatment group，25 cases were markedly effective，4 cases were effective，and 1 case was ineffective，the total effective rate being 96.67%；while in the control group，20 cases were markedly effective，7 cases were effective，and 3 cases were invalid，the total effective rate being 90%.The difference between the two groups was statistically significant （P 　　【Keywords】 lumbar disc herniation；liver-kidney-deficiency-type；Duhuo Jisheng Tang （独活寄生汤）；discectomy；diskoscope 　　腰椎间盘突出症是临床常见病，多见于中老年人，是引起腰腿痛的最常见原因。本病病程长，容易反复，不易根治，严重影响生活质量。笔者分