早期手术联合补阳还五汤治疗颈椎间盘突出合并脊髓损伤继发中枢性疼痛临床研究
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Clinical Study on Early Surgery Combined with Buyang Huanwu Tang for Central Pain Secondary to Spinal Cord Injury Complicated with Cervical Disc Herniation
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    摘要:

    目的:观察早期手术联合补阳还五汤治疗颈椎间盘突出合并脊髓损伤(SCI) 继发中枢性疼痛(CP) 的疗效。方法:选取88例颈椎间盘突出症合并SCI继发CP患者,根据其治疗意愿分为试验组25例、单纯手术组30例及保守组33例。试验组和单纯手术组患者入院3 d内采用前路颈椎间盘切除融合术(ACDF) 治疗,试验组术后联合补阳还五汤及营养神经等对症治疗,保守组给予制动及甲钴胺片治疗。比较3组田中靖久颈椎病症状量表评分、颈椎功能障碍指数(NDI) 及简化版McGill问卷(SF-MPQ) 评分。结果:治疗1 个月、随访6 个月及随访12 个月,3 组田中靖久颈椎病症状量表评分均较治疗前升高(P<0.05),NDI均较治疗前降低(P<0.05)。治疗1个月、随访6个月,试验组田中靖久颈椎病症状量表评分均高于单纯手术组和保守组(P<0.05),NDI 评分均低于单纯手术组和保守组(P<0.05);单纯手术组田中靖久颈椎病症状量表评分高于保守组(P<0.05),NDI低于保守组(P<0.05)。随访12个月,试验组与单纯手术组上述2项评分均优于保守组(P<0.05);试验组与单纯手术组上述2 项评分比较,差异均无统计学意义(P>0.05)。治疗1 个月、随访6 个月、随访12 个月,3 组疼痛分级指数(PRI)(感觉项、情感项)、视觉模拟评分(VAS) 及现时疼痛强度(PPI) 评分均较治疗前降低(P<0.05)。治疗1个月、随访6个月,试验组与单纯手术组PRI、VAS 及PPI 评分均低于保守组(P<0.05),试验组PRI、VAS 及PPI 评分均低于单纯手术组(P<0.05)。随访12 个月,试验组和单纯手术组PRI 感觉项评分、VAS 评分及PPI 评分均低于保守组(P<0.05);试验组与单纯手术组上述3项评分比较,差异均无统计学意义(P>0.05)。结论:对于颈椎间盘突出症合并SCI继发CP患者,早期采取手术联合补阳还五汤治疗可有效缓解疼痛,加速颈椎功能恢复。

    Abstract:

    Abstract:Objective:To observe the curative effect of early surgery combined with Buyang Huanwu tang for central pain (CP) secondary to spinal cord injury(SCI) complicated with cervical disc herniation. Methods:A total of 88 cases of patients with cervical disc herniation complicated with SCI secondary to CP were selected and divided into the experiment group,the simple surgery group and the conservative group according to patients'willingness to receive treatment,25 cases,30 cases and 33 cases in each group respectively. The experiment group and the simple surgery group were given anterior cervical discectomy and fusion(ACDF) during the first three days of hospitalization; the experiment group was given such symptomatic treatment as Buyang Huanwu tang and nerve- nourishing after surgery; the conservative group was given immobilization and mecobalamin tablets. The scores of Tanaka Yasuhisa's Cervical Spondylosis Symptom Scale, Neck Disability Index(NDI) and Short- form of McGill Pain Questionnaire(SF- MPQ) were compared among the three groups.Results:During the one- month treatment,as well as six- month and twelve- month follow- ups,the scores of Cervical Spondylosis Symptom Scale in the three groups were increased when compared with those before treatment(P<0.05),and the NDI were decreased when compared with those before treatment(P<0.05). During the one- month treatment and sixmonth follow-up,the scores of Cervical Spondylosis Symptom Scale in the experiment group were higher than those in the simple surgery group and the conservative group(P<0.05),the NDI were lower than those in the simple surgery group and the conservative group(P<0.05); compared with those in the conservative group, the scores of Cervical Spondylosis Symptom Scale in the simple surgery group were higher(P<0.05), and the NDI were lower(P<0.05). During the twelvemonth follow- up, the scores of Cervical Spondylosis Symptom Scale and NDI in the experiment group and the simple surgery group were better than those in the conservative group(P<0.05), and when compared the above two scores between the experiment group and the simple surgery group,there was no significance in the difference(P>0.05). During the one- month treatment, six- month and twelve- month follow- ups, the scores of Pain Rating Index(PRI) including the sensory and affective dimensions, Visual Analogue Scale(VAS) and present pain intensity(PPI) in the three groups were decreased when compared with those before treatment(P<0.05). During the one-month treatment and six-month follow-up, the scores of PRI, VAS and PPI in the experiment group and the simple surgery group were lower than those in the conservative group(P<0.05), and the above three scores in the experiment group were lower than those in the simple surgery group(P<0.05). During the twelve- month follow- up,the scores of PRI- sensory,VAS and PPI in the experiment group and the simple surgery group were lower than those in the conservative group(P<0.05), and when compared the above three scores between the experiment group and the simple surgery group,there was no significance in the difference (P>0.05). Conclusion:For senile patients with cervical disc herniation complicated with CP secondary to SCI,the therapy of early surgery combined with Buyang Huanwu tang can effectively alleviate the pain and accelerate the recovery of the function of cervical vertebra.

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安忠诚,王国强,朱宇尘,魏浩,董黎强.早期手术联合补阳还五汤治疗颈椎间盘突出合并脊髓损伤继发中枢性疼痛临床研究[J].新中医,2020,52(11):38-42

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  • 在线发布日期: 2020-06-04
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