三圣汤加减方联合中药熏蒸对腰椎间盘突出症患者经皮椎间孔镜下腰椎间盘切除术后的疗效观察

Observation on the Therapeutic Effect of Sansheng Decoction Combined with Chinese Herbal Medicine Fumigation on Patients with Lumbar Disc Herniation After Percutaneous Endoscopic Lumbar Discectomy

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摘要【目的】探讨三圣汤加减方联合中药熏蒸对腰椎间盘突出症患者经皮椎间孔镜下腰椎间盘切除术(PELD)后的临床疗效。【方法】将66例拟行PELD治疗的腰椎间盘突出症肝肾亏虚夹瘀证患者随机分为对照组和治疗组,每组各33例。2组患者均行PELD治疗,对照组术后常规予以消炎镇痛、营养神经、抗感染等治疗,治疗组在对照组的基础上加用三圣汤加减方(由杜仲、白术、山茱萸、三七、五加皮等组成)联合中药熏洗(中药薰蒸方由牛膝、当归、鸡血藤、桑寄生、黑老虎等组成)治疗。观察2组患者治疗前后腰椎疼痛视觉模拟量表(VAS)评分以及腰椎功能日本骨科协会(JOA)评分、Oswestry功能障碍指数(ODI)评分的变化情况,并比较2组患者的术后并发症及复发情况。【结果】(1)腰椎疼痛程度方面,治疗1个月、3个月和6个月后,除对照组在治疗6个月后与3个月后的腰椎疼痛VAS评分比较差异无统计学意义(P>0.05)外,2组患者的腰椎疼痛VAS评分均较前1个观察时点明显下降(P<0.05),且治疗组在治疗1个月、3个月和6个月后对腰椎疼痛VAS评分的下降幅度均明显优于对照组(P<0.05或P<0.01)。(2)腰椎功能JOA评分方面,治疗1个月、3个月和6个月后,除对照组在治疗6个月后与3个月后的JOA评分比较差异无统计学意义(P>0.05)外,2组患者的JOA评分均较前1个观察时点明显升高(P<0.05),且治疗组在治疗1个月、3个月和6个月后对JOA评分的升高幅度均明显优于对照组(P<0.01)。(3)腰椎功能ODI评分方面,治疗1个月、3个月和6个月后,2组患者的ODI评分均较前1个观察时点明显下降(P<0.05),且治疗组在治疗1个月、3个月和6个月后对ODI评分的下降幅度均明显优于对照组(P<0.01)。(4)并发症方面,2组患者术后均未发生神经根、硬脑膜损伤及其他不良反应。(5)复发情况方面,2组患者均有1例脱失,其余患者均获得3年随访。3年内,对照组有4例患者复发,治疗组有1例患者复发,但均未再次手术治疗。【结论】三圣汤加减方联合中药熏蒸治疗腰椎间盘突出症PELD术后肝肾亏虚夹瘀证患者疗效较好,可有效缓解术后疼痛,促进术后腰椎功能恢复。 Objective To investigate the clinical effect of Sansheng Decoction combined with Chinese herbal medicine fumigation on patients with lumbar disc herniation after percutaneous endoscopic lumbar discectomy(PELD).Methods Sixty-six patients with lumbar disc herniation of liver and kidney deficiency complicated with blood-stasis syndrome who were planning to take PELD were randomly divided into control group and treatment group,33 cases in each group.Both groups were treated with PELD.After PELD,the control group was routinely treated with anti-inflammatory,analgesic,neurotrophic and anti-infective treatment.On the basis of treatment for the control group,the treatment group was treated with modified Sansheng Decoction(composed of Eucommiae Cortex,Atractylodis Macrocephalae Rhizoma,Corni Fructus,Notoginseng Radix et Rhizoma,Acanthopanacis Cortex,etc.)orally combined with Chinese herbal medicine fumigation(consists of Achyranthis Bidentatae Radix,Angelicae Sinensis Radix,Spatholobi Caulis,Taxilli Herba,Kadsurae Coccineae Radix,etc.).Before and after treatment,the changes of Visual Analogue Scale(VAS)score of lumbar pain,Japanese Orthopedic Association(JOA)score and Oswestry Disability Index(ODI)score of lumbar function in the two groups were observed.Moreover,the postoperative complications and recurrence in the two groups were compared.Results(1)After 1 month,3 months and 6 months of treatment,except that there was no significant difference between the post-6-month VAS scores and the post-3-month VAS scores in the control group(P>0.05),the VAS scores of lumbar pain in the two groups were all significantly lowered compared with those at the previous observation time point(P<0.05),and the decrease in the treatment group after 1 month,3 months and 6 months of treatment was significantly superior to that in the control group(P<0.05 or P<0.01).(2)After 1 month,3 months and 6 months of treatment,except that the JOA scores of lumbar function in the control group after 6 months of treatment did not differ from those after 3 months of treatment(P>0.05),the JOA scores of the two groups were all significantly increased compared with those at the previous observation time point(P<0.05),and the increase in the treatment group after 1 month,3 months and 6 months of treatment was significantly superior to that in the control group(P<0.01).(3)After 1 month,3 months and 6 months of treatment,the ODI score of lumbar function in the two groups were all significantly decreased compared with those at the previous observation time point(P<0.05),and the decrease in the treatment group after 1 month,3 months and 6 months of treatment was significantly superior to that in the control group(P<0.01).(4)In terms of the complications,no injury of nerve root and dura mater or other adverse reactions occurred in the two groups after operation.(5)During the trial,there was one patient lost from each group,and the remaining patients were followed up for 3 years.Within the 3 years,4 patients in the control group relapsed,and one patient in the treatment group relapsed,and all of the relapsed patients did not receive reoperation.Conclusion Sansheng Decoction combined with Chinese herbal medicine fumigation exerts certain effect in the treatment of patients with liver and kidney deficiency complicated with blood-stasis syndrome after PELD for lumbar disc herniation.The therapy can effectively relieve postoperative pain and promote the recovery of postoperative lumbar function.

作者童源浩吕炤莹桑莉莉池科德吴俊哲 TONG Yuanhao;LYU Zhaoying;SANG Lili;CHI Kede;WU Junzhe(Zhongshan Hospital of Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine,Zhongshan 528400 Guangdong,China)

机构地区广州中医药大学附属中山中医院

出处《广州中医药大学学报》 2025年第5期1097-1103,共7页 Journal of Guangzhou University of Traditional Chinese Medicine

基金广东省中医药局科研项目(编号:20232197) 广东省中山市“吴俊哲市级名中医药专家传承工作室”建设项目。

关键词三圣汤加减方中药熏蒸腰椎间盘突出症经皮椎间孔镜下腰椎间盘切除肝肾亏虚夹瘀证腰椎功能 modified Sansheng Decoction Chinese herbal medicine fumigation lumbar disc herniation(LDH) percutaneous endoscopic lumbar discectomy(PELD) liver and kidney deficiency complicated with blood-stasis syndrome lumbar function

分类号 R274.9 [医药卫生—中西医结合]

作者简介童源浩(1998-),男,硕士研究生,E-mail:1093526126@qq.com;通信作者:吴俊哲(1970-),男,主任医师,博士研究生导师,E-mail:2640625235@qq.com。