Yang Feng, Tan Ming-Sheng, Yi Ping, Tang Xiang-Sheng, Hao Qing-Ying, Qi Ying-Na
Department of Spinal Surgery, China-Japan Friendship Hospital, Beijing 100029, China.
Department of Spinal Surgery, China-Japan Friendship Hospital, Beijing 100029, China;
Zhongguo Gu Shang. 2018 Jan 25;31(1):30-36. doi: 10.3969/j.issn.1003-0034.2018.01.006.
To compare the clinical effect between spinal card decompression combined with traditional Chinese medicine and simple spinal card decompression for cervical spondylotic myelopathy.
From June 2012 to June 2015, 73 patients with cervical spondylotic myelopathy were treated, including 42 males and 31 females, aged from 29 to 73 years old with a mean of 50.9 years old. The patients were divided into the simple operation group (34 cases) and the operation combined with traditional Chinese medicine group(39 cases) according to the idea of themselves. The anterior discectomy or subtotal corpectomy with internal fixation or posterior simple open-door decompression with lateral mass screw fixation were performed in the patients. Among them, 39 cases were treated with traditional Chinese medicine after surgery. The Japanese orthopedic association (JOA) score of spinal cord function, the improvement rate of neural function, the neck dysfunction index (NDI) score and the governor vessel stasis syndrome score were compared between two groups preoperative and postoperative 1 week, 1 month and the final follow-up respectively. The internal fixation and the condition of spinal cord decompression were observed by CT, MRI and X-rays before and after operation.
All the operations were successful, no injuries such as dura mater, spinal cord and nerve root were found. All the wounds were healed without infection except one patient had a superficial infection. It was solved after intermittent debridement and anti-infective therapy. Hematoma occurred in 1 case, complicated with spinal cord compression, caused incomplete paralysis, and promptly performed the re-operation to remove the hematoma without any obvious sequelae. All the patients were followed up from 12 to 24 months, (14.6±0.8) months for simple operation group and (13.5±0.7) months for operation combined with traditional Chinese medicine group, and there was no significant difference(>0.05). The scores of JOA, NDI and the governor's vessel stasis syndrome in simple operation group were 8.31±3.15, 29.91±4.52, 6.58±1.31 before operation, and 10.21±2.58, 18.67±4.31, 8.24±1.18 one week after operation, and 11.38±2.85, 16.11±3.18, 8.91±2.11 one month after operation, and 12.21±3.12, 14.61±3.28, 9.12±1.56 at final follow-up, respectively; and in operation combined with traditional Chinese medicine group were 8.29±3.47, 30.83±4.14, 6.38±1.81before operation, and 10.48±2.39, 17.59±5.14, 8.33±1.57 one week after operation, and 12.14±3.12, 13.14±3.21, 9.55±2.49 one month after operation, and 13.85±3.34, 12.11±2.51, 10.33±1.95 at final follow-up, respectively. Postoperative JOA , NDI, and the governor vessel stasis syndrome score of two groups were significantly higher than preoperativee(<0.05). There was no significant difference in JOA, NDI, and the governor vessel stasis syndrome score between two groups one week after operation (>0.05). The above items in operation combined with traditional Chinese medicine group was better than that of simple operation group one month and final follow-up after operation (<0.05). The improvement rate of neural function in simple operation group was (67.59±10.78)%, and in operation combined traditional Chinese medicine group was (66.88±12.15)%, there was no significant difference between two groups(>0.05). There were no complications such as internal fixation failure or re-dislocation of atlas by postoperative CT, MRI and X-rays examination.
Spinal card decompression for the treatment of cervical spondylotic myelopathy can extend the spinal canal, relieve the compression of nerve, achieve the deoppilation of governor vessel, the regulation of qi and blood, the restore of Yangqi, combined with traditional Chinese medicine of activating blood removing stasis, warming yang and activating meridians, reinforcing liver benefiting kidney, which may obtain better clinical effect.
比较脊髓减压联合中药与单纯脊髓减压治疗脊髓型颈椎病的临床效果。
选取2012年6月至2015年6月收治的73例脊髓型颈椎病患者，其中男42例，女31例，年龄29～73岁，平均50.9岁。患者根据自身意愿分为单纯手术组（34例）和手术联合中药组（39例）。患者行前路椎间盘切除或椎体次全切除内固定术或后路单纯开门减压侧块螺钉内固定术。其中39例术后加用中药治疗。分别比较两组患者术前、术后1周、1个月及末次随访时脊髓功能日本骨科协会（JOA）评分、神经功能改善率、颈部功能障碍指数（NDI）评分及督脉瘀证评分。通过术前、术后CT、MRI及X线观察内固定及脊髓减压情况。
所有手术均成功，未发现硬脊膜、脊髓及神经根损伤等情况。除1例患者出现浅表感染，经间断清创及抗感染治疗后治愈外，其余伤口均愈合良好，无感染发生。1例出现血肿，并发脊髓压迫，导致不全瘫，及时行再次手术清除血肿，无明显后遗症。所有患者随访12～24个月，单纯手术组平均（14.6±0.8）个月，手术联合中药组平均（13.5±0.7）个月，差异无统计学意义（>0.05）。单纯手术组术前JOA、NDI及督脉瘀证评分分别为8.31±3.15、29.91±4.52、6.58±1.31，术后1周分别为10.21±2.58、18.67±4.31、8.24±1.18，术后1个月分别为11.38±2.85、16.11±3.18、8.91±2.11，末次随访分别为12.21±3.12、14.61±3.28、9.12±1.56；手术联合中药组术前分别为8.29±3.47、30.83±4.14、6.38±1.81，术后1周分别为10.48±2.39、17.59±5.14、8.33±1.57，术后1个月分别为12.14±3.12、13.14±3.21、9.55±2.49，末次随访分别为13.85±3.34、12.11±2.51、10.33±1.95。两组术后JOA、NDI及督脉瘀证评分均显著高于术前（<0.05）。术后1周两组JOA、NDI及督脉瘀证评分差异无统计学意义（>0.05）。术后1个月及末次随访时，手术联合中药组上述各项指标均优于单纯手术组（<0.05）。单纯手术组神经功能改善率为（67.59±10.78）%，手术联合中药组为（66.88±12.15）%，两组差异无统计学意义（>0.05）。术后CT、MRI及X线检查未发现内固定失败或寰椎再脱位等并发症。
脊髓减压治疗脊髓型颈椎病可扩大椎管，解除神经压迫，达到督脉通畅、气血调和、阳气恢复，联合活血化瘀、温阳通脉、补益肝肾的中药，可能获得更好的临床效果。
