[1]移平 谭明生△ 吕国华 杨峰 唐向盛 郝庆英 周英杰 张恩忠 姜良海 刘楚吟 齐英娜.督脉瘀阻型寰枢椎脱位手术联合中药治疗的临床研究[J].中国中医骨伤科杂志,2017,25(01):14-18,22.
　YI Ping TAN Mingsheng Lv Guohua YANG Feng TANG Xiangsheng HAO Qingying ZHOU Yingjie ZHANG Enzhong JIANG Lianghai LIU Chuyin QI Yingna.Clinical Research on Operation Combined with Traditional Chinese Medicine for Treating Atlantoaxial Dislocation of Governor Vessel Stasis[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2017,25(01):14-18,22.
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督脉瘀阻型寰枢椎脱位手术联合中药治疗的临床研究()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第25卷
期数:
2017年01期
页码:
14-18,22
栏目:
临床研究
出版日期:
2017-01-15

文章信息/Info

Title:
Clinical Research on Operation Combined with Traditional Chinese Medicine for Treating Atlantoaxial Dislocation of Governor Vessel Stasis
文章编号:
1005-0205(2017)01-0014-05
作者:
移平1 谭明生1△ 吕国华2 杨峰1 唐向盛1 郝庆英1 周英杰3 张恩忠4 姜良海1 刘楚吟1 齐英娜1
1中日友好医院(北京,100029) 2中南大学湘雅医院 3河南洛阳正骨医院 4山东文登整骨医院
Author(s):
YI Ping1 TAN Mingsheng1△ Lv Guohua2 YANG Feng1 TANG Xiangsheng1 HAO Qingying1 ZHOU Yingjie2 ZHANG Enzhong4 JIANG Lianghai1 LIU Chuyin1 QI Yingna1
1China-Japan Friendship Hospital, Beijing 100029, China; 2Xiangya Hospital Central South University,Changsha 410008,China; 3Luoyang Orthopedic Traumatological Hospital, Luoyang 471002,Henan China; 4Wendeng Osteopath Hospital, Wendeng 264400,Shandong China.
关键词:
寰枢椎脱位;  督脉;  补阳还五汤;  手术治疗
Keywords:
atlantoaxial dislocation;  governor vessel;  Buyanghuanwu decoction;  operation
分类号:
R684.7
文献标志码:
A
摘要:
目的: 比较手术联合补阳还五汤与单纯手术治疗督脉瘀阻型寰枢椎脱位的临床疗效。方法:自2005年1月至2014年1月,寰枢椎脱位的患者351例,分为单纯手术组及手术联合补阳还五汤治疗的手术中药组。分别比较术前、术后1个月及末次随访时,两组患者的日本骨科协会脊髓功能(JOA)评分、颈部疼痛视觉模拟评分(VAS)、颈椎功能障碍指数评分(NDI)和督脉瘀阻证候积分。结果:所有手术均顺利完成,患者随访时间6～13个月。术后两组患者督脉瘀阻证候积分、JOA评分均较术前明显提高,VAS,NDI评分均较术前明显降低,差异均有统计学意义(P＜ 0.05)。两组患者术前督脉瘀阻证候积分,JOA,VAS,NDI评分差异无统计学意义(P＞0.05); 术后1个月时,手术中药组的督脉瘀阻证候积分和JOA评分高于手术组,VAS和NDI评分低于手术组,差异均有统计学意义(P＜0.05); 至末次随访时,两组的督脉瘀阻证候积分,JOA,VAS,NDI评分虽然差异无统计学意义(P＞0.05),但手术中药组的督脉瘀阻证候积分和JOA评分高于手术组,VAS和NDI评分低于手术组,提示手术中药组疗效较单纯手术组好。结论:通过手术复位和椎管减压治疗寰枢椎脱位,可解除督脉(脊髓)的瘀阻和压迫,解剖形态结构上疏通督脉。围手术期采用中药活血化瘀、补益肝肾、益气活络,可改善微循环、消除炎症介质和保护神经细胞,进一步疏通督脉,促进恢复神经功能。
Abstract:
Objective:To compare the clinical effect between operation combined with Buyanghuanwu decoction(BYHWD)and only operation for treating atlantoaxial dislocation of governor vessel stasis.Methods: From January 2005 to June 2015, 351 cases with atlantoaxial dislocation were included.The patients were divided into the only operation group and the operation combined with BYHWD group.The Japanese orthopedic association spinal cord function(JOA)score, the visual analogue scale of neck pain(VAS), the neck dysfunction index(NDI)score and the governor vessel stasis syndrome score of the patients in two groups were compared preoperative and postoperative 1 month and the last follow-up respectively.Results: All operations were completed successfully.Patients were followed up for 6 to 13 months.After operation, the governor vessel stasis syndrome score and the JOA score of the patients in two groups were significantly higher than those before operation, while the VAS and NDI score were significantly lower(P＜0.05).There was no statistically significant difference in the governor vessel stasis syndrome score, JOA, VAS and NDI score between the two groups before operation(P＞0.05).The governor vessel stasis syndrome score and the JOA score in operation and combined group were higher than those of operation group, while the VAS and NDI score were lower(P＜0.05).At the last follow-up, although there was no statistical difference in the governor vessel stasis syndrome score, JOA, VAS and NDI score between the two groups(P＞0.05), the governor vessel stasis syndrome score and the JOA score in operation and combined group were higher than operation group, and the VAS and NDI score were lower, which meant the clinical effect of operation and traditional Chinese medicine group was better than the operation group.Conclusion: In the treatment of atlantoaxial dislocation, surgical reduction and spinal canal decompression can remove governor vessel(spinal cord)stasis and oppression, clear the governor pulse in anatomical structure.During perioperative period, using Chinese medicine of Houxuehuayu, Buyiganshen and Yiqihuolou methods, can improve micro-circulation, eliminate inflammatory mediators and protect nerve cells, and further dredge governor vessel, promote the recovery of neurological function.

参考文献/References:

[1] 谭明生.上颈椎外科学[M].北京:人民卫生出版社,2010:334.
[2] 刘汝专.活血化瘀中药治疗脊髓损伤的研究概况[J].云南中医中药杂志,2007,28(4):43-45.
[3] 陈宇飞,王四旺,罗卓荆,等.中药治疗脊髓损伤的研究现状[J].现代生物医学进展,2010,10:1983-1982.
[4] 何兴伟,黄建华.痿证从督脉论治探讨[J].中国针灸,2008,28(3):231-233.
[5] 张亚,饶耀剑.补阳还五汤加减治疗急性颈髓损伤临床研究[J].中医临床研究,2014,6(2):21-22.
[6] 鲁贵生,陈杰,高晓鹏,等.补阳还五汤加味在胸腰椎骨折伴急性脊髓损伤治疗中的价值[J].中国中医急症,2015,24(10):1822-1824.
[7] 彭祖年,姚晓勃.补阳还五汤对大鼠脊髓损伤后神经功能影响的实验研究[J].中医药导报,2008,5(14):109-110.
[8] 谭明生,张光铂,李子荣,等.寰椎测量及其经后弓侧块螺钉固定通道的研究[J].中国脊柱脊髓杂志,2002,12(1):5-8.
[9] 王和鸣,葛继荣,沈冯君,等.丹鹿通督片治疗瘀阻督脉型腰椎管狭窄症Ⅲ期临床试验总结[J].中国中医骨伤科杂志,2005,13(4):1-3.
[10] 谭明生,李显,张恩忠,等.寰枢椎脱位外科治疗与疏通督脉瘀阻相关性研究[J].中国骨伤,2012,25(11):915-919.
[11] 谭明生,张光铂,王文军,等.寰枢椎脱位的外科分型及其处理对策[J].中国脊柱脊髓杂志,2007,17(2):111-115.
[12] 蔡钦林.寰枢椎不稳或脱位的诊断与治疗[J].中国脊柱脊髓杂志,2001,11(1),60-62.
[13] 何兴伟,周茂福.中医学对脊髓生理功能的认识探析[J].江西中医学院学报,2006,18(5):8-9.
[14] Lee J,Koyanagi I,Hida K,et al.Spinal cord edema:unusual magnetic resonance imaging findingsin cervical spondylosis[J].J Neurosurg,2003,99(1 Suppl):8-13.
[15] 程艳彬,房敏,朱清广,等.论“督脉生病治督脉,治在骨上”的理论蕴义[J].中华中医药杂志,2013,28(9):2515-2517.
[16] 韦以宗.中国正脊学[M].北京:人民卫生出版社,2012:33.
[17] 谭明生,麻昊宁,郝定均.寰枢椎脱位TOI外科分型临床应用的前瞻性多中心研究[J].中华骨科杂志,2015,35(5):465-473.
[18] 姜春华.活血化瘀研究新编[M].上海:上海医科大学出版社,1990:466-533.
[19] Chen A,Wang H,Zhang J,et al.BYHWD reScues axotomized neurons and promotes functional recovery after spinal cord injury in rats[J].J Ethnopharmacol,2008,117(3):451-456.
[20] 徐志华,余勤,白月双,等.补阳还五汤联合鞘内注射间充质干细胞治疗脊髓损伤的研究[J].中华中医药学刊,2012,30(12):2726-2730.
[21] 陈安,王慧,伍校琼,等.补阳还五汤对大鼠脊髓损伤后红核脊髓束再生及功能修复的影响[J].神经解剖学杂志,2007,23(6):587-590.

备注/Memo

备注/Memo:
基金项目:国家自然科学基金(81173423) △通信作者 E-mail:13911025605@163.com
更新日期/Last Update: 2017-01-15