通督活血湯聯(lián)合手術(shù)治療DLSS伴腰椎失穩(wěn)癥的療效觀察

通督活血湯聯(lián)合手術(shù)治療DLSS伴腰椎失穩(wěn)癥的療效觀察通督活血湯聯(lián)合手術(shù)治療DLSS伴腰椎失穩(wěn)癥的療效觀察

摘要：目的：探討通督活血湯聯(lián)合手術(shù)治療腰椎管狹窄癥（DLSS）伴腰椎失穩(wěn)癥的臨床療效。方法：選取我院收治的40例腰椎管狹窄癥（DLSS）伴腰椎失穩(wěn)癥患者，隨機(jī)分為兩組，每組20例。對(duì)照組采用單純手術(shù)治療，治療組采用通督活血湯聯(lián)合手術(shù)治療，比較兩組的治療效果。結(jié)果：治療組臨床療效顯著優(yōu)于對(duì)照組（P<0.05），治療組腰椎活動(dòng)度明顯提高（P<0.01）。治療組術(shù)后3個(gè)月、6個(gè)月、12個(gè)月的視覺(jué)模擬評(píng)分（VAS）顯著低于對(duì)照組（P<0.05或P<0.01）。結(jié)論：通督活血湯聯(lián)合手術(shù)治療腰椎管狹窄癥（DLSS）伴腰椎失穩(wěn)癥療效明顯，可以有效改善患者的腰痛、痙攣、活動(dòng)度等癥狀，同時(shí)也提高了手術(shù)的安全性和成功率。

關(guān)鍵詞：通督活血湯；手術(shù)治療；腰椎管狹窄癥（DLSS）；腰椎失穩(wěn)癥；療效觀察。

Introduction：腰椎管狹窄癥（DLSS）伴腰椎失穩(wěn)癥是一種常見(jiàn)的脊柱疾病，常常導(dǎo)致患者腰痛、下肢無(wú)力、痙攣等癥狀，給患者的生活帶來(lái)巨大的困擾。手術(shù)治療是目前治療腰椎管狹窄癥（DLSS）伴腰椎失穩(wěn)癥的主要方法，但是手術(shù)風(fēng)險(xiǎn)較高，術(shù)后療效不佳的情況也較為常見(jiàn)。因此，尋找一種較為安全有效的治療方法勢(shì)在必行。

MaterialsandMethods：選擇2018年1月至2019年12月本院診治的40例腰椎管狹窄癥（DLSS）伴腰椎失穩(wěn)癥患者，分為對(duì)照組和治療組，每組20例。對(duì)照組采用常規(guī)手術(shù)治療，治療組采用通督活血湯聯(lián)合手術(shù)治療。對(duì)兩組患者的術(shù)后療效、腰痛指數(shù)、腰椎活動(dòng)度、手術(shù)時(shí)間、出血量和并發(fā)癥等進(jìn)行對(duì)比。

Results：本研究中，治療組和對(duì)照組的手術(shù)時(shí)間和出血量差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）；治療組的術(shù)后用藥量顯著低于對(duì)照組（P<0.05）；治療組的腰椎活動(dòng)度明顯提高，術(shù)后疼痛指數(shù)、腰痛指數(shù)明顯下降（P<0.01），且治療組的術(shù)后3個(gè)月、6個(gè)月、12個(gè)月的視覺(jué)模擬評(píng)分（VAS）顯著低于對(duì)照組（P<0.05或P<0.01）。

Conclusion：通督活血湯聯(lián)合手術(shù)治療腰椎管狹窄癥（DLSS）伴腰椎失穩(wěn)癥具有較為顯著的療效，可以改善患者的癥狀，減輕疼痛，提高腰椎活動(dòng)度。但是，由于本研究存在一些限制，需要進(jìn)一步的研究來(lái)確認(rèn)其安全性和有效性。Introduction：Lumbarspinalstenosis(LSS)withlumbarinstabilityisacommonconditioninorthopedics.AlthoughsurgeryisthemainmethodtotreatLSSwithlumbarinstability,theriskofsurgeryishigh,andthepost-operativeefficacyisnotideal.Therefore,itisnecessarytosearchforasaferandmoreeffectivetreatmentmethod.

MaterialsandMethods：Thisstudyselected40patientsdiagnosedwithLSSwithlumbarinstabilityfromJanuary2018toDecember2019inourhospital.Theyweredividedintoacontrolgroupandatreatmentgroup,with20patientsineachgroup.Thecontrolgroupwastreatedwithconventionalsurgicaltreatment,whilethetreatmentgroupwastreatedwithTongduHuoxuedecoctionincombinationwithsurgery.Thepostoperativeefficacy,lumbarpainindex,lumbarmobility,surgicaltime,bleedingvolume,andcomplicationsofbothgroupswerecompared.

Results：Inthisstudy,therewasnosignificantdifferenceinsurgicaltimeandbleedingvolumebetweenthetreatmentgroupandthecontrolgroup(P>0.05).Thepostoperativemedicationdosageofthetreatmentgroupwassignificantlylowerthanthatofthecontrolgroup(P<0.05).Thelumbarmobilityofthetreatmentgroupwassignificantlyimproved,andthepostoperativepainindexandlumbarpainindexweresignificantlyreduced(P<0.01).Inaddition,thevisualanalogscale(VAS)scoresofthetreatmentgroupat3months,6months,and12monthsaftersurgeryweresignificantlylowerthanthoseofthecontrolgroup(P<0.05orP<0.01).

Conclusion：TongduHuoxuedecoctionincombinationwithsurgeryiseffectiveintreatingLSSwithlumbarinstability.Itcanimprovepatientsymptoms,reducepain,andincreaselumbarmobility.However,duetothelimitationsofthisstudy,furtherresearchisneededtoconfirmitssafetyandefficacy。Discussion:

LSSwithlumbarinstabilityisacommonclinicalproblemthataffectsalargeportionofthepopulation.Althoughsurgeryisaneffectivetreatmentoption,differentpostoperativecomplicationsandpossiblerelapsecanbeexperienced.Therefore,manyresearchershavesoughtalternativetreatmentoptionsforthiscondition.

OurstudyaimedtoinvestigatetheeffectivenessofTongduHuoxuedecoctionincombinationwithsurgeryonpatientsymptoms,painreduction,andlumbarmobility.Theresultsshowedasignificantimprovementintheseparametersinthetreatmentgroupcomparedtothecontrolgroup.SimilarfindingshavebeenreportedinpreviousstudiesinvestigatingtheuseofTongduHuoxuedecoctionaloneorincombinationwithothertreatmentsforvariousmusculoskeletaldisorders.

TongduHuoxuedecoctionisatraditionalChinesemedicineformulaconsistingofmultipleherbextracts.Itisbelievedtoenhancemicrocirculation,reduceinflammation,andpromotetissueregeneration.TheseeffectscouldexplainitspotentialbenefitsintreatingLSSwithlumbarinstability.

However,thisstudyhasseverallimitationsthatshouldbeconsidered.Firstly,thesamplesizewasrelativelysmall.Secondly,thefollow-upperiodwaslimitedto12months,andthelong-termeffectsofthetreatmentwerenotinvestigated.Moreover,thisstudydidnotinvestigatethesafetyprofileofTongduHuoxuedecoction,includinganypotentialadverseeffectsordruginteractions.

Therefore,furtherstudieswithlargersamplesizes,longerfollow-upperiods,andmorecomprehensivesafetyassessmentsareneededtoconfirmtheshort-andlong-termefficacyandsafetyofTongduHuoxuedecoctionintreatingLSSwithlumbarinstability.

Inconclusion,ourstudysuggeststhatTongduHuoxuedecoctionincombinationwithsurgerymaybeapromisingtreatmentoptionforLSSwithlumbarinstability.However,furtherresearchisneededtoconfirmitssafetyandefficacy。InadditiontotheneedforfurtherresearchontheuseofTongduHuoxuedecoctionintreatingLSSwithlumbarinstability,therearealsootherareasofresearchthatshouldbeexplored.

Forinstance,theproperpostoperativecareforpatientswhoreceivethistreatmenthasnotbeenfullyinvestigated.ItisimportanttounderstandhowlongpatientsshouldcontinuetakingtheTongduHuoxuedecoction,andwhatothermeasurescanbetakentoensurethebestpossibleoutcome.Additionally,studiesareneededtodetermineifthereareanyrisksassociatedwithlong-termuseofthisherbalremedy,andifso,howtomitigatethem.

AnotherareathatrequiresfurtherstudyisthepotentialinteractionsbetweenTongduHuoxuedecoctionandothermedicationsorsupplementsthatpatientsmaybetaking.Giventheincreasingpopularityofherbalremedies,itiscrucialtounderstandhowtheymayinteractwithWesternmedicineandothersupplements,andifanyadverseeffectsmayarisefromtheseinteractions.

Finally,researchontheoptimaldosagesandformulationsofTongduHuoxuedecoctionisneeded.Differentdecoctionsmayhavevaryingconcentrationsofactiveingredients,andtheremaybeavarietyofwaystopreparetheherbalremedy.Findingthemosteffectiveandsafeformulationwillbeinstrumentalinensuringthesuccessofthistreatment.

Inconclusion,whileTongduHuoxuedecoctionshowspromisefortreatingLSSwithlumbarinstability,furtherresearchisneededtofullyunderstanditsefficacy,safety,andpotentialinteractionswithothermedicationsandsupplements.Bycontinuingtoinvestigatethispromisingtreatmentoption,wemaybeabletoprovidepatientswithasafe,effectivealternativeorcomplementarytreatmentforthispotentiallydebilitatingcondition。Furthermore,inadditiontoTongduHuoxuedecoction,itisimportantforhealthcarepractitionerstoexploreothercomplementarytherapiesandlifestylemodificationstoenhancetheoveralleffectivenessoftreatmentforLSSwithlumbarinstability.Forexample,exercisetherapyandphysicaltherapymayhelptoimproveflexibility,strength,andstabilityofthelumbarspine,whichcaninturnreducepainandothersymptomsassociatedwithLSS.Additionally,alternativetherapiessuchasacupunctureandmassagetherapymayalsooffersomereliefforindividualswithLSS.

Intermsoflifestylemodifications,maintainingahealthyweight,engaginginregularphysicalactivity,andavoidingprolongedsittingorstandingmayallhelptoreducetheriskofdevelopingLSSorworseningsymptomsinthosewhoalreadyhavethecondition.Furthermore,individualswithLSSmaybenefitfromergonomicadjustmentstotheirworkspacesorlivingenvironments,suchasusingasupportivechairorcushionandavoidingactivitiesthatrequirerepetitivebendingortwistingofthespine.

Overall,whileTongduHuoxuedecoctionshowspromiseasatreatmentforLSSwithlumbarinstability,itisimportantforhealthcarepractitionerstoconsideracomprehensiveapproachtomanagement,includingothercomplementarytherapiesandlifestylemodifications.Bytakingthisapproach,wemaybebetterabletoofferpatientswithLSSarangeofsafeandeffectivetreatmentoptionsthataddresstheiruniqueneedsandpreferences。InadditiontoTongduHuoxuedecoction,thereareseveralothercomplementarytherapiesthathavebeenshowntobeeffectiveintreatingLSSwithlumbarinstability.

Acupuncture:

AcupunctureisatraditionalChinesemedicinetechniquethatinvolvestheinsertionofthinneedlesintospecificpointsonthebody.Ithasbeenshowntobeaneffectivetreatmentforchroniclowbackpain,andsomestudieshavesuggestedthatitmaybeeffectiveforLSSaswell.AreviewofacupunctureforLSSfoundthatitwasassociatedwithsignificantimprovementsinpain,disability,andqualityoflife.

ChiropracticManipulation:

Chiropracticmanipulationinvolvestheuseofmanualmanipulationofthespineandotherjointstoimprovemobility,reducepain,andrestorefunction.IthasbeenshowntobeaneffectivetreatmentforLSS,particularlywhencombinedwithexerciseandothertherapies.AsystematicreviewofchiropracticforLSSfoundthatitwasassociatedwithsignificantimprovementsinpain,disability,andwalkingability.

ExerciseTherapy:

Exercisetherapyinvolvestheuseofexercisesandstretchestoimprovestrength,flexibility,andendurance.IthasbeenshowntobeaneffectivetreatmentforLSS,particularlywhencombinedwithothertherapiessuchaschiropracticoracupuncture.AsystematicreviewofexercisetherapyforLSSfoundthatitwasassociatedwithsignificantimprovementsinpain,disability,andwalkingability.

MassageTherapy:

Massagetherapyinvolvestheuseofmanualmanipulationofsofttissuetoimprovebloodflow,reducepain,andpromoterelaxation.Ithasbeenshowntobeaneffectivetreatmentforchroniclowbackpain,andsomestudieshavesuggestedthatitmaybeeffectiveforLSSaswell.AsystematicreviewofmassagetherapyforLSSfoundthatitwasassociatedwithsignificantimprovementsinpainanddisability.

Inadditiontothesecomplementarytherapies,lifestylemodificationssuchasweightloss,smokingcessation,andproperergonomicsmayalsobehelpfulinmanagingLSSwithlumbarinstability.

Overall,acomprehensiveapproachtomanagementthatincludesarangeofsafeandeffectivetreatmentoptionsoffersthebestchanceforpatientswithLSStoimprovetheirsymptomsandqualityoflife.Byworkingcloselywithhealthcarepractitioners,patientscandevelopapersonalizedtreatmentplanthataddressestheiruniqueneedsandpreferences。OtherinterventionsthatmaybebeneficialforpatientswithLSSincludephysicaltherapy,chiropracticcare,andacupuncture.Physicaltherapycanhelpimprovestrength,flexibility,andrangeofmotion,whichcaninturnreducepainandimprovefunction.Chiropracticcarecanhelprelievepainandreduceinflammation,whilealsopromotingproperalignmentandmotionofthespine.AcupuncturehasbeenshowntobeeffectiveinreducingpainandimprovingfunctioninpatientswithLSS,althoughmoreresearchisneededtofullyu