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1、改良手术方式联合补阳还五汤治疗T10L3爆裂型骨折伴脊髓损伤的应用研究熊云志 张萍 鞠跃蕊摘 要目的：研究补阳还五汤辅助改良手术方式治疗T10L3爆裂型骨折 伴脊髓损伤患者的疗效，探讨改善该病治疗效果的有效手段；方法：首先通过解 剖学对人的脊柱(T10L3)段及神经的形态及周围结构进行研究，以解剖学基 础为依据对我院创伤外科收治的部分患者釆用改良手术方式进行手术治疗，并在 术后给予中药补阳还五汤进行辅助治疗。选择我院创伤外科于2008年4月2013 年4月间收治的58例具备手术指征的T10L3段骨折伴脊髓损伤患者为研究对 象，前35例患者构成对照组，按常规手术方式进行手术，术后给予常规药物治
2、疗和常规护理，后23例患者构成观察组，采用改良手术方式进行手术治疗，术 后3天开始服用中药辅助治疗。对所有55例患者均进行随访，随访时间618 个月，平均9个月。观察两组患者的手术时间、出血量多少、术后短期及长期并 发症、骨折愈合情况、痛觉评分、触觉评分、运动评分、ASIA残损分级等；结 果:对照组35例患者术中失血量580.5ml-795.0mL平均失血(670.6±35.6) ml,手术时间162.0分钟-245.0分钟，平均(198.6±32.4)分钟。观察组 23例患者术中失血量371.5ml-462.5ml,平均失血量为(435.5±25.6
3、) ml, 手术时间为162.0分钟-245.0分钟，平均手术用时(138.2±25.3)分钟。 随访过程中，55例患者复查X线片或CT片，伤椎高度基本恢复正常，脊柱曲度 大多恢复正常，植骨块位于椎体中后部且均已融合。未发现植骨块塌陷及椎体高 度丢失、钢板或螺钉断裂或松动现象，无暇关节形成。痛觉评分方面：对照组患 者治疗前痛觉评分为(89.89±12.98),观察组治疗前痛觉评分为(91.45±11.67),对照组治疗后痛觉评分为(109.5±13.09),观察 组治疗后痛觉评分为(110.6±12.85),对照组治疗后的痛
4、觉评分明显高于 治疗前，其差异有统计学意义(PV0.05),观察组治疗后的痛觉评分明显高于治 疗前，其差异有统计学意义(P0.05),对照组和观察组在治疗后的痛觉评分方面无统计学差异(P0.05)；触觉评分方面：对照组患者治疗前触觉评分为(92.73±14.08), 观察组治疗前触觉评分为(93.07±14.43),对照组治疗后触觉评分为(106.5±12.31),观察组治疗后触觉评分为(108.3±13.61),对照 组治疗后的触觉评分明显高于治疗前，其差异有统计学意义(PV0.05),观察组 治疗后的触觉评分明显高于治疗前，其差异有统
5、计学意义(P0.05),对照组和观察组在治疗后 的触觉评分方面无统计学差异(P0.05)；运动评分方面：对照组患者治疗前运 动评分为(76.56±13.86),观察组治疗前运动评分为(78.23±12.38), 对照组治疗后运动评分为(86.52&plusnw;14.09),观察组治疗后运动评分为(99.67±14.82),对照组治疗后的运动评分明显高于治疗前，其差异有统 计学意义(PV0.05),观察组治疗后的运动评分明显高于治疗前，其差异有统计 学意义(PV0.05),对照组和观察组在治疗前的运动评分无统计学差异(P0.05), 治疗后的观察组的运
6、动评分高于对照组，其差异具备统计学意义(P0.05)； ASIA 残损分级方面：经治疗后对照组和观察组的脊髓损伤程度均较治疗前有明显改善, 观察组效果优于对照组(PV0.05)；结论 改良手术能有效治疗T1013爆裂型 骨折伴脊髓损伤患者，并减少的手术时间和术中出血，减轻了手术创伤，降低了 术后并发症的发牛，术后联合中药口服能够改善患者的预后，改善患者的ASIA 残损等级，建议临床进一步推广应用。关键词JT10-L3段爆裂型骨折改良手术方式脊髓损伤感觉评分 运动评分ASIA 补阳还五汤The Effect of Improved Operation Method Combined with B
7、uyang Huangwu Decoction in the Treatment of T10L3 Segment Blowout Fracture with Spinal Cord InjuryXiong Yunzhi, Zhang Ping, Ju YueruiAbstract: Objective To study the effect of Buyang Huangwu decoction together with improved surgical treatment in the curing of T10L3 segment blowout fracture with spin
8、al cord injury in order to explore the effective means to improve the treatme nt effect of this disease. Methods First, through the an atomy of huma n spine (of T10 L3) and the study of the morphology of nerve and surrounding structures, based on the an atomical basis of patie nts admitted in the au
9、thor’s hospital, improved surgical treatment were given to the patients. Besides, the Chinese medicine Buyang Huanwu decoction was also given as adjuvant therapy after the operation. 58 cases with surgical indications of T10 L3 segment fracture with spinal cord injury patients from April 2008
10、to April 2013 visiting the trauma surgery department of the author’s hospital were taken as the research object. The control group, which has 35 patients, took conventional operation method, and received routine drug therapy and routine nursing care after operation, while the observation group
11、, with 23 patients, received improved operation method and began adopting adjuvant therapy of traditional Chinese medicine 3 days after the operation. All 58 patie nts were followed up, for 6 18 mon ths, with an average of 9 months. The operation time, blood loss, short-term and Iong-term postoperat
12、ive complications, fracture healing, pain evaluation, touch, sports scores and grade of ASIA were compared between the two group. Results The intraoperative blood loss of the control group is 580.5 ml to 795.0 ml, with an average blood loss 670.6± 35.6 ml; the surgery time 162.0 minutes to 16
13、2.0 minutes, with an average 198.6± 32.4 minutes The intraoperative blood loss in the observation group is 371.5 ml to 462.5 ml, with an average blood loss 435.5 ± 25.6 ml; the operation time is 162.0 minutes to 162.0 minutes, with an operation time 138.2 ± 25.3 minutes. During
14、the follow-up, the 58 patients’ X-ray or CT pills, injured vertebral height basic returned to normal, curvature of the spine is mostly back to normal, block is located in the rear part of the vertebral body and bone graft are fused. No blocks collapse bone graft, vertebral body height loss, br
15、oken or loose plate or screws were found, and flawless joints were formed. Pain scores: the pain score of the control group patients before treatment was 89.89 ± 12.98, while the observation group was 91.45±11.67z the pain score of the control group after the treatment was 109.5 &plusm
16、n; 13.09, while the observation group was 110.6 ± 12.85. The pain score of the control group after treatment was obviously higher than that of before the treatment, and the differenee was statistically significant (P < 0.05); the pain score of observation group after treatment was obviously higher than that before the treatment, which was statistically significant (P < 0.05
