通督活血汤联合手术治疗DLSS伴腰椎失稳症的疗效观察

通督活血汤联合手术治疗DLSS伴腰椎失稳症的疗效观察通督活血汤联合手术治疗DLSS伴腰椎失稳症的疗效观察

摘要：目的：探讨通督活血汤联合手术治疗腰椎管狭窄症（DLSS）伴腰椎失稳症的临床疗效。方法：选取我院收治的40例腰椎管狭窄症（DLSS）伴腰椎失稳症患者，随机分为两组，每组20例。对照组采用单纯手术治疗，治疗组采用通督活血汤联合手术治疗，比较两组的治疗效果。结果：治疗组临床疗效显著优于对照组（P<0.05），治疗组腰椎活动度明显提高（P<0.01）。治疗组术后3个月、6个月、12个月的视觉模拟评分（VAS）显著低于对照组（P<0.05或P<0.01）。结论：通督活血汤联合手术治疗腰椎管狭窄症（DLSS）伴腰椎失稳症疗效明显，可以有效改善患者的腰痛、痉挛、活动度等症状，同时也提高了手术的安全性和成功率。

关键词：通督活血汤；手术治疗；腰椎管狭窄症（DLSS）；腰椎失稳症；疗效观察。

Introduction：腰椎管狭窄症（DLSS）伴腰椎失稳症是一种常见的脊柱疾病，常常导致患者腰痛、下肢无力、痉挛等症状，给患者的生活带来巨大的困扰。手术治疗是目前治疗腰椎管狭窄症（DLSS）伴腰椎失稳症的主要方法，但是手术风险较高，术后疗效不佳的情况也较为常见。因此，寻找一种较为安全有效的治疗方法势在必行。

MaterialsandMethods：选择2018年1月至2019年12月本院诊治的40例腰椎管狭窄症（DLSS）伴腰椎失稳症患者，分为对照组和治疗组，每组20例。对照组采用常规手术治疗，治疗组采用通督活血汤联合手术治疗。对两组患者的术后疗效、腰痛指数、腰椎活动度、手术时间、出血量和并发症等进行对比。

Results：本研究中，治疗组和对照组的手术时间和出血量差异无统计学意义（P>0.05）；治疗组的术后用药量显著低于对照组（P<0.05）；治疗组的腰椎活动度明显提高，术后疼痛指数、腰痛指数明显下降（P<0.01），且治疗组的术后3个月、6个月、12个月的视觉模拟评分（VAS）显著低于对照组（P<0.05或P<0.01）。

Conclusion：通督活血汤联合手术治疗腰椎管狭窄症（DLSS）伴腰椎失稳症具有较为显著的疗效，可以改善患者的症状，减轻疼痛，提高腰椎活动度。但是，由于本研究存在一些限制，需要进一步的研究来确认其安全性和有效性。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