恒古骨傷愈合劑促進(jìn)腰椎板開(kāi)窗微小骨�；刂补侵亟ǖ难芯�
發(fā)布時(shí)間：2019-04-09 09:23
【摘要】：目的：觀察恒古骨傷愈合劑對(duì)腰椎板開(kāi)窗術(shù)后微小骨粒回植骨重建的實(shí)驗(yàn)研究及初步臨床應(yīng)用,探討恒古骨傷愈合劑促進(jìn)椎板開(kāi)窗處自體微小骨粒骨重建的療效及作用機(jī)制。方法：(1)動(dòng)物實(shí)驗(yàn)研究：選取清潔級(jí)健康雄性新西蘭大白兔22只,隨機(jī)分為3組,A組(治療組,n=9)；B組(對(duì)照組,n=9)；C組(正常組,n=4)。A組建立兔腰椎板開(kāi)窗術(shù)后微小骨粒回植的模型,給予恒古骨傷愈合劑治療,(按經(jīng)由人與兔體表面積用藥量換算計(jì)算出的劑量,兔用藥量為1.30ml/kg)灌胃,1次／2d,服用3個(gè)月；B組建立模型后,服用相同劑量的生理鹽水,C組未進(jìn)行手術(shù)處理,相同劑量的生理鹽水灌服,治療后4、8、12周分別行大體標(biāo)本粘連組織觀察、羥脯氨酸(hydroxyproline, Hyp)測(cè)定、CT檢查及組織形態(tài)學(xué)觀察。(2)初步臨床應(yīng)用：采用前瞻性研究方法,收集2013年10月至2014年8月,因腰椎間盤突出癥(血瘀型)需行腰椎手術(shù)治療患者50例,按照入院時(shí)間隨機(jī)分為治療組和對(duì)照組,最后因隨訪問(wèn)題納入數(shù)據(jù)統(tǒng)計(jì)的有41例(41/50),即治療組(常規(guī)治療+恒古骨傷愈合劑組,21例)、對(duì)照組(常規(guī)治療組,20例),觀察隨訪期限6個(gè)月。采用VAS、ODI評(píng)分法于術(shù)前1天及術(shù)后1、3、6月評(píng)價(jià)臨床癥狀改善情況,并行腰椎術(shù)后CT檢查,觀察骨重建變化情況,所有數(shù)據(jù)采用SPSS18.0軟件進(jìn)行比較分析。結(jié)果：(1)實(shí)驗(yàn)部分：大體觀察及組織學(xué)發(fā)現(xiàn),A組的粘連程度Rydell分級(jí)及組織學(xué)分級(jí)要遠(yuǎn)低于B組(P0.05)。羥脯氨酸濃度分析結(jié)果顯示A組瘢痕組織中羥脯氨酸濃度要明顯低于B組(P0.05)。CT檢查示術(shù)后12周A組微小骨粒形成骨板與開(kāi)窗椎板骨質(zhì)相連、骨梁連續(xù),無(wú)明顯界限,椎管形態(tài)及容積無(wú)明顯變化,未見(jiàn)脊髓受壓；B組對(duì)照節(jié)段椎板缺損,少量瘢痕突入椎管內(nèi),椎管重建未完成。(2)臨床中患者有41例(41/50)獲隨訪(隨訪率為82.0%)。比較兩組患者基線特征(年齡、病程、突出節(jié)段、腰椎間盤突出類型、術(shù)前VAS、ODI評(píng)分及術(shù)后3天CT值),均未見(jiàn)顯著性差異(P0.05),具有可比性。兩組患者均獲得6個(gè)月的隨訪,無(wú)椎管狹窄、神經(jīng)、血管損傷等并發(fā)癥發(fā)生。兩組VAS不同時(shí)間比較,治療組術(shù)后1、3、6個(gè)月VAS評(píng)分低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組在術(shù)后1、6個(gè)月各觀察點(diǎn)ODI評(píng)分均有顯著差異(P0.05),且治療組的臨床療效優(yōu)于對(duì)照組。CT檢查示治療組微小骨粒植骨區(qū)CT值在術(shù)后3、6個(gè)月較對(duì)照組均明顯增高,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論：(1)恒古骨傷愈合劑可有效促進(jìn)兔椎板開(kāi)窗處再植自體微小骨粒的骨重建,形成的骨板可遮擋疤痕侵入椎管,減少椎管內(nèi)粘連。(2)恒古骨傷愈合劑聯(lián)合腰椎后路髓核摘除微小骨�；刂矐�(yīng)用于腰椎間盤突出癥手術(shù)治療,回植微小骨粒重建椎管(骨性結(jié)構(gòu))效果好,術(shù)后隨訪發(fā)現(xiàn)術(shù)后粘連引起的并發(fā)癥減少。
[Abstract]:Aim: to observe the experimental study and preliminary clinical application of Henggu Gushangyu mixture (HGJM) in the reconstruction of small bone granule bone graft after lumbar laminar fenestration, and to explore the therapeutic effect and mechanism of Henggu Gu Shuangyu mixture on autogenous small bone particle bone reconstruction at lamina fenestration. Methods: (1) Animal experiment: 22 healthy male New Zealand rabbits of clean grade were randomly divided into 3 groups: group A (treatment group, n = 9); B); Group C (normal group, n = 4). A) was used to establish the model of small bone particle reimplantation after fenestration of lumbar lamina in rabbits and treated with Henggu Gushangyu mixture (according to the dose calculated by the amount of drugs used in the conversion between human and rabbit body surface area). The dosage of 1.30ml/kg was given to rabbits once a day for 3 months. After the model was established in group B, the rats in group B were treated with the same dose of saline, while the group C was not treated surgically. The same dose of saline was administered in group C. After 4, 8 and 12 weeks of treatment, the adhesive tissues of gross specimens were observed and the hydroxyproline (hydroxyproline, Hyp) was measured. CT examination and histomorphology observation. (2) preliminary clinical application: from October 2013 to August 2014, 50 patients with lumbar disc herniation (blood stasis type) who needed lumbar spine surgery were collected by prospective study method. According to the admission time, 41 cases (41 cases) were randomly divided into the treatment group and the control group according to the time of admission. The treatment group (21 cases) and the control group (routine treatment group, 21 cases) and the control group (routine treatment group) were included in the data statistics according to the follow-up problem. The follow-up period was 6 months. VAS,ODI scoring method was used to evaluate the improvement of clinical symptoms 1 day before operation and 1, 3 and 6 months after operation. The changes of bone reconstruction were observed by CT after lumbar surgery. All the data were compared and analyzed with SPSS18.0 software. Results: (1) the experimental part: gross observation and histology showed that the adhesion degree of group A was significantly lower than that of group B (P 0.05). The Rydell grade and histological grade of group A were significantly lower than those of group B (P0.05). The results of hydroxyproline concentration analysis showed that the concentration of hydroxyproline in scar tissue of group A was significantly lower than that of group B (P0.05). Ct examination showed that the bone plate of group A was connected with the bony of fenestrated lamina at 12 weeks after operation, the bone beam was continuous, and there was no obvious limit. There were no significant changes in the shape and volume of spinal canal and no compression of spinal cord. (2) 41 patients (41 / 50) were followed up (follow-up rate was 82.0%) in group B compared with segmental laminae defect, a small number of cicatricial processes entered the spinal canal, and the spinal canal reconstruction was not completed. (2) in the clinic, 41 cases (41%) were followed up. There was no significant difference in baseline characteristics (age, course of disease, herniation segment, type of lumbar disc herniation, preoperative VAS,ODI score and CT value 3 days after operation) between the two groups (P0.05). The patients in both groups were followed up for 6 months without complications such as spinal canal stenosis, nerve and vascular injury. The VAS scores in the treatment group were significantly lower than those in the control group at 1, 3 and 6 months after operation (P0.05). The VAS scores of the two groups were significantly lower than those of the control group at different time (P0.05). There were significant differences in ODI scores between the two groups at 1 and 6 months after operation (P0.05), and the clinical efficacy of the treatment group was better than that of the control group. Ct examination showed that the CT value of the minimal bone graft area in the treatment group was significantly higher than that in the control group at 3 and 6 months after operation. The difference was statistically significant (P0.05). Conclusion: (1) Henggu Guishuangyu mixture can effectively promote the reconstruction of autogenous tiny bone particles at the fenestration of lamina in rabbits, and the resulting bone plate can occlude scar and invade the spinal canal. (2) Henggu Gu Shuangyu mixture combined with posterior lumbar nucleus pulposus implantation for lumbar disc herniation was applied to the surgical treatment of lumbar intervertebral disc herniation, and the reconstruction of spinal canal (bony structure) with small bone particle was good, and the effect of reconstruction of spinal canal (bony structure) was good. Postoperative follow-up showed that complications caused by postoperative adhesion decreased.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3
本文編號(hào)：2455049
[Abstract]:Aim: to observe the experimental study and preliminary clinical application of Henggu Gushangyu mixture (HGJM) in the reconstruction of small bone granule bone graft after lumbar laminar fenestration, and to explore the therapeutic effect and mechanism of Henggu Gu Shuangyu mixture on autogenous small bone particle bone reconstruction at lamina fenestration. Methods: (1) Animal experiment: 22 healthy male New Zealand rabbits of clean grade were randomly divided into 3 groups: group A (treatment group, n = 9); B); Group C (normal group, n = 4). A) was used to establish the model of small bone particle reimplantation after fenestration of lumbar lamina in rabbits and treated with Henggu Gushangyu mixture (according to the dose calculated by the amount of drugs used in the conversion between human and rabbit body surface area). The dosage of 1.30ml/kg was given to rabbits once a day for 3 months. After the model was established in group B, the rats in group B were treated with the same dose of saline, while the group C was not treated surgically. The same dose of saline was administered in group C. After 4, 8 and 12 weeks of treatment, the adhesive tissues of gross specimens were observed and the hydroxyproline (hydroxyproline, Hyp) was measured. CT examination and histomorphology observation. (2) preliminary clinical application: from October 2013 to August 2014, 50 patients with lumbar disc herniation (blood stasis type) who needed lumbar spine surgery were collected by prospective study method. According to the admission time, 41 cases (41 cases) were randomly divided into the treatment group and the control group according to the time of admission. The treatment group (21 cases) and the control group (routine treatment group, 21 cases) and the control group (routine treatment group) were included in the data statistics according to the follow-up problem. The follow-up period was 6 months. VAS,ODI scoring method was used to evaluate the improvement of clinical symptoms 1 day before operation and 1, 3 and 6 months after operation. The changes of bone reconstruction were observed by CT after lumbar surgery. All the data were compared and analyzed with SPSS18.0 software. Results: (1) the experimental part: gross observation and histology showed that the adhesion degree of group A was significantly lower than that of group B (P 0.05). The Rydell grade and histological grade of group A were significantly lower than those of group B (P0.05). The results of hydroxyproline concentration analysis showed that the concentration of hydroxyproline in scar tissue of group A was significantly lower than that of group B (P0.05). Ct examination showed that the bone plate of group A was connected with the bony of fenestrated lamina at 12 weeks after operation, the bone beam was continuous, and there was no obvious limit. There were no significant changes in the shape and volume of spinal canal and no compression of spinal cord. (2) 41 patients (41 / 50) were followed up (follow-up rate was 82.0%) in group B compared with segmental laminae defect, a small number of cicatricial processes entered the spinal canal, and the spinal canal reconstruction was not completed. (2) in the clinic, 41 cases (41%) were followed up. There was no significant difference in baseline characteristics (age, course of disease, herniation segment, type of lumbar disc herniation, preoperative VAS,ODI score and CT value 3 days after operation) between the two groups (P0.05). The patients in both groups were followed up for 6 months without complications such as spinal canal stenosis, nerve and vascular injury. The VAS scores in the treatment group were significantly lower than those in the control group at 1, 3 and 6 months after operation (P0.05). The VAS scores of the two groups were significantly lower than those of the control group at different time (P0.05). There were significant differences in ODI scores between the two groups at 1 and 6 months after operation (P0.05), and the clinical efficacy of the treatment group was better than that of the control group. Ct examination showed that the CT value of the minimal bone graft area in the treatment group was significantly higher than that in the control group at 3 and 6 months after operation. The difference was statistically significant (P0.05). Conclusion: (1) Henggu Guishuangyu mixture can effectively promote the reconstruction of autogenous tiny bone particles at the fenestration of lamina in rabbits, and the resulting bone plate can occlude scar and invade the spinal canal. (2) Henggu Gu Shuangyu mixture combined with posterior lumbar nucleus pulposus implantation for lumbar disc herniation was applied to the surgical treatment of lumbar intervertebral disc herniation, and the reconstruction of spinal canal (bony structure) with small bone particle was good, and the effect of reconstruction of spinal canal (bony structure) was good. Postoperative follow-up showed that complications caused by postoperative adhesion decreased.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3
【引證文獻(xiàn)】
相關(guān)會(huì)議論文 前1條
1 喻贛鵬;李剛;荊浩;周岳;胡寧敏;;自體微小顆粒骨復(fù)合萬(wàn)古霉素治療感染性骨缺損的實(shí)驗(yàn)研究[A];寧夏醫(yī)學(xué)會(huì)第八屆骨科學(xué)術(shù)會(huì)議論文匯編[C];2013年
，本文編號(hào)：2455049
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