The clinical study of Bushen Huoxue Decoction combined with unilateral biportal endoscopy (UBE) in the treatment of lumbar spinal stenosis with kidney deficiency and blood stasis
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摘要:
目的 观察补肾活血汤联合单侧双通道脊柱内镜(UBE)对肾虚血瘀型腰椎管狭窄症(LSS)患者的恢复情况、机体炎症、术后并发症的影响，探究中西医联合治疗对肾虚血瘀型LSS患者的疗效及作用机制。 方法 选取2023年6月—2024年4月常州市武进中医医院符合纳排标准的120例肾虚血瘀型LSS患者，按随机数字表法分为治疗组(给予补肾活血汤联合UBE治疗)和对照组(UBE治疗)。比较2组视觉疼痛模拟评分法(VAS)评分、Oswestry功能障碍指数(ODI)评分、血清干扰素γ(IFN-γ)/白细胞介素-1α(IL-1α)等指标。 结果 治疗总有效率比较，观察组高于对照组[86.67%(52/60) vs. 71.67%(43/60)，χ2=4.093, P=0.043]。术后2周、术后1个月，观察组的VAS评分低于对照组(P＜0.05)。术后1、6个月ODI评分比较，观察组低于对照组(P＜0.05)。治疗后，观察组外周血血清IFN-γ、IL-1α均低于对照组(P＜0.05)。观察组术后并发症总发生率低于对照组[6.67%(4/60) vs. 23.33%(14/60)，χ2=6.536，P=0.011]。 结论 补肾活血汤联合UBE可显著提高肾虚血瘀型LSS治疗效果，降低肾虚血瘀型LSS患者术后VAS、ODI评分，降低血清IFN-γ、IL-1α浓度，且可降低术后并发症发生风险。 Abstract:Objective To evaluate the effects of Bushen Huoxue Decoction combined with unilateral biportal endoscopy (UBE) in patients with lumbar spinal stenosis (LSS) of kidney deficiency and blood stasis, focusing on recovery, inflammatory response, and postoperative complications, and to explore the therapeutic effect of integrated Chinese and Western medicine. Methods From June 2023 to April 2024, 120 patients with kidney deficiency and blood stasis type LSS were enrolled at Wujin Hospital of Traditional Chinese Medicine, Changzhou, and randomly divided into a treatment group (Bushen Huoxue Decoction + UBE) and a control group (UBE alone). The indicators such as visual analogue scale (VAS) score, Oswestry disability index (ODI) score, changes of serum interferon-γ (IFN-γ)/ interleukin-1α (IL-1α) were assessed. Results The treatment group demonstrated a higher overall response rate compared with the control group [86.67% (52/60) vs. 71.67% (43/60), χ2=4.093, P=0.043]. The VAS score in the treatment group was lower than that in the control group at 2 weeks and 1 month postoperatively (P < 0.05), while ODI score was lower at 1 and 6 months (P < 0.05). After treatment, serum IFN-γ and IL-1α levels in peripheral blood were significantly reduced in the treatment group compared with the control group (P < 0.05). The incidence of postoperative complications was also lower in the treatment group [6.67% (4/60) vs. 23.33% (14/60), χ2=6.536, P=0.011]. Conclusion Bushen Huoxue Decoction combined with UBE can significantly improve the efficacy of kidney deficiency and blood stasis type LSS, reduce postoperative VAS and ODI scores, decrease serum IFN-γ and IL-1α levels, and reduce the risk of postoperative complications, supporting its value as an integrated therapeutic strategy. -
表 1 2组肾虚血瘀型LSS患者一般资料比较
Table 1. Comparison of general data between two groups of LSS patients with kidney deficiency and blood stasis type
组别 >例数 性别[例(%)] >年龄(x±s，岁) >病程(x±s，月) >BMI (x±s) 手术节段[例(%)] >手术时间(x±s，min) >术中失血量(x±s，mL) 临床症状[例(%)] 男性 女性 单节段 双节段 双下肢无力 腰骶部酸胀疼痛 跛行 观察组 60 25(41.67) 35(58.33) 62.00±17.51 28.34±3.70 22.38±2.00 49(81.67) 11(18.33) 46.96±7.00 43.00±5.73 25(41.67) 45(75.00) 60(100.00) 对照组 60 31(51.67) 29(48.33) 63.87±12.99 27.00±5.72 21.75±1.98 40(66.67) 20(33.33) 44.80±6.22 45.16±6.70 27(45.00) 41(68.33) 60(100.00) 统计值 1.205a 0.664b 1.524b 1.734b 3.523a 1.787b 1.898b 0.136a 0.657a P值 0.272 0.508 0.130 0.086 0.061 0.077 0.060 0.713 0.418 注：a为χ2值，b为t值。 
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表 2 2组肾虚血瘀型LSS患者治疗总有效率比较[例(%)]
Table 2. Comparison of the overall treatment response rate between the two groups of LSS patients with kidney deficiency and blood stasis pattern[cases (%)]
组别 例数 治愈 显效 好转 无效 总有效 观察组 60 2(3.33) 39(65.00) 11(18.33) 8(13.33) 52(86.67) 对照组 60 0 25(41.67) 18(30.00) 17(28.33) 43(71.67) 注：2组总有效率比较，χ2=4.093，P=0.043。
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表 3 2组肾虚血瘀型LSS患者手术前后VAS比较(x±s，分)
Table 3. Comparison of VAS scores between the two groups of LSS patients with kidney deficiency and blood stasis pattern, pre- and post-operatively(x±s, points)
组别 例数 术前 术后2周 术后1个月 F值 P值 观察组 60 5.60±0.95 1.30±0.22a 0.85±0.27ab 36.733 ＜0.001 对照组 60 5.43±1.00 2.14±0.33a 1.04±0.19ab 28.507 ＜0.001 F值 0.955 6.542 14.024 P值 0.342 ＜0.001 0.030 注：与同组术前比较，aP＜0.05；与同组术后1个月比较，bP＜0.05。
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表 4 2组肾虚血瘀型LSS患者手术前后ODI比较(x±s，分)
Table 4. Comparison of the oswestry disability index (ODI) scores between the two groups of LSS patients with kidney deficiency and blood stasis pattern, before and after surgery(x±s, points)
组别 例数 术前 术后1个月 术后6个月 F值 P值 观察组 60 30.24±6.73 15.73±3.50a 8.73±2.11ab 129.654 ＜0.001 对照组 60 32.66±8.20 20.05±4.21a 9.07±1.19ab 59.773 ＜0.001 统计量 1.767 10.364 5.904 P值 0.080 ＜0.001 0.017 注：与同组术前比较，aP＜0.05；与同组术后1个月比较，bP＜0.05。
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表 5 2组肾虚血瘀型LSS患者血清炎症因子指标比较(x±s，pg/mL)
Table 5. Comparison of serum inflammatory markers between the two groups of LSS patients with kidney deficiency and blood stasis pattern(x±s, pg/mL)
组别 例数 IFN-γ t值 P值 IL-1α t值 P值 治疗前 治疗后 治疗前 治疗后 观察组 60 17.00±2.81 6.05±1.33 40.975 ＜0.001 23.57±3.50 8.22±1.54 47.183 ＜0.001 对照组 60 18.01±3.02 7.24±1.16 39.916 ＜0.001 24.18±1.71 13.27±2.80 37.476 ＜0.001 统计量 1.897a 1 100.220b 1.213a 702.655b P值 0.060 ＜0.001 0.228 ＜0.001 注：a为t值，b为F值。
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表 6 2组肾虚血瘀型LSS患者术后并发症发生率比较[例(%)]
Table 6. Comparison of postoperative complications between the two groups of LSS patients with kidney deficiency and blood stasis pattern[cases (%)]
组别 例数 血肿 切口感染 脑脊液渗漏 硬脊膜撕裂 总发生 观察组 60 3(5.00) 1(1.67) 0 0 4(6.67) 对照组 60 7(11.67) 6(10.00) 0 1(1.67) 14(23.33) χ2值 1.746 2.427 6.536 P值 0.186 0.119 0.999a 0.011 注：a为采用Fisher精确检验。
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