来源：风湿病与关节炎,2017,6（12）:19-23.

减压融合内固定术联合局部复方倍他米松注射治疗腰椎间盘突出症临床观察（临床研究）

张楷广，高延征，余正红，王红强，张敬乙，施新革，高　坤，邢　帅，邵　佳

　　【摘　要】目的：观察局部减压融合内固定术联合局部复方倍他米松注射治疗腰椎间盘突出症的临床疗效。方法：选取行单节段腰椎减压植骨融合内固定术的腰椎间盘突出症患者175例，按照术中是否局部复方倍他米松注射将患者分为治疗组82例和对照组93例，记录患者术后症状改善情况、生活质量、腰椎日本骨科协会评估治疗分数（JOA评分）、腰部疼痛视觉模拟评分法（VAS）评分以及并发症情况。结果：纳入患者均顺利完成手术，术后均获随访，术后6个月随访时全部达到骨性融合；术后1周、6个月、1年腰椎JOA评分和生活能力（ADL）评分逐渐增加，与术前比较，差异均有统计学意义（P < 0.05）；术后1周腰椎JOA评分和生活能力（ADL）评分，治疗组优于对照组，差异有统计学意义（P < 0.05）；术后3 d、1周、6个月、1年，2组患者VAS评分逐渐降低，与术前比较，差异有统计学意义（P < 0.05）；术后3 d治疗组腰部VAS评分优于对照组，差异有统计学意义（P < 0.05）。结论：减压融合内固定术治疗腰椎间盘突出症，可取得良好的效果，联合局部复方倍他米松注射可有效缓解患者术后早期神经症状，对于因手术创伤导致的炎症反应，具有良好的控制作用。

　　【关键词】　腰椎间盘突出症；减压融合内固定术；复方倍他米松；局部注射；疗效观察

Clinical Observation on the Treatment of Lumbar Disc Herniation with Decompression Fusion and Internal Fixation Therapy Combined with Local Injection of Compound Betamethasone

ZHANG Kai-guang,GAO Yan-zheng,YU Zheng-hong,WANG Hong-qiang,ZHANG Jing-yi,SHI Xin-ge,GAO Kun,XING Shuai,SHAO Jia

　　【ABSTRACT】Objective:To observe the clinical curative effect of decompression fusion and internal fixation therapy combined with local application of compound betamethasone in the treatment of lumbar disc herniation.Methods:One hundred and seventy five cases with lumbar disc herniation underwent lumbar interbody fusion surgery,according to intraoperative topical application of compound betamethasone,were divided into an observation group（82 cases）and a control group（93 cases）.The improvement of the postoperative symptoms,the quality of life,the JOA score of the lumbar spine,and the complications of the patients were recorded.Results:Surgery of all patients included was successful,and the postoperative follow-up for them was done.The follow-up after 6 months showed that all patients obtained bone fusion.Respectively after 1 week,6 months and 1 year after surgery,lumbar JOA score and ability of daily life（ADL）score of patients gradually increased,and compared with that before operation,the differences were statistically significant（P < 0.05）.One week after operation,the differences of the lumbar JOA score and the ADL score between the two groups were statistically significant（P < 0.05）,and the observation group was better than the control group.After 3 days,1 week,6 months and 1 year,the VAS score of waist pain in both groups decreased gradually and the differences were statistically significant（P < 0.05）compared with those before operation.Three days after operation,the VAS score of waist pain in the observation group was better than the control group,and the difference was statistically significant（P < 0.05）.Conclusion:Decompression fusion and internal fixation therapy can obtain a good effect for the treatment of lumbar disc herniation.When combined with local application of compound betamethasone,it can effectively relieve early postoperative neurological symptoms and control the inflammatory reaction caused by surgical trauma.

　　【Keywords】 lumbar disc herniation;decompression fusion and internal fixation therapy;compound betamethasone;local injection;clinical observation