Clinical Effects And Experimental Study Of Shentong Zhuyu Decoction On The Paraspinal Muscle Damage After Lumbar Posterior Surgery

Objective: To observe the animal and clinical effect of Shentong Zhuyu Decoction on the paraspinal muscle damage after lumbar posterior decompression and internal fixation through the animal experiment and clinical trail, which can provide possibly experimental mechanism and clinical evidence to the further application of Shentong Zhuyu Decoction in clinical treatment of paraspinal muscle damage after lumber posterior surgery.Methods: Animal experiments:In total of forty-eight fermale SD rats were randomly divided into two groups (control group is A, the experimental group is B), each group included24cases. All of SD rats were set into animal model of paraspinal muscle damage according to the clinical lumbar posterior decompression and internal fixation operation. Group A were given lavage of physiological saline (0.02ml/g) and group B were given lavage of Shentong Zhuyu Decoction (0.02ml/g) one time each12hours in the postoperative12hours. All rats were tested the serum inflammatory cytokines(IL-1B,IL-6,TNF-a,PGE2) activity in the preoperative1day and in the postoperative first day, third day, seventh day. Collecting the specimens of lumbar paraspinal muscle around the operation area to do HE staining for tissue morphology observation at the postoperative first, third, and seventh day. And then, compare histopathologic score between groups. Clinical research: Between Jenuary2012and December2012,one hundred and twenty-eight patients of L4-5intervertebral disc herniation were enrolled in this study,109of128patients were available for at least12months. All patients were randomly divided into control group (group C, n=53) and interventional group (group D, n=56).All of the patients were taken lumbar posterior decompression and internal fixation by a senior doctor at a single institution during this time period. Group C patients were given clinical routine treatment after operation, group D patients were added treatment of Shentong Zhuyu Decoction on the basis of routine therapy. All patients were evaluated by ODI score and VAS at last follow-up after surgery, and were given MRI to calculate multifidus (MF) atrophy ratio. The data were analyzed using statistical software SPSS18.0.Results:Animal experiments: Comparison between group A and group B. Their inflammatory cytokines activity were no significant difference between groups (P>0.05) at preoperative1day and postoperative1day. They had significant difference (P<0.05) at third day and seventh day after surgery. The histological score had significant difference (P<0.05) at third and seventh day after operation, there were no difference(p>0.05) at first day after operation. Clinical research: Group C compared with Group D. Their ODI and VAS score had significant difference (P<0.05) at12months after surgery. The multifidus atrophy ratio had significant difference (P<0.05) at12months after operation. Correlation analyses revealed a significant positive correlation between MF atrophy ratio and VAS(r=0.516, p<0.05),MF atrophy ratio was not correlated with ODI (r=0.029, p=0.767)Conclutions: l.Shentong Zhuyu Decoction can improve the inflammatory reaction of paraspinal muscle and decrease inflammatory cytokines activity after lumbar posterior decompression and internal fixation operation in the early.2. Shentong Zhuyu Decoction can reduce the Atrophy degree of multifidus after lumbar posterior surgery.3. ShentongZhuyu Decoction can promote the paraspinal muscle’s functiona recovery after lumbar posterior surgery.