Observation On The Clinical Efficacy Of Buyang Huanwu Decoction Combined With Posterior Cervical Surgery In The Treatment Of Multi-segment Cervical Spondylotic Myelopathy

Purpose:To observe the clinical effect of Buyang Huanwu decoction combined with unilateral open-door laminoplasty and fixation with titanium plate in the treatment of multi-segment cervical spondylotic myelopathy.Material and method:The patients with multi-segment cervical spondylotic myelopathy admitted to the Department 1 of Orthopaedics,Affiliated Hospital of Liaoning University of TCM(Traditional Chinese Medicine,TCM)from October 2016 to November2018 were selected as subjects.According to the operation time,the postoperative patients with the syndrome of qi deficiency and blood stasis syndrome were randomly divided into the control group(32 cases)and the TCM group(35 cases),and the background date of the patients(gender,age,duration of the disease,surgical segment)were collected.These 67 patients were received unilateral open-door laminoplasty and fixation with titanium plate.Two weeks postoperatively,Buyang Huanwu Decoction was applied to the TCM group.Both groups were followed up regularly.The JOA scores were recorded preoperative and 3months postoperatively.The improvement rate was calculated at 3 months postoperatively.The standard of improvement rate: excellent: RIS ? 75%,good:75% <RIS?50%,average:50% <RIS?25%,poor: RIS<25%.All patients were evaluated for efficacy according to the criteria for determining the efficacy of TCM symptoms at 3 months postoperatively.cervical Curvature and SVA value were recorded at preoperative and 3 months postoperatively from cervical lateral DR.laminoplasty angle were recorded at 2 weeks and 3 months postoperatively from Cervical CT.At 3 months postoperatively,bone fusion at the hinge side were observed and the occurrence of complications were recorded.Results:1.The backgound data(gender,age,duration of disease,surgical segment)of the two groups were compared,and the difference was not statistically significant(P > 0.05).2.The preoperative JOA scores of the two groups were compared,and the difference was notstatistically significant(P > 0.05).To compared with preoperative conditions,the JOA scores of the two group patients 3 months postoperative were improved,the difference was statistically significant(P<0.01).The JOA scores of the two groups were compared at 3months postoperatively,and the difference was statistically significant(P > 0.05).It indicated that the spinal cord function of both groups were improved to some extent,the efficacy of the TCM group was better than the control group.3.Comparison of the RIS(rate of the improved JOA score)between the two groups at 3months postoperatively: control group: 14 cases were excellent,7 cases were good,9 cases were average,2 cases were poor.The rate of good was 66%.TCM group: 22 cases were excellent,11 cases were good and 2 cases were average,the good rate was 94%.The difference of the two groups was statistically significant(P < 0.05).It indicated that the efficacy of the TCM group was better than the control group at 3 months postoperatively.4.The efficacy of TCM symptoms was evaluated in the two groups at 3 months postoperatively.In the control group,6 cases were cured,16 cases were markedly effective,10 cases were effective and 0 case was ineffective.The effective rate was 69%.In the TCM group,17 cases were cured,13 cases were markedly effective,5 cases were effective and 0case was ineffective.The effective rate was 86%.,The difference of the two groups was statistically significant(P<0.05).It indicated that the efficacy of the TCM group was better than the control group at 3 months postoperatively.5.To Compare with the preoperative,the change of the cervical curvature and SVA value of all patients 3 months postoperatively were not significant.The difference was not statistically significant(P > 0.05).It indicated that the operation has little effect on the cervical curvature and sagittal balance.6.The change of the laminoplasty angle two weeks postoperatively of all patients were not obvious,the difference was not statistically significant(P > 0.05).Bone fusion at the hinge side were observed 3 months postoperatively.7.No cerebrospinal fluid leakage occurred during operation in all patients,3 cases of Nerve C5 root paralysis complications were appeared,the symptoms disappeared after dehydration and nutritional nerve treatment.No axial symptoms and door shaft breakage and "re-closing" phenomenon occurred.Conclusion:1.In early postoperative stage(Qi deficiency and blood stasis syndrome),it is effective to apply Buyang Huanwu Decoction for cervical spondylotic myelopathy patients,it is beneficial to promote the recovery of spinal cord function,and improve TCM syndrome,with a good clinical effect.2.To the multi-segment cervical spondylotic myelopathy,unilateral open-door laminoplasty and fixation with titanium plate is safe and effective,and the spinal cord function could improved effectively with this operation.The influnce on sagittal balance and cervical curvature is little,and the angle of laminoplasty is stabled.