壮骨汤联合合经皮椎体后凸成形术治疗老年性骨质疏松性脊柱压缩性骨折的临床疗效及对患者骨代谢的影响
|
摘要
目的:探讨壮骨汤联合经皮椎体后凸成形术(PKP)治疗老年性骨质疏松性脊柱压缩性骨折的临床疗效,并分析其对患者骨代谢指标的影响。方法:选取2016年9月至2018年2月琼海市中医院收治的老年性骨质疏松性脊柱压缩性骨折患者66例作为研究对象,根据治疗方法不同将所有患者分为对照组(n=28)和观察组(n=38)。2组患者均实施PKP治疗,观察组术后增加壮骨汤治疗,连续服用1个月。比较2组治疗后临床疗效、骨折愈合情况及腰部功能恢复情况,检测并比较2组治疗前后骨代谢的变化。结果:治疗后观察组总有效率高达94. 74%,高于对照组的89. 29%,差异无统计学意义(P> 0. 05)。与治疗前比较,治疗后2组患者伤椎前缘高度均明显升高,伤椎楔变角及后凸Cobb角均明显降低,且2组差异有统计学意义(P <0. 05);治疗后2组患者骨密度(BMD)、血清骨钙素(BGP)及骨碱性磷酸酶(BALP)水平和日本骨科协会腰痛评价表(JOA)评分均明显增加,且观察组明显高于对照组,差异有统计学意义(P <0. 05)。结论:壮骨汤联合PKP治疗老年性骨质疏松性脊柱压缩性骨折,可明显抑制骨丢失,改善骨代谢,促进骨折愈合,改善临床症状,提高总体治疗效果。
Objective: To investigate the clinical efficacy of Zhuanggu Decoction combined with percutaneous kyphoplasty( PKP)in the treatment of elderly osteoporotic spinal compression fracture,analyze its effects on bone metabolism indexes of patients.Methods: A total of 66 patients with elderly osteoporotic spinal compression fracture who were treated in Qionghai Hospital of Traditional Chinese Medicine from September 2016 to February 2018 were selected. All patients were divided into a control group( n =28) and an observation group( n = 38) according to different treatment methods. Patients in the 2 groups were treated with PKP,and the observation group added Zhuanggu Decoction after surgery and took 1 month continuously. The clinical efficacy,fracture healing and recovery of lumbar function were compared between the 2 groups after treatment. The changes of bone metabolism indexes levels were detected and compared before and after treatment. Results: The total effective rate was 94. 74% in the observation group,which was higher than 89. 29% in the control group( P > 0. 05). Compared with before treatment,the height of anterior margin of the injured significantly rose in the 2 groups after treatment,vertebral wedge angle and Cobb angle significantly decreased,and the difference between the 2 groups was significant( P < 0. 05). After treatment,the levels of bone metabolism markers such as BMD,serum BGP,BALP and JOA scores significantly increased in the 2 groups after treatment,and the observation group was significantly higher than those of the control group( P < 0. 05). Conclusion: Zhuanggu Decoction combined with PKP in the treatment of elderly osteoporotic spinal compression fracture can significantly inhibit bone loss,improve bone metabolism,promote fracture healing,improve clinical symptoms and overall treatment efficacy.
Objective: To investigate the clinical efficacy of Zhuanggu Decoction combined with percutaneous kyphoplasty( PKP)in the treatment of elderly osteoporotic spinal compression fracture,analyze its effects on bone metabolism indexes of patients.Methods: A total of 66 patients with elderly osteoporotic spinal compression fracture who were treated in Qionghai Hospital of Traditional Chinese Medicine from September 2016 to February 2018 were selected. All patients were divided into a control group( n =28) and an observation group( n = 38) according to different treatment methods. Patients in the 2 groups were treated with PKP,and the observation group added Zhuanggu Decoction after surgery and took 1 month continuously. The clinical efficacy,fracture healing and recovery of lumbar function were compared between the 2 groups after treatment. The changes of bone metabolism indexes levels were detected and compared before and after treatment. Results: The total effective rate was 94. 74% in the observation group,which was higher than 89. 29% in the control group( P > 0. 05). Compared with before treatment,the height of anterior margin of the injured significantly rose in the 2 groups after treatment,vertebral wedge angle and Cobb angle significantly decreased,and the difference between the 2 groups was significant( P < 0. 05). After treatment,the levels of bone metabolism markers such as BMD,serum BGP,BALP and JOA scores significantly increased in the 2 groups after treatment,and the observation group was significantly higher than those of the control group( P < 0. 05). Conclusion: Zhuanggu Decoction combined with PKP in the treatment of elderly osteoporotic spinal compression fracture can significantly inhibit bone loss,improve bone metabolism,promote fracture healing,improve clinical symptoms and overall treatment efficacy.
引文
[1]乔芳,常静.骨质疏松流行病学调查分析[J].中国实用医药,2012,7(30):271-272.
[2]邢兰坤.骨质疏松脊柱压缩性骨折的微创治疗进展[J].中国现代药物应用,2012,6(6):51-52.
[3]邹戟,赵红卫,陈卫东,等.经皮椎体成形术与经皮椎体后凸成形术治疗骨质疏松脊柱压缩性骨折的临床对比分析[J].中国老年学杂志,2012,32(24):5581-5582.
[4]印飞,孙振中,宋升,等.单双侧经皮椎体后凸成形术治疗中位胸椎骨质疏松性压缩骨折对比研究[J].中国修复重建外科杂志,2016,30(1):77-81.
[5]谭斌,刘雄文,刘刚,等.经皮椎体后凸与经皮椎体成形术修复骨质疏松椎体压缩性骨折:随机分组比较[J].中国组织工程研究,2016,20(4):539-543.
[6]黄建华,黄建武,李慧辉,等.加味左归丸对绝经后骨质疏松症肝肾不足证患者骨密度的影响[J].中医正骨,2013,25(11):19-21.
[7]中国老年学学会骨质疏松委员会骨质疏松诊断标准学科组.中国人骨质疏松症建议诊断标准(第二稿)[J].中国骨质疏松杂志,2000,6(1):1-3.
[8]刘志雄.骨科常用诊断分类方法和功能结果评定标准[M].北京:北京科学技术出版社,2005:335-336.
[9]Kim GD,Kim YJ,Chae SU,et al.Analysis of Clinical Features of Hip Fracture Patients with or without Prior Osteoporotic Spinal Compression Fractures[J].J Bone Metab,2013,20(1):11-15.
[10]邓秀珍.脊柱微创手术治疗骨质疏松性椎体压缩性骨折术中危险因素分析与护理对策[J].医药前沿,2012,2(14):75-76.
[11]Chotigavanich C,Sanpakit S,Wantthanaapisith T,et al.The surgical treatment of the osteoporotic vertebral compression fracture in the elderly patients with the spinal instrumentation[J].J Med Assoc Thai,2009,92 Suppl5:S109-115.
[12]黄卫国,李玉民,海涌.PKP治疗骨质疏松性椎体压缩性骨折的中期临床疗效分析[J].实用骨科杂志,2015,21(2):105-109.
[13]陈惠国,张喆,梁海萍,等.椎体后凸成形术治疗骨质疏松性椎体骨折中期疗效及并发症的临床观察[J].中国骨伤,2010,23(10):743-745.
[14]李建鹏,谢雁鸣.从肾虚血瘀论治绝经后骨质疏松症的研究进展[J].世界中医药,2012,7(2):179-180.
[15]许永超.骨痿灵胶囊治疗绝经后骨质疏松症(肝肾不足型)的临床观察[D].长春:长春中医药大学,2016.
[16]许静,张晶晶,郭非非,等.淫羊藿黄酮类主要成分促进骨髓间充质干细胞向成骨细胞增殖分化作用及机制的影响[J].中国实验方剂学杂志,2017,23(14):113-120.
[17]徐展望,刘国岩.骨碎补提取液培养BMSCs移植对模型大鼠骨质疏松性骨折愈合的影响[J].山东中医杂志,2013,32(9):51-53.
[18]胡向阳,李小芳.壮骨汤治疗老年性骨质疏松脊柱压缩性骨折临床研究[J].中医临床研究,2014,6(5):8-10.
[19]肖恩,孟萍.骨质疏松骨代谢生化指标的研究进展[J].中国骨质疏松杂志,2008,14(3):212-216,147.
[2]邢兰坤.骨质疏松脊柱压缩性骨折的微创治疗进展[J].中国现代药物应用,2012,6(6):51-52.
[3]邹戟,赵红卫,陈卫东,等.经皮椎体成形术与经皮椎体后凸成形术治疗骨质疏松脊柱压缩性骨折的临床对比分析[J].中国老年学杂志,2012,32(24):5581-5582.
[4]印飞,孙振中,宋升,等.单双侧经皮椎体后凸成形术治疗中位胸椎骨质疏松性压缩骨折对比研究[J].中国修复重建外科杂志,2016,30(1):77-81.
[5]谭斌,刘雄文,刘刚,等.经皮椎体后凸与经皮椎体成形术修复骨质疏松椎体压缩性骨折:随机分组比较[J].中国组织工程研究,2016,20(4):539-543.
[6]黄建华,黄建武,李慧辉,等.加味左归丸对绝经后骨质疏松症肝肾不足证患者骨密度的影响[J].中医正骨,2013,25(11):19-21.
[7]中国老年学学会骨质疏松委员会骨质疏松诊断标准学科组.中国人骨质疏松症建议诊断标准(第二稿)[J].中国骨质疏松杂志,2000,6(1):1-3.
[8]刘志雄.骨科常用诊断分类方法和功能结果评定标准[M].北京:北京科学技术出版社,2005:335-336.
[9]Kim GD,Kim YJ,Chae SU,et al.Analysis of Clinical Features of Hip Fracture Patients with or without Prior Osteoporotic Spinal Compression Fractures[J].J Bone Metab,2013,20(1):11-15.
[10]邓秀珍.脊柱微创手术治疗骨质疏松性椎体压缩性骨折术中危险因素分析与护理对策[J].医药前沿,2012,2(14):75-76.
[11]Chotigavanich C,Sanpakit S,Wantthanaapisith T,et al.The surgical treatment of the osteoporotic vertebral compression fracture in the elderly patients with the spinal instrumentation[J].J Med Assoc Thai,2009,92 Suppl5:S109-115.
[12]黄卫国,李玉民,海涌.PKP治疗骨质疏松性椎体压缩性骨折的中期临床疗效分析[J].实用骨科杂志,2015,21(2):105-109.
[13]陈惠国,张喆,梁海萍,等.椎体后凸成形术治疗骨质疏松性椎体骨折中期疗效及并发症的临床观察[J].中国骨伤,2010,23(10):743-745.
[14]李建鹏,谢雁鸣.从肾虚血瘀论治绝经后骨质疏松症的研究进展[J].世界中医药,2012,7(2):179-180.
[15]许永超.骨痿灵胶囊治疗绝经后骨质疏松症(肝肾不足型)的临床观察[D].长春:长春中医药大学,2016.
[16]许静,张晶晶,郭非非,等.淫羊藿黄酮类主要成分促进骨髓间充质干细胞向成骨细胞增殖分化作用及机制的影响[J].中国实验方剂学杂志,2017,23(14):113-120.
[17]徐展望,刘国岩.骨碎补提取液培养BMSCs移植对模型大鼠骨质疏松性骨折愈合的影响[J].山东中医杂志,2013,32(9):51-53.
[18]胡向阳,李小芳.壮骨汤治疗老年性骨质疏松脊柱压缩性骨折临床研究[J].中医临床研究,2014,6(5):8-10.
[19]肖恩,孟萍.骨质疏松骨代谢生化指标的研究进展[J].中国骨质疏松杂志,2008,14(3):212-216,147.