基于“治未病”思想探讨骨质疏松性脊柱骨折的防治策略
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摘要
骨质疏松症属于骨科慢性、增龄性疾患,病变呈现渐进性的动态变化,后期极易发生脊柱骨折。针对这一发病特点,基于中医"治未病"思想,从"未病先防,降低骨折发生风险"、"已病防变,选择最佳治疗方案"、"后期巩固,提高患者生活质量"三方面探讨骨质疏松性脊柱骨折的防治,从而达到减少脊柱骨折的发生,减轻患者疼痛症状,降低致畸、致残率的目的。
Osteoporosis belongs to the chronic,aging diseases of the orthopedics,which shows dynamic changes gradually,and spinal fractures are prone to occur in the later stage. According to the characteristics of this disease,based on the thought of "preventive treatment of disease" of traditional Chinese medicine,we investigate the prevention and treatment of osteoporotic spinal fracture from three aspects. Anterior prevention before disease onset and to reduce fracture risk firstly,diseases have been developed to prevent further change and to choose the best treatment scheme secondly,later consolidation and to improve the quality of life of patients thirdly,so as to reduce the incidence of spinal fractures,to relieve the symptoms of pain and to decrease the rate of teratogenic and disability.
Osteoporosis belongs to the chronic,aging diseases of the orthopedics,which shows dynamic changes gradually,and spinal fractures are prone to occur in the later stage. According to the characteristics of this disease,based on the thought of "preventive treatment of disease" of traditional Chinese medicine,we investigate the prevention and treatment of osteoporotic spinal fracture from three aspects. Anterior prevention before disease onset and to reduce fracture risk firstly,diseases have been developed to prevent further change and to choose the best treatment scheme secondly,later consolidation and to improve the quality of life of patients thirdly,so as to reduce the incidence of spinal fractures,to relieve the symptoms of pain and to decrease the rate of teratogenic and disability.
引文
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[2]何渝煦,魏庆中,熊启良,等.骨质疏松性骨折与骨密度关系的研究进展[J].中国骨质疏松杂志,2014,20(2):219-224.
[3]蔡舒婷,孙雯,刘红.骨折风险评估工具(FRAX?)在评价绝经后女性骨密度的临床意义[J].中国骨质疏松杂志,2017,23(2):177-182.
[4]原发性骨质疏松症诊疗指南(2017)[J].中华骨质疏松和骨矿盐疾病杂志,2017,10(05):413-443.
[5] Didier H,Sanford B.Quantitative Ultrasound(QUS)in the Management of Osteoporosis and Assessment of Fracture Risk[J].Journal of Clinical Densitometry,2017,20(3):322-333.
[6] Kanis JA,Burlet N. European guidance for the diagnosis and management of osteoporosis in postmenopausal women[J].Osteoporosis International,2008,19(4):399-428.
[7] Raluca P,Remus C.Accuracy of quantitative ultrasound parameters in the diagnosis of osteoporosis[J]. Open Medicine,2009,5(4):478-485.
[8]俞海燕,唐伟,王尧.骨质疏松性骨折风险预测方法的研究进展[J].中国骨质疏松杂志,2015,21(03):372-375.
[9]朱婧颖,韩颖颖.机械应力、骨细胞凋亡和骨重建[J].中国骨质疏松杂志,2014(1):91-94.
[10] Gennari LG,Rotatori S.Treatment needs and current options for postmenopausal osteoporosis[J]. Expert opinion on pharmacotherapy,2016,17(8):1141-1152.
[11] Winarno AS,Kyvernitakis I. Successful treatment of 1-34parathyroid hormone(PTH)after failure of bisphosphonate therapy in a complex case of pregnancy associated osteoporosis and multiple fractures[J]. Zeitschrift Für Geburtshilfe Und Neonatologie,2014,218(4):171-173.
[12] Scott G,Timothy L. Effects of exercise on bone mineral density in calcium-replete postmenopausal women with and without hormone replacement therapy[J]. Osteoporosis International,2003,14(8):637-643.
[13]邹军,章岚,任弘,等.运动防治骨质疏松专家共识[J].中国骨质疏松杂志,2015,21(11):1291-1302+1306.
[14] Curtis EM,Moon RJ. Recent advances in the pathogenesis and treatment of osteoporosis[J].Clinical medicine,2016,16(4):360-364.
[15]马艺璇,郭琪,侯安安,等.运动防治老年人骨质疏松的研究进展[J].中国骨质疏松杂志,2015,21(11):1385-1388,1411.
[16]王春燕,何成奇.骨质疏松症治疗中的运动疗法[J].中国组织工程研究,2013,17(37):6657-6663.
[17] Rajaa Al-Raddadi.The prevalence of lifestyle practices that might affect bone health in relation to Vitamin D status among Saudi adolescent females[J].Nutrition,2018,45(1):108-113.
[18]董万涛,吕泽斌,宋敏,等.中医“骨枯髓空”的病理机制及从肾论治原发性骨质疏松症的科学涵义[J].中国骨质疏松杂志,2014,20(10):1245-1249.
[19]宋敏,刘涛,巩彦龙,等.基于中医传承辅助平台系统的骨质疏松症组方用药规律分析[J].中国骨质疏松杂志,2017,23(4):519-523.
[20]宋敏,李泽佳,董万涛,等.基于“补肾法”治疗原发性骨质疏松症的研究述评[J].中国骨质疏松杂志,2014,20(8):973-977.
[21]蒋俊,崔莉,孙娥,等.基于淫羊藿黄酮类化合物的体内代谢阐述其抗骨质疏松药效物质基础[J].中草药,2014,45(5):721-729.
[22]罗晓,宋敏,刘艳.淫羊藿含药血清对成骨细胞增殖与分化影响的实验研究进展[J].中国骨质疏松杂志,2008,(11):818-822
[23]刘小钰,宋敏,蒋林博,等.补骨脂活性成分对骨质疏松相关信号通路影响的研究概况[J].中国骨质疏松杂志,2017,23(6):831-836.
[24]杨勇晖,陈平洋.葛根素防治骨质疏松的研究进展[J].中国骨质疏松杂志,2015,21(3):376-378.
[25]覃裕,邱冰,朱思刚,等.仙灵骨葆胶囊治疗骨质疏松症的疗效及其对骨代谢及骨转换指标的影响分析[J].中国骨质疏松杂志,2015,21(9):1056-1060+1064.
[26]徐陆晨,李运峰.骨质疏松性骨折药物治疗的研究进展[J].中国骨质疏松杂志,2017,23(7):947-953.
[27] Henriksen K,Byrjalsen I,et al.A randomized,doubleblind,multicenter,placebo-controlled study to evaluate the efficacy and safety of oral salmon calcitonin in the treatment of osteoporosis in postmenopausal women taking calcium and vitamin D[J].Bone,2016,91:122-129.
[28] Pui Kit Suen,Ling Qin.Sclerostin,an emerging therapeutic target for treating osteoporosis and osteoporotic fracture:A general review[J].Journal of Orthopaedic Translation,2016,4:1-13.
[29]崔莹,冯正平.抗骨质疏松药物的研究进展[J].中国骨质疏松杂志,2015(3):367-371.
[30] Jellinger KA. Prevention and Treatment of Osteoporosis-A Clinician’s Guide[J].European Journal of Neurology,2006,13(7):e14.
[31]严红梅,张振海,孙娥,等.中药治疗骨质疏松症的研究进展[J].中草药,2014,45(8):1174-1178.
[32]宋敏,曹林忠,柴居堂,张晓刚,董万涛.基于阶梯疗法探讨腰椎间盘突出症的临床治疗[J].颈腰痛杂志,2015,36(6):445-448.
[33]秦大平,张晓刚,宋敏,等.老年骨质疏松性胸腰椎压缩骨折治疗研究进展[J].中华中医药杂志,2017,32(2):679-684.
[34]白宝华.胸腰椎压缩性骨折应用中西医结合治疗的临床疗效分析[J].时珍国医国药,2014,25(3):658-659.
[35] Ma,Xing D,Chen Y,et al.Risk factors for new vertebral compression fractures after percutaneous vertebroplasty:Qualitative evidence synthesized from a systematic review[J].Spine(Phila Pa1976),2013,38(12):E713-E722.
[36]钱明,潘俊,孟斌,等.聚甲基丙烯酸甲酯骨水泥与Cortoss骨水泥生物力学性能及聚合温度比较[J].中国组织工程研究,2012,16(16):2935-2938.
[37] Blondel B,Fuentes S,et al.Percutaneous management of thoracolumbar burst fractures:Evolution of techniques and strategy[J].Orthopaedics&Traumatology Surgery&Research Otsr,2011,97(5):527.
[38]史晓林,王健,王博,等.脆性骨折的防治进展[J].中医正骨,2017,29(5):20-22.
[39] Maryam,Golchin,et al.Osteoporosis:A Silent Disease with Complex Genetic Contribution[J]. Journal of Genetics and Genomics,2016,43(2):49-61.
[2]何渝煦,魏庆中,熊启良,等.骨质疏松性骨折与骨密度关系的研究进展[J].中国骨质疏松杂志,2014,20(2):219-224.
[3]蔡舒婷,孙雯,刘红.骨折风险评估工具(FRAX?)在评价绝经后女性骨密度的临床意义[J].中国骨质疏松杂志,2017,23(2):177-182.
[4]原发性骨质疏松症诊疗指南(2017)[J].中华骨质疏松和骨矿盐疾病杂志,2017,10(05):413-443.
[5] Didier H,Sanford B.Quantitative Ultrasound(QUS)in the Management of Osteoporosis and Assessment of Fracture Risk[J].Journal of Clinical Densitometry,2017,20(3):322-333.
[6] Kanis JA,Burlet N. European guidance for the diagnosis and management of osteoporosis in postmenopausal women[J].Osteoporosis International,2008,19(4):399-428.
[7] Raluca P,Remus C.Accuracy of quantitative ultrasound parameters in the diagnosis of osteoporosis[J]. Open Medicine,2009,5(4):478-485.
[8]俞海燕,唐伟,王尧.骨质疏松性骨折风险预测方法的研究进展[J].中国骨质疏松杂志,2015,21(03):372-375.
[9]朱婧颖,韩颖颖.机械应力、骨细胞凋亡和骨重建[J].中国骨质疏松杂志,2014(1):91-94.
[10] Gennari LG,Rotatori S.Treatment needs and current options for postmenopausal osteoporosis[J]. Expert opinion on pharmacotherapy,2016,17(8):1141-1152.
[11] Winarno AS,Kyvernitakis I. Successful treatment of 1-34parathyroid hormone(PTH)after failure of bisphosphonate therapy in a complex case of pregnancy associated osteoporosis and multiple fractures[J]. Zeitschrift Für Geburtshilfe Und Neonatologie,2014,218(4):171-173.
[12] Scott G,Timothy L. Effects of exercise on bone mineral density in calcium-replete postmenopausal women with and without hormone replacement therapy[J]. Osteoporosis International,2003,14(8):637-643.
[13]邹军,章岚,任弘,等.运动防治骨质疏松专家共识[J].中国骨质疏松杂志,2015,21(11):1291-1302+1306.
[14] Curtis EM,Moon RJ. Recent advances in the pathogenesis and treatment of osteoporosis[J].Clinical medicine,2016,16(4):360-364.
[15]马艺璇,郭琪,侯安安,等.运动防治老年人骨质疏松的研究进展[J].中国骨质疏松杂志,2015,21(11):1385-1388,1411.
[16]王春燕,何成奇.骨质疏松症治疗中的运动疗法[J].中国组织工程研究,2013,17(37):6657-6663.
[17] Rajaa Al-Raddadi.The prevalence of lifestyle practices that might affect bone health in relation to Vitamin D status among Saudi adolescent females[J].Nutrition,2018,45(1):108-113.
[18]董万涛,吕泽斌,宋敏,等.中医“骨枯髓空”的病理机制及从肾论治原发性骨质疏松症的科学涵义[J].中国骨质疏松杂志,2014,20(10):1245-1249.
[19]宋敏,刘涛,巩彦龙,等.基于中医传承辅助平台系统的骨质疏松症组方用药规律分析[J].中国骨质疏松杂志,2017,23(4):519-523.
[20]宋敏,李泽佳,董万涛,等.基于“补肾法”治疗原发性骨质疏松症的研究述评[J].中国骨质疏松杂志,2014,20(8):973-977.
[21]蒋俊,崔莉,孙娥,等.基于淫羊藿黄酮类化合物的体内代谢阐述其抗骨质疏松药效物质基础[J].中草药,2014,45(5):721-729.
[22]罗晓,宋敏,刘艳.淫羊藿含药血清对成骨细胞增殖与分化影响的实验研究进展[J].中国骨质疏松杂志,2008,(11):818-822
[23]刘小钰,宋敏,蒋林博,等.补骨脂活性成分对骨质疏松相关信号通路影响的研究概况[J].中国骨质疏松杂志,2017,23(6):831-836.
[24]杨勇晖,陈平洋.葛根素防治骨质疏松的研究进展[J].中国骨质疏松杂志,2015,21(3):376-378.
[25]覃裕,邱冰,朱思刚,等.仙灵骨葆胶囊治疗骨质疏松症的疗效及其对骨代谢及骨转换指标的影响分析[J].中国骨质疏松杂志,2015,21(9):1056-1060+1064.
[26]徐陆晨,李运峰.骨质疏松性骨折药物治疗的研究进展[J].中国骨质疏松杂志,2017,23(7):947-953.
[27] Henriksen K,Byrjalsen I,et al.A randomized,doubleblind,multicenter,placebo-controlled study to evaluate the efficacy and safety of oral salmon calcitonin in the treatment of osteoporosis in postmenopausal women taking calcium and vitamin D[J].Bone,2016,91:122-129.
[28] Pui Kit Suen,Ling Qin.Sclerostin,an emerging therapeutic target for treating osteoporosis and osteoporotic fracture:A general review[J].Journal of Orthopaedic Translation,2016,4:1-13.
[29]崔莹,冯正平.抗骨质疏松药物的研究进展[J].中国骨质疏松杂志,2015(3):367-371.
[30] Jellinger KA. Prevention and Treatment of Osteoporosis-A Clinician’s Guide[J].European Journal of Neurology,2006,13(7):e14.
[31]严红梅,张振海,孙娥,等.中药治疗骨质疏松症的研究进展[J].中草药,2014,45(8):1174-1178.
[32]宋敏,曹林忠,柴居堂,张晓刚,董万涛.基于阶梯疗法探讨腰椎间盘突出症的临床治疗[J].颈腰痛杂志,2015,36(6):445-448.
[33]秦大平,张晓刚,宋敏,等.老年骨质疏松性胸腰椎压缩骨折治疗研究进展[J].中华中医药杂志,2017,32(2):679-684.
[34]白宝华.胸腰椎压缩性骨折应用中西医结合治疗的临床疗效分析[J].时珍国医国药,2014,25(3):658-659.
[35] Ma,Xing D,Chen Y,et al.Risk factors for new vertebral compression fractures after percutaneous vertebroplasty:Qualitative evidence synthesized from a systematic review[J].Spine(Phila Pa1976),2013,38(12):E713-E722.
[36]钱明,潘俊,孟斌,等.聚甲基丙烯酸甲酯骨水泥与Cortoss骨水泥生物力学性能及聚合温度比较[J].中国组织工程研究,2012,16(16):2935-2938.
[37] Blondel B,Fuentes S,et al.Percutaneous management of thoracolumbar burst fractures:Evolution of techniques and strategy[J].Orthopaedics&Traumatology Surgery&Research Otsr,2011,97(5):527.
[38]史晓林,王健,王博,等.脆性骨折的防治进展[J].中医正骨,2017,29(5):20-22.
[39] Maryam,Golchin,et al.Osteoporosis:A Silent Disease with Complex Genetic Contribution[J]. Journal of Genetics and Genomics,2016,43(2):49-61.