益肾补骨复元汤联合PKP术治疗老年骨质疏松性胸腰椎骨折不愈合的临床观察

目的:观察益肾补骨复元汤联合经皮椎体后凸成形术(PKP)治疗老年骨质疏松性胸腰椎骨折不愈合的临床效果。方法:选取2016年1月~2018年3月我院收治的老年骨质疏松性胸腰椎骨折不愈合患者84例,按照随机数字表分成观察组与对照组各42例,对照组行PKP术治疗,观察组在对照组之上加服益肾补骨复元汤,持续治疗1个月后,比较两组中医症候积分及疗效、疼痛(VAS评分)、Cobb角及骨密度、骨代谢指标血清骨碱性磷酸酶(BALP)、人胶原交联羧基末端肽(CTX),血骨钙素(BGP)]以及治疗后3个月生活质量日本骨协会(JOA)评分、Oswestry功能障碍指数问卷(ODI)]。结果:治疗后,两组中医症候积分较治疗前显著降低(P<0.05),且观察组降低幅度大于对照组(P<0.05);观察组疗效97.62%,显著高于对照组的80.95%(P<0.05);两组VAS评分、Cobb角均显著低于治疗前,骨密度显著高于治疗前(P<0.05),且观察组下降或升高幅度大于对照组(P<0.05);观察组BALP、BGP水平高于对照组,CTX水平低于对照组(P<0.05);治疗后3个月,两组JOA评分均显著高于治疗前,ODI评分均显著低于治疗前(P<0.05),且观察组上升或下降幅度大于对照组(P<0.05)。结论:对老年骨质疏松性胸腰椎骨折不愈合患者采用益肾补骨复元汤联合PKP术治疗,能够减轻患者中医症候,提高治疗效果,减缓疼痛,降低Cobb角,提高骨密度,同时能改善患者骨代谢指标,提高后期生活质量。

Clinical Observation of Applying Yishen Bugu Fuyuan Decoction Combined with PKP in the Treatment of Senile Osteoporotic Thoracolumbar Fracture Nonunion

Objective:To observe the clinical effect of applying Yishen Bugu Fuyuan Decoction combined with percutaneous kyphoplasty(PKP)in the treatment of senile osteoporotic thoracolumbar fracture nonunion.Methods:84 cases of patients with senile osteoporotic thoracolumbar fracture nonunion who were treated in our hospital from January 2016 to March 2018 were selected.According to the random number table method,the patients were divided into observation group and controlled group with 42 cases in each group.The controlled group was treated with PKP,and observation group was given Yishen Bugu Fuyuan Decoction on the basis of the controlled group.After 1 month of continuous treatment,the TCM syndromes scores and efficacy,pain(VAS score),Cobb angle and bone density,bone metabolism indexesserum bone alkaline phosphatase(BALP),human collagen cross-linked carboxyl terminal peptide(CTX),bone gla protein(BGP)]and quality of life at 3 months after treatmentJapanese Orthopaedic Association(JOA)score,Oswestry dysfunction index(ODI)]were compared between the two groups.Results:After treatment,the TCM syndromes scores in the two groups were significantly lower than those before treatment(P<0.05),and the decrease in the observation group was greater than that in the controlled group(P<0.05).The efficacy in the observation group was significantly higher than that in the controlled group(97.62%vs 80.95%)(P<0.05).The VAS score and Cobb angle were significantly lower than those before treatment while the bone mineral density was significantly higher than that before treatment(P<0.05),and the decrease or increase in the observation group was greater than that in the controlled group(P<0.05).The levels of BALP and BGP in the observation group were higher than those in the controlled group while the CTX level was lower than that in the controlled group(P<0.05).At 3 months after treatment,the JOA score in the two groups was significantly higher than that before treatment while the ODI score was significantly lower than that before treatment(P<0.05),and the increase or decrease in the observation group was greater than that in the controlled group(P<0.05).Conclusions:For patients with osteoporotic thoracolumbar fracture nonunion,Yishen Bugu Fuyuan Decoction combined with PKP can reduce TCM symptoms,improve treatment effects,relieve pain,reduce Cobb angle,increase bone density,and improve bone metabolism indicators and quality of life in the later period.