芍药甘草汤加味联合针灸对骨质疏松性椎体压缩性骨折术后Oswestry功能障碍指数的影响

探析芍药甘草汤加味联合针灸治疗对骨质疏松性椎体压缩性骨折（OVCF）患者术后 Oswestry 功能障碍指数（ODI）的影响。【方法】 将94例肝肾不足、阴血亏虚型OVCF患者随机分为观察组和对照组，每组各47例。2组患者均接受手术治疗（包括经皮穿刺球囊椎体后凸成形术或经皮椎体成形术），术后对照组接受针灸治疗，观察组接受芍药甘草汤加味联合针灸治疗，连续治疗 12周（共 3个月）。观察 2组患者术后不同观察时点的疼痛程度视觉模拟量表（VAS）评分、ODI评分、骨密度[腰椎第 2～4 节椎体（L2~4）、股骨颈、Wards 三角、全髋]、骨代谢指标[人Ⅰ型胶原 C 端肽（CTX-1）、骨碱性磷酸酶（BALP）、血钙]血清水平的变化情况，并评价2组患者的临床疗效。【结果】（1）疗效方面，治疗3个月后，观察组的总有效率为 100.00%（47/47），对照组为 87.23%（41/47），组间比较（Fisher精确检验），观察组的临床疗效明显优于对照组（P＜0.01）。（2）疼痛程度及胸腰椎功能评分方面，术后第7天及1个月和3个月，2组患者的疼痛程度VAS评分及胸腰椎ODI评分均较前一观察时点明显下降（P＜0.05），且观察组在术后第7天及1个月和3个月对疼痛程度VAS评分及胸腰椎ODI评分的下降幅度均明显优于对照组（P＜0.05或P＜0.01）。（3）骨密度方面，治疗后（术后1个月），2组患者的L2~4、股骨颈、Wards三角、全髋骨密度值均较治疗前明显升高（P＜0.05），且观察组对L2~4、股骨颈、Wards三角、全髋骨密度值的升高幅度均明显优于对照组（P＜0.01）。（4）骨代谢指标方面，治疗后（术后1个月），2组患者的血清CTX-1、BALP和血钙水平均较治疗前明显下降（P＜0.05），且观察组对血清CTX-1、BALP和血钙水平的下降幅度均明显优于对照组（P＜0.01）。【结论】 芍药甘草汤加味联合针灸治疗肝肾不足、阴血亏虚型OVCF患者疗效确切，能显著减轻患者术后疼痛症状，改善患者骨密度和骨代谢，促进胸腰椎功能恢复，有效提升其整体治疗效果。

Effect of Modified Shaoyao Gancao Decoction Combined with Acupuncture on Oswestry Dysfunction Index of Patients After Surgery for Osteoporotic Vertebral Compression Fracture

To explore the effect of modified Shaoyao Gancao Decoction combined with acupuncture on Oswestry Disability Index（ODI） of patients after surgery for osteoporotic vertebral compression fracture（OVCF）.Methods A total of 94 patients with OVCF of liver-kidney deficiency and yin-blood deficiency type were randomly divided into an observation group and a control group，with 47 cases in each group. Both groups were treated with surgical treatment by percutaneous balloon kyphoplasty or percutaneous vertebroplasty. After the operation， the control group was given acupuncture therapy，and the observation group was treated with modified Shaoyao GancaoDecoction combined with acupuncture therapy. Both groups were treated for 12 weeks（3 months in total）. The changes of pain visual analogue scale（VAS） score，ODI score，bone mineral density（BMD） of lumbar vertebrae 2-4（L2-4），femoral neck，Wards triangle and total hip，and serum levels of bone metabolism indicators of type I collagen C-terminal peptide （CTX-1），bone alkaline phosphatase （BALP） and blood calcium in the two groups at different observation time points after operation were observed. After treatment，the clinical efficacy of the two groups was evaluated. Results （1）After 3 months of treatment，the total effective rate of the observation group was 100.00%（47/47），and that of the control group was 87.23%（41/47）. The intergroup comparison （tested by Fisher’sexact test） showed that the clinical efficacy of the observation group was significantly superior to that of the control group （P＜0.01）.（2）On the seventh day，first month and third month after operation，the pain VAS score and thoracolumbar function of ODI scores of the two groups were significantly lower than those at the previous observation time point （P＜0.05），and the decrease of VAS score and thoracolumbar ODI score in the observation group was significantly superior to that in the control group on the seventh day，first month and third month after operation（P＜0.05 or P＜0.01）.（3）After treatment （one month after operation）， the BMD values of L2-4，femoral neck，Wards triangle and total hip in the two groups were significantly higher than those before treatment （P＜0.05）， and the increase of BMD values in the observation group was significantly superior to that in the control group （P＜0.01）.（4）After treatment （one month after operation），the serum levels of bone metabolism indicators of CTX-1，BALP and calcium of the two groups were significantly lower than those before treatment （P＜0.05）， and the decrease of serum CTX-1， BALP and calcium levels in the observation group was significantly superior to that in the control group（P＜0.01）. Conclusion Modified Shaoyao Gancao Decoction combined with acupuncture exerts certain effect for the treatment of OVCF patients with liver-kidney deficiency and yin-blood deficiency type. The combined therapy can significantly relieve postoperative pain symptoms，improve BMD and bone metabolism，promote the recovery of thoracolumbar function，and effectively enhance the overall efficacy.