筋骨并重理论在腰椎骨质疏松性压缩性骨折经皮椎体成形术中的应用

目的：探讨中医"筋骨并重"理论指导下经皮椎体成形术联合竖脊肌及关节突关节阻滞治疗腰椎骨质疏松性压缩性骨折的临床疗效。方法：回顾性分析2015年1月至2022年3月行经皮椎体成形术（percutaneous vertebroplasty,PVP）治疗的腰椎骨质疏松性压缩性骨折患者115例,男51例,女64例,年龄25~86（60.5±15.9）岁;其中48例采用PVP手术结合竖脊肌阻滞及伤椎关节突关节阻滞治疗（筋骨并重组）,67例采用常规PVP手术治疗（常规组）。比较两组患者术前、术后3 d及术后1、6个月的视觉模拟评分（visual analogue scale,VAS）、Oswestry功能障碍指数（Oswestry disability index,ODI）,对比两组的手术时长、穿刺次数、术中出血量。结果：两组术后VAS、ODI评分均较术前明显改善（P<0.05）。筋骨并重组术后3 d、1个月的VAS、ODI评分较常规组改善更明显（P<0.05）,术前、术后6个月两组VAS、ODI评分比较差异无统计学意义（P>0.05）。两组穿刺次数、术中出血量比较差异无统计学意义（P>0.05）。结论：基于"筋骨并重"理论,PVP联合竖脊肌及关节突关节阻滞可有效缓解椎旁软组织痉挛等"筋伤",相比常规PVP治疗可明显改善患者术后短期腰背部疼痛和腰椎活动度,加快术后康复,获得满意的临床疗效。

Application of the theory of equal emphasis on muscle and bone in percutaneous vertebroplasty of lumbar osteoporotic compression fracture

Objective To explore the clinical efficacy of percutaneous vertebroplasty(PVP) combined with nerve block in the treatment of lumbar osteoporotic vertebral compression fractures under the guidance of traditional chinese medicine "theory of equal emphasis on muscle and bone".Methods Total of 115 patients with lumbar osteoporotic vertebral compression fractures were treated by percutaneous vertebroplasty from January 2015 to March 2022, including 51 males and 64 females, aged 25 to 86 (60.5±15.9) years. Among them, 48 cases were treated with PVP operation combined with erector spinae block and joint block of the injured vertebral articular eminence (intervention group), and 67 cases were treated with conventional PVP operation (control group). The visual analogue scale(VAS) and Oswestry disability index(ODI) before operation, 3 days, 1 month and 6 months after operation between two groups were evaluated. The operation time, number of punctures and intraoperative bleeding between two groups were compared.Results The VAS and ODI scores of both groups improved significantly after operation compared with those before operation(P<0.05). Moreover, the VAS and ODI scores of 3 days and 1 month after operation of the intervention group improved more significantly than that of the control group(P<0.05). The difference of VAS and ODI scores before operation and 6 months after operation between two groups had no statistical significances(P>0.05). There was no statistically significant difference in the number of punctures and intraoperative bleeding between the two groups (P>0.05).Conclusion Based on the theory of "equal emphasis on muscles and bones", PVP combined with nerve block can effectively relieve paravertebral soft tissue spasm and other "muscle injuries", which can significantly improve short-term postoperative low back pain and lumbar spine mobility compared to conventional PVP treatment, and accelerate postoperative recovery, resulting in satisfactory clinical outcomes.