补肾壮骨汤联合经皮椎体后凸成形术治疗老年骨质疏松性胸腰椎压缩性骨折

目的:观察补肾壮骨汤联合经皮椎体后凸成形术对老年骨质疏松性胸腰椎压缩骨折术后血清瘦素(Leptin)水平及生活质量的影响。方法:将103例骨质疏松性胸腰椎压缩骨折老年患者随机分为对照组51例和观察组52例。对照组采用经皮椎体后凸成形术治疗,治疗组在对照组治疗基础上加用补肾壮骨汤治疗,药物组成:牡蛎15 g,丹参15 g,生地黄10 g,巴戟天10 g,山药15 g,黄芪10 g,白术6 g,龙骨6 g,刺五加6 g,淫羊藿5 g,紫河车3 g。以上药物以水煎服,每日1剂,每日2次,每次200 m L,1个疗程30 d,共治疗3个疗程。随访6个月,观察两组患者的临床疗效、治疗前后椎体前缘丢失高度、伤椎Cobb角、血清Leptin水平及生活质量(generic quality of life inventory-74,GQOL-74)评分,比较两组治疗前及治疗后1个月、6个月疼痛程度(visual analogue scale,VAS)评分及Oswestry功能障碍指数问卷表(oswestry dability index,ODI)评分情况。结果:观察组有效率为96.15%高于对照组80.39%,差异有统计学意义(P0.05);两组患者治疗后椎体前缘丢失高度、伤椎Cobb角、血清Leptin水平及GQOL-74评分均明显改善,且观察组椎体前缘丢失高度、伤椎Cobb角、血清Leptin水平均低于对照组,GQOL-74评分高于对照组,差异均有统计学意义(P0.05);两组患者治疗后1个月及治疗后6个月VAS及ODI评分均明显改善,且治疗后6个月观察组VAS及ODI评分均低于对照组,差异均有统计学意义(P0.05)。结论:对老年骨质疏松性胸腰椎压缩骨折患者予以补肾壮骨汤联合经皮椎体后凸成形术治疗,可明显降低血清Leptin水平,改善其生活质量。

Bushen Zhuanggu Decoction Combined with Percutaneous Kyphoplasty Treatment of Elderly Patients After Osteoporotic Thoracolumbar Compression Fracture Surgery

Objective:To explore the influence of Bushen Zhuanggu decoction combined with percutaneous kyphoplasty on serum Leptin levels and quality of life of elderly patients after osteoporotic thoracolumbar compression fracture surgery.Methods:103 cases of elderly patients with osteoporotic thoracolumbar compression fracture were randomly divided into the control group of 51 cases and the observation group of 52 cases.The control group was given percutaneous kyphoplasty treatment,and the observation group was additionally treated with Bushen Zhuanggu decoction based on the control group.Its composition:Muli(Oyster) 15 g,Danshen (Salvia) 15 g,Shengdihuang (Rehmannia Glutinosa) 10 g,Bajitian (Morinda) 10 g,Shanyao (Yam) 15 g,Huangqi (Astragalus) 10 g,Baizhu (Atractylodes Macrocephala) 6 g,Longgu (Fossil Fragments) 6 g,Ciwujia (Acanthopanax Senticosus) 6 g,Yinyanghuo (Epimedium) 5 g,and Ziheche (Placenta) 3 g.All the above drugs were decocted with water,one dose a day,twice a day,200 mL once,1 course of 30 d treatment,and for 3 courses.All were followed up for 6 months,clinical efficacy,anterior vertebral body loss height,Cobb angle of the injured vertebra,serum Leptin level and Generic Quality of Life Inventory 74 (GQOL-74) scores were observed,and the degree of pain (Visual analogue scale,VAS) and Oswestry disability index questionnaire (ODI) were compared before treatment and at a month and six months after treatment in the two groups.Results:The effective rate of observation group was 96.15 ％,higher than that of 80.39％ of the control group,with statistically significant difference (P ＜ 0.05).After treatment,anterior vertebral loss height,vertebral Cobb angle and serum Leptin and GQOL-74 score significantly improved,and anterior vertebral loss height,vertebral Cobb angle and serum Leptin in the observation group were all lower than those in the control group,and GQOL-74 score was higher than that in the control group,with statistically significant difference (P ＜ 0.05).The scores of VAS and ODI in the two groups obviously improved at a month and 6 months after treatment,and those in the observation group were lower than those in the control group at 6 months after treatment,with statistically significant difference (P ＜ 0.05).Conclusion:Bushen Zhuanggu decoction combined with percutaneous kyphoplasty can significantly reduce serum Leptin level in treatment of elderly patients with osteoporotic thoracolumbar compression fracture,and improve quality of life.