俯卧位骨盆牵引下手法复位治疗胸腰椎单纯压缩骨折的疗效观察

Observation on the curative effect of pelvic traction in prone position combined with manipulative reduction on thoracolumbar compression fracture

目的:探讨俯卧位骨盆牵引下手法复位治疗胸腰椎单纯压缩骨折的临床疗效。方法:将符合要求的78例胸腰椎单纯压缩骨折患者随机分为2组,治疗组41例,采用俯卧位骨盆牵引下手法复位治疗;对照组37例,采用卧硬板床腰背部垫软枕治疗。2组患者均同时按照骨折三期辨证用药原则服用中药治疗,并进行腰背部功能锻炼。分别于治疗前、治疗后2周、治疗后1个月及治疗后6个月,测定2组患者脊柱后凸Cobb’s角和伤椎前缘高度,同时于治疗后6个月采用口述分级评分法评定患者的腰部疼痛情况,参照《中医病证诊断疗效标准》中胸腰椎骨折的疗效评定标准评定患者的总体疗效。结果:①腰部疼痛。治疗组0级32例、1级8例、2级1例,对照组0级22例、1级12例、2级2例、3级1例。2组患者的腰部疼痛程度比较,差异无统计学意义[R治疗组=0.454,95%CI(0.389,0.519);R对照组=0.551,95%CI(0.466,0.636)]。②脊柱后凸Cobb’s角。治疗前后不同时间Cobb’s角的差异有统计学意义,即存在时间效应[治疗组:(18.40°±0.94°),(5.00°±0.92°),(4.30°±0.98°),(3.90°±0.45°),对照组:(18.10°±1.21°),(8.10°±1.02°),(7.80°±1.01°),(7.60°±0.82°),F=14.573,P=0.017];2组患者Cobb’s角的组间差异总体上有统计学意义,即存在分组效应(F=22.350,P=0.008),除治疗前外(t=0.973,P=0.139),其余各时点对照组的Cobb’s角均大于治疗组(t=20.573,P=0.007;t=22.840,P=0.005;t=22.350,P=0.003);时间因素和分组因素之间存在交互效应(F=11.567,P=0.012)。③伤椎前缘高度。治疗前后不同时间伤椎前缘高度的差异有统计学意义,即存在时间效应[治疗组:(11.70±0.78)mm,(18.90±0.22)mm,(18.90±0.26)mm,(18.90±0.36)mm,对照组:(11.70±0.68)mm,(13.10±1.02)mm,(13.90±0.23)mm,(13.90±0.24)mm,F=14.553,P=0.014];2组患者伤椎前缘高度的组间差异总体上有统计学意义,即存在分组效应(F=14.670,P=0.016),除治疗前外(t=0.987,P=0.175),其余各时点对照组的伤椎前缘高度均小于治疗组(t=13.654,P=0.018;t=13.986,P=0.017;t=18.535,P=0.014);时间因素和分组因素之间存在交互效应(F=12.597,P=0.011)。④总体疗效。治疗组治愈36例、好转3例、未愈2例,对照组治愈29例、好转4例、未愈4例。2组患者的总体疗效比较,差异无统计学意义[R治疗组=0.477,95%CI(0.425,0.529);R对照组=0.525,95%CI(0.455,0.596)]。结论:俯卧位骨盆牵引下手法复位可有效缓解胸腰椎单纯压缩骨折患者的腰背部疼痛症状,在纠正脊柱后凸畸形、恢复伤椎前缘高度方面疗效优于卧硬板床腰背部垫软枕疗法,是治疗该病的有效方法。

Objective ： To observe the clinical effects of pelvic traction in prone position combined with manipulative reduction on thoraco- lumbar compression fracture. Methods：Seventy-eight patients with thoracolumbar compression fracture who met the requirement were ran- domly divided into 2 groups ,41 patients（ treatment group）were treated with pelvic traction in prone position combined with manipulative re- duction, while 37 patients （control group）were ordered to stay in hard bed with a soft pillow under the low back. Meanwhile, the patients in both of the 2 groups were treated with low back functional exercise and oral application of traditional Chinese medicine according to syn- drome differentiation principles. The Cobb angle and the anterior border height of injured vertebrae were measured in both of the 2 groups before the treatment and at 2 weeks and 1 and 6 months after the treatment respectively. The low back pain wm＇e evaluated according to ver- bal rating scale, and the total curative effect were also evaluated according to Standard for diagnosis and therapeutic effectiveness evaluation of traditional Chinese medicine syndromes 6 months after the treatment. Results：Thirty-two patients were categorized as grade 0,8 patients as grade [ , 1 patients as grade 1I in treatment group, while 22 patients were categorized as grade 0,12 patients as grade I ,2 patients as grade lI and 1 patients as grademin control group. There was no statistical difference in the low back pain degree between the 2 groups（ treatment group ：/） = 0. 454,95 % C10. 389 to 0.519 ; control group ： R = 0.551,95 % CI0. 466 to 0. 636）. There was statistical difference in kyphosis Cobb angle between different time points, in other words, there was time effect（ treatment group ： 18.40 4/- O. 94,5. O0 ＋/, O. 92,4.30 ＋/- 0.98,3.90 ＋/-0.45 degrees;control group： 18.10 ＋/- 1.21,8.10 ＋/- 1.02,7.80 4^- 1.01,7.60 4/-0.82 degrees; F = 14. 573,P = 0.017 ）. There was statistical difference in kyphosis Cobb angle between the 2 groups in general, in other words, there was grouping effect （F = 22. 350 ,P = 0.008 ）. The kyphosis Cobb angle of control group was higher than that of treatment group at posttreatment timepoints （ t = 20.573, P = 0. 007 ; t = 22. 840, P = 0. 005 ; t = 22. 350, P = 0. 003 ） except at pretreatment point （ t = 0. 973, P = 0.139 ）. There was in- teraction between time factor and grouping factor（ F = 11. 567 ,P = 0.012 ）. There was statistical difference in anterior border height of in- jured vertebrae between different time points, in other words, there was time effect （ treatment group ： 11.70 4/- 0.78,18.90 ＋/- 0.22, 18.90 ＋/-0.26,18.90 ＋/-0.36 mm ;control group： 11.70 ＋/-0.68,13.10 ＋/- 1.02,13.90 ＋/-0.23,13.90 ＋/-0.24 mm;F = 14. 553, P = 0.014 ）. There was statistical difference in anterior border height of injured vertebrae between the 2 groups in general, in other words, there was grouping effect（ F = 14. 670, P = 0. 016 ）. The anterior border height of injured vertebrae of control group was less than that of treatment group at posttreatment timepoints （ t = 13. 654,P = 0.018 ; t = 13. 986, P = 0. 017 ; t = 18. 535, P = 0. 014 ） except at pretreatment point（ t = 0. 987, P _-0. 175 ）. There was interaction between time factor and grouping factor （ F = 12. 597, P = 0.011 ）. Thirty-six patients obtained an excellent result,3 good and 2 poor in the treatment group;while 29 patients obtained an excellent result,4 good and 4 poor in the control group. There was no statistical difference in total curative effect between the 2 groups （ treatment group ： R = 0. 477,95 % CI O. 425 to O. 529;control gronp：R =0.525,95% CI O. 455 to 0. 596）. Conclusion：The therapy of pelvic traction in prone position combined with manipulative reduction can relieve the low back pain effectively, and it surpassed the therapy of staying in hard bed with a soft pillow under the low back in kyphotic deformity correction and injured vertebral anterior border height restoration, so it is an effective method in the treat- ment of simplex thoraeolumbar compression fracture.