枳壳甘草汤在保守治疗胸腰椎压缩性骨折中的运用

Application of Zhikegancao decoction in patients with thoracolumbar vertebral compression fractures

目的探讨枳壳甘草汤在保守治疗胸腰椎压缩性骨折中的作用。方法回顾2014年1月-2016年4月本院脊柱科保守治疗的胸腰椎压缩性骨折患者104例,观察其骨折后住院治疗过程中下腰痛的严重程度以及伴随的腹胀、便秘情况。分为治疗组52例、对照组52例,治疗组除卧床、腰背肌锻炼等常规治疗外,采用枳壳甘草汤(枳壳20 g,生甘草10 g,当归10 g,莪术10 g,黑丑、白丑各6 g)口服,对照组予番泻叶泡服,分别观察记录2组患者治疗1周及1月后下腰痛的视觉模拟评分(VAS评分)及服药后腹胀、便秘症状改善的有效率、症状解除时间、复发率及不良反应的发生率。结果治疗组患者接受保守治疗前的VAS评分为(8.25±1.34);1周后VAS评分为(6.32±0.86);1月后VAS评分为(2.51±0.67)。对照组相应的评分分别为(8.23±1.14);(6.96±1.06);(2.53±0.71)。经治疗1周后,治疗组患者下腰痛改善情况同对照组相比,具有统计学意义。治疗1月后,2组患者间比较,不存在显著差异。2组病例腹胀、便秘症状总有效率均为100%,枳壳甘草汤治疗组的症状平均解除时间为40.1 h,优于番泻叶组的51.5 h(P<0.05)。治疗组患者住院期间便秘症状无复发,并无明显不良反应发生;对照组有18例便秘复发(34.6%)。结论枳壳甘草汤具有行气活血、松弛平滑肌的功效,能够显著缓解胸腰椎压缩性骨折引起的疼痛、便秘等症状。

Objective To explore the application of Zhikegancao decoction in the treatment of thoracolumbar vertebral compression fractures. Methods Retrospectively analyze the clinical effects of 104 in-patient with single thoracolumbar vertebral compression fractures by observing the severity of low back pain and the accompanying abdominal distension and constipation during hospitalization. All patients were divided into treatment group（n = 52） and control group（n = 52）. In addition to bed rest, back muscle exercise and other conventional treatments, the patients of treatment group were griven Zhikegancao decoction（component：orange fruit 20 g, liquorice root 10 g, Chinese angelica 10 g, zedoray rhizome 10 g, black pharbitis seed 6 g, white pharbitis seed 6 g）the other group were treated with folium sennae. The visual analogue scale（VAS score） of the low back pain after treatment for 1 week and 1 month were observed. The effective rate of bloating, constipation symptoms, relapse rate and side reaction were observed. Results The VAS score of the treatment group was（8.25±1.34） before conservative treatment, and the VAS score was（6.32±0.86） after 1 week; the VAS score was（2.51±0.67） after 1 month. The corresponding scores in the control group were（8.23±1.14）;（6.96±1.06）;（2.53±0.71）, respectively. After 1 week of treatment, the improvement of lower back pain in the treatment group was statistically significant compared with the control group. After treatment in January, the two groups of patients compared, there is no significant difference. The total effective rate of bloating and constipation symptoms was 100% in both groups, and the average time to relieve symptoms was 40.1 hours in the treatment group, which was 51.5 hours higher than that in senna group（P 0.05）. There was no recurrence of constipation in the treatment group. There were 18 cases of constipation recurrence（34.6%） in the control group.Conclusions Zhikegancao decoction has the effect of promoting qi and activating blood circulation and relaxing smooth muscle, can significantly relieve pain and constipation caused by compression fracture of thoracolumbar vertebra.