中医综合疗法与微创手术治疗骨质疏松性椎体压缩骨折比较研究

Effects Comparisons of TCM Comprehensive Therapy and Minimally Invasive Surgery in Treating Osteoporotic Vertebral Compression Fractures

目的:比较中医综合疗法和经皮椎体后凸成形术(PKP)两种方法治疗骨质疏松性椎体压缩骨折的疗效。方法:将骨质疏松性椎体压缩骨折患者76例随机分为中医综合治疗组40例和PKP组36例,分别接受中医综合治疗和PKP术治疗。观察并记录2组患者疼痛视觉模拟评分(Visual Analogue Score,VAS)、生活质量评分(Oswestry评分)、Cobb角及椎体前、后缘高度的变化,比较同组内治疗前和治疗后不同时间点患者各指标的变化情况及2组间治疗前后不同时间点各观察指标差值的变化情况,并记录相关并发症情况。结果:PKP和中医综合疗法均能明显缓解疼痛(P<0.05),改善机体功能(P<0.05),恢复椎前、后缘的高度(P<0.05),减小脊柱后凸角(P<0.05)。PKP组治疗后1周VAS评分改善显著(P<0.05),治疗3个月及6个月后,2组间VAS评分无明显差别(P>0.05),与治疗前差值比较差异亦无统计学意义(P>0.05)。2组患者Oswestry评分在治疗后1周及治疗后3月均下降(P<0.05)。2组治疗前及治疗后1周患椎前缘高度及Cobb角均有所恢复(P<0.05),治疗6个月后中医综合组同治疗前相比无明显改变(P>0.05)。出现8例继发椎体骨折患者,其中6例(16.7%)来自于PKP组,2例(5.0%)来自于中医综合治疗组,2组继发骨折发生率比较差异无统计学意义(P=0.083)。结论:中医综合疗法与PKP治疗骨质疏松性椎体压缩骨折均可有效缓解疼痛,有效改善患者生活质量;PKP短期内止痛效果迅速,可有效稳定椎体,能更好地恢复患椎高度,矫正椎体后凸畸形。

Objective:To compare curative effects of TCM comprehensive therapy and PKP in treating osteoporotic vertebral compression fractures(OVCFs).Methods:All 76 patients with OVCFs were randomized into 40 cases of the treatment group of TCM comprehensive therapy and 36 cases of PKP group,who accepted TCM comprehensive therapy and PKP respectively.VAS,Oswestry scales,Cobb angle,anterior vertebral height and posterior vertebral height of both groups were observed and recorded,the changes of different indexes at different times were compared within the group before and after the treating,D-values of different indexes were observed both groups before and after treating at different times,and the conditions of the related complications were recorded.Results:PKP and TCM comprehensive therapy could relieve the pain obviously(P<0.05),improve organism function(P<0.05),recover anterior and posterior vertebral height(P<0.05)and reduce the kyphosi angle(P<0.05).VAS scales were improved notably when PKP group was treated for one week(P<0.05),there was no significant difference in the comparisons of both groups after treating for three months and six months(P>0.05),the difference had no statistical meaning compared with D-values before treating(P>0.05).Oswestry scales in both groups decreased in one week and three months after treating(P<0.05).Anterior vertebral height and Cobb angles of both groups restored before treating and in one week after the treating in both groups(P<0.05),there was no significant difference when the treatment group of TCM comprehensive therapy in six months after treating was compared with before treating(P<0.05).There were eight cases happened secondary vertebral fractures,among them,six cases(16.7%)from PKP group and two cases from the treatment group of TCM comprehensive therapy,and the difference hadnostatisticalmeaninginthe comparisonof the incidence of secondarybone fracture betweenboth groups(P=0.083).Conclusion:TCMcomprehensive therapy and PKP in treating OVCFs could effectively relieve the pain,effectively improve quality of life.PKP could stop the pain rapidly in short term,it could effectively stabilize the centrum,restore the affected vertebral height better and correct kyphosis.