补肾健骨汤联合经皮穿刺球囊扩张椎体后凸成形术治疗老年骨质疏松性胸腰椎压缩骨折临床研究

The Clinical Research into Kidney-Nourishing and Bone-Strengthening Decoction in Combination with Percutaneous Balloon Dilatation kyphoplasty in Treating Osteoporotic Thoracolumbar Vertebral Compression Fractures in the Elderly

目的:观察补肾健骨汤联合经皮穿刺球囊扩张椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗老年骨质疏松性胸腰椎压缩骨折(osteoporotic vertebral compression fracture,OVCF)的临床疗效。方法:选取2016年4月至2018年2月在本院就诊的老年OVCF患者94例,按照随机数字表法分为对照组和试验组各47例。两组均行PKP,对照组术后给予常规西药治疗,试验组在对照组治疗的基础上给予补肾健骨汤,连续治疗2个月。比较两组治疗前后骨折愈合情况(伤椎前缘高度、后凸Cobb角)、骨密度[腰椎正位(L2-4)、右股骨颈]、疼痛及功能障碍(VAS及ODI)、疾病相关因子[骨保护素(osteoprotegerin,OPG)、瘦素(Leptin)、核因子κB受体活化因子配体(ligand of receptor activator of NF-κB,RANKL)],并于治疗后3个月随访两组治疗效果。结果:两组老年OVCF患者治疗后伤椎前缘高度明显升高,后凸Cobb角明显降低,与治疗前比较均有统计学意义(P<0.05),且治疗后试验组伤椎前缘高度高于对照组,后凸Cobb角小于对照组(P<0.05);治疗后两组老年OVCF患者股骨颈及腰椎正位(L2-4)骨密度均增高,与治疗前比较差异有统计学意义(P<0.05),且治疗后试验组右股骨颈及腰椎正位(L2-4)骨密度高于对照组(P<0.05);治疗后两组老年OVCF患者VAS及ODI评分均较治疗前降低,差异有统计学意义(P<0.05),且治疗后试验组VAS、ODI评分低于对照组(P<0.05);治疗后两组老年OVCF患者RANKL、Leptin水平较治疗前明显降低,OPG水平较治疗前升高,差异有统计学意义(P<0.05),且治疗后试验组血清RANKL、Leptin水平低于对照组,OPG水平高于对照组(P<0.05);治疗后3个月随访,对照组有效率为76.60%,试验组有效率为93.62%,两组有效率比较,差异有统计学意义(P<0.05)。结论:补肾健骨汤联合PKP用于老年OVCF患者,可改善骨密度、缓解疼痛、恢复腰椎功能,可能与调节OPg,RANKL、Leptin水平有关。

Objective: To observe the clinical curative effect of Kidney-Nourishing and Bone-Strengthening Decoction in combination with percutaneous balloon dilatation kyphoplasty ( PBKP) on osteoporotic thoracolumbar vertebral compression fractures ( PBKP) in the elderly. Methods: Ninety-four elderly patients with OTVCF treated in our hospital from April 2016 to February 2018 were selected and divided into the control group and the experimental group according to random number table method,with 47 cases in each group. Both groups were treated with PBKP. The control group was additionally treated with routine Western medicine after operation. The experimental group was additionally treated with Kidney-Nourishing and Bone-Strengthening Decoction on the basis of the control group. The treatment lasted for 2 months. Fracture healing ( including anterior height of injured vertebrae,Cobb angle of kyphosis),bone mineral density including lumbar vertebrae orthostasis ( L2-L4 ) and right femoral neck,pain and dysfunction ( VAS and ODI),disease-related factors including osteoprotegerin ( OPG),Leptin,ligand of receptor activator of NF-kB,RANKL were compared before and after the treatment. The therapeutic effects of the two groups were followed up for after 3 months' treatment. Results: The anterior height of injured vertebra in the two groups increased significantly after the treatment,and the Cobb angle of kyphosis decreased significantly compared with that before treatment,and all the differences were statistically significant ( P < 0. 05). After the treatment,the anterior height of injured vertebra in the experimental group was higher than that in the control group,and the Cobb angle of kyphosis was smaller than that in the control group ( P < 0. 05). Bone mineral density ( BMD) of femoral neck and lumbar spine in orthogonal position ( L2-L4 ) of elderly OTVCF patients in the two groups increased after the treatment,and all the differences were statistically significant ( P < 0. 05),and BMD of right femoral neck and lumbar spine in orthogonal position ( L2-L4 ) in the experimental group was higher than that in the control group ( P < 0. 05). After the treatment,the VAS and ODI scores of the two groups of elderly OTVCF patients were lower than those before the treatment,and all the differences were statistically significant ( P < 0. 05),and the VAS and ODI scores of the experimental group were lower than those of the control group ( P < 0. 05). After the treatment,the levels of RANKL and Leptin in two groups of elderly patients with OTVCF were significantly lower than those before the treatment,the levels of OPG were significantly higher than those before treatment and all the differences were statistically significant ( P < 0. 05). The levels of serum RANKL and Leptin in the experimental group were lower than those in the control group,and the levels of OPG in the experimental group were higher than those in the control group ( P < 0. 05). After 3 months of follow-up,the effective rate of the control group was 76. 60%,and that of the experimental group was 93. 62%. There was significant difference between the two groups ( P < 0. 05). Conclusion: Kidney-Nourishing and Bone-Strengthening Decoction in combination with PBKP has a remarkable efficacy on PBKP in the elderly,can improve bone mineral density,relieve pain and restore lumbar function,which may be related to the regulation of OPg,RANKL and Leptin levels.