中医正骨手法联合骨填充网袋灌注骨水泥治疗老年骨质疏松性椎体爆裂骨折的临床研究

Clinical Study on Treatment of Osteoporotic Vertebral Burst Fracture in the Elderly by Traditional Chinese Spinal Orthopedic Manipulation Combined with Bone Filling Mesh Pouch Perfusion of Bone Cement

目的探讨中医脊柱正骨手法(TCSOM)联合骨填充网袋灌注骨水泥(BFMCs)治疗老年骨质疏松性椎体爆裂骨折(OVBF)的临床效果。方法225例老年单节段OVBF患者根据随机数字表法分为TCSOM+BFMCs组、BFMCs组、经皮后凸成形术(PKP)组,每组75例。各组采用相对应方法手术治疗。比较3组患者术前、术后(1天,1、6、12个月)腰背部疼痛及功能[疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)]。比较3组患者术前、术后(1天,1、3、6、12个月)测量Cobb′s角、伤椎前缘高度恢复率、伤椎中部椎体高度恢复率、伤椎侧面面积恢复率。比较3组患者术后骨水泥渗漏例数。结果与本组术前比较,3组患者术后(1天、1、6、12个月)VAS、ODI评分降低(P<0.05),且术后1、6、12个月VAS、ODI评分低于术后1天(P<0.05);与本组术后1个月比较,BFMCs组术后6、12个月及PKP组术后6个月ODI评分降低(P<0.05)。与BFMCs组、PKP组比较,TCSOM+BFM组患者术后1天VAS评分及术后1个月ODI评分降低(P<0.05)。与本组术前比较,3组术后1天、1、3、6、12个月Cobb′s角度数减少(P<0.05),前缘椎体高度恢复率、中部椎体高度恢复率及伤椎侧面面积恢复率增高(P<0.05)。与本组术后1天比较,TCSOM+BFMCs组术后1、3、6、12个月Cobb′s角度数增加(P<0.05),前缘椎体高度恢复率、中部椎体高度恢复率及伤椎侧面面积恢复率降低(P<0.05);BFMCs组术后1、3、6、12个月Cobb′s角度数增加,前缘椎体高度恢复率、中部椎体高度恢复率降低(P<0.05),术后12个月伤椎侧面面积恢复率降低(P<0.05);PKP组术后3、12个月Cobb′s角度数增加(P<0.05)。与本组术后1个月比较,TCSOM+BFMCs组术后6、12个月Cobb′s角度数增加(P<0.05),术后3、6、12个月前缘椎体高度恢复率、中部椎体高度恢复率及伤椎侧面面积恢复率降低(P<0.05)。与BFMCs组、PKP组比较,TCSOM+BFMCs组术后1天、1、3个月Cobb′s角度数减少(P<0.05),术后1天及术后1个月前缘椎体高度恢复率、术后1天、1、3、6个月中部椎体高度恢复率及术后1、3个月伤椎侧面面积恢复率增加(P<0.05)。TCSOM+BFMCs组及BFMCs组骨水泥渗漏例数低于PKP组(χ^2=4.118、6.336,P=0.042、0.012)。结论3种治疗方案均能有效治疗OVBF患者。TCSOM联合BFMCs在术后腰背部疼痛及功能改善程度方面更为满意;此外,也具有更好的维持伤椎高度,恢复脊椎生物力学作用。

Objective To investigate the clinical effect of traditional Chinese spinal orthopedic manipulation(TCSOM)and bone filling mesh container(BFMCs)in the treatment of senile osteoporotic vertebral burst fracture(OVBF).Methods Totally 225 elderly single segment OVBF patients were assigned to TCSOM+BFMCs group,BFMCs group and percutaneous kyphoplasty(PKP)group according to the random number table,75 cases in each group.Each group was treated with corresponding surgical methods.Lumbar and back pain and function[Visual Analogue Scale(VAS)and Oswestry dysfunction index(ODI)]of before and postoperative(1 day,1 month,6 months,12 months)were compared among the three groups.Before and postoperative(1 day,1 month,6 months,12 months),the Cobb′s angle,the recovery rate of the anterior height of the injured vertebra,the recovery rate of the middle height of the injured vertebra and the recovery rate of the lateral area of the injured vertebra were measured.The number of patients with leakage of bone cement was compared.Results Compared with the group before operation,the VAS and ODI scores of the three groups after operation(1 day,1 month,6 months,12 months)were lower(P<0.05),and the VAS and ODI scores of the three groups after operation(1,6,12 months)were lower than those of the group at 1 day after operation(P<0.05).Compared with 1 month after operation,the ODI score of BFMCs group was lower at 6,12 months after operation and PKP group at 6 months after operation(P<0.05).Compared with BFMCs group and PKP group,the VAS score at 1 day after operation and ODI score at 1 month after operation of TCSOM+BFMCs group decreased(P<0.05).Compared with the group before operation,the Cobb′s angle decreased at 1 day,1,3,6 and 12 months after operation in the three groups(P<0.05),and the recovery rate of anterior vertebral body height,middle vertebral body height and lateral area of injured vertebral body increased(P<0.05).Compared with 1 day after operation,the Cobb′s angle increased at 1,3,6 and 12 months after operation in TCSOM+BFMCs group(P<0.05),and the recovery rate of anterior vertebral body height,middle vertebral body height and lateral area of injured vertebral body decreased(P<0.05).In BFMCs group,Cobb′s angle increased at 1,3,6 and 12 months after operation,and the recovery rate of anterior and middle vertebrae decreased(P<0.05).In PKP group,Cobb′s angle increased at 3 and 12 months after operation(P<0.05).Compared with 1 month after operation,Cobb′s angle increased at 6 and 12 months after operation in TCSOM+BFMCs group(P<0.05),and the recovery rate of anterior vertebral body height,middle vertebral body height and lateral area of injured vertebral body decreased at 3,6 and 12 months after operation(P<0.05).Compared with BFMCs group and PKP group,the Cobb′s angle in TCSOM+BFMCs group decreased at 1 day,1 month and 3 months after operation(P<0.05),the recovery rate of anterior vertebral body height at 1 day,1 month after operation,the recovery rate of middle vertebral body height at 1 day,1,3,6 months and lateral area of injured vertebral body at 1,3 months increased(P<0.05).The number of cement leakage in TCSOM+BFMCs group and BFMCs group was lower than that in PKP group(χ^2=4.118,6.336,P=0.042,0.012).Conclusions All three treatments can effectively treat OVBF patients.TCSOM combined with BFMCs is more obvious in the improvement of lumbar and back pain and function after operation.In addition,TCSOM combined with BFMCs can maintain the height of injured vertebrae and restore the biomechanical function of vertebrae.