骨质疏松椎体压缩性骨折经皮椎体成形术前后中医证候演变与继发邻近椎体骨折的关系研究

Study on the relationship between the evolution of TCM syndromes and secondary fractures of adjacent vertebral bodies before and after percutaneous vertebroplasty for osteoporotic vertebral compression fractures

目的:探讨骨质疏松椎体压缩性骨折(OVCF)经皮椎体成形术(PVP)前后中医证候演变与继发邻近椎体骨折之间的关系。方法:纳入158例OVCF患者,所有患者均行PVP治疗;统计PVP术前中医证候频次、术后中医证型,包括脾肾阳虚证;肝肾阴虚型;气滞血瘀型、气血亏虚型;术后继发邻近椎体骨折的发生情况。结果:OVCF患者以气虚、肾虚、脾虚和血瘀为主;而术后3个月,肝肾阴虚证、脾肾阳虚证占比均高于术后1周(P<0.05),气滞血瘀证占比低于术后1周(P<0.05);术后6个月,气滞血瘀证占比低于术后3个月(P<0.05);6个月的随访得出,邻近椎体发生骨折例数为26例,发生率为18.44%(26/141);其中肝肾阴虚证患者8例占30.77%(8/26),脾肾阳虚证患者12例占46.15%(12/26),气血两虚证患者4例占15.38%(4/26),气滞血瘀证患者2例占7.69%(2/26)。结论:OVCF患者中医证候以气虚、肾虚脾虚和血瘀为主;OVCP患者PVP术后原气滞血瘀证患者在术后6个月内出现向肝肾阴虚证或脾肾阳虚证转变趋势,而气血两虚证者则未见明显改变;PVP术后出现邻近节段骨折以肝肾阴虚证或脾肾阳虚证患者占比最大,且脾肾阳虚证者最为明显。

Objective:To explore the relationship between the evolution of TCM syndromes before and after osteoporotic vertebral compression fracture(OVCF)percutaneous vertebroplasty(PVP)and secondary adjacent vertebral fractures.Methods:158 patients with OVCF were included,and all patients were treated with PVP.Statistics of PVP frequency of TCM syndromes before surgery,TCM syndrome types after surgery(including spleen and kidney yang deficiency syndrome,liver and kidney yin deficiency syndrome,qi stagnation and blood stasis syndrome,qi and blood deficiency syndrome)and the incidence of postoperative secondary adjacent vertebral body fractures were analyzed.Results:The patients with OVCF were mainly qi deficiency,kidney deficiency,spleen deficiency and blood stasis.Three months after the operation,the proportions of liver-kidney yin deficiency syndrome and spleen-kidney yang deficiency syndrome were all higher than that of 1 week after the operation(P<0.05),while the proportions of qi stagnation and blood stasis syndrome were lower than that of 1 week after the operation(P<0.05).After 6 months,the proportion of qi and blood stasis was lower than that of the postoperative 3 months(P<0.05).After 6 months of follow-up,there were 26 cases of adjacent vertebral fracture,with the incidence 18.44%(26/141).Among them,8 cases of liver and kidney yin deficiency syndrome accounted for 30.77%(8/26),12 patients with spleen and kidney yang deficiency syndrome accounted for 46.15%(12/26),4 patients with qi and blood deficiency syndrome accounted for 15.38%(4/26),and 2 patients with qi and blood stasis accounted for 7.69%(2/26).Conclusion:(1)The traditional Chinese medicine syndromes of OVCF patients are mainly qi deficiency,kidney deficiency,spleen deficiency and blood stasis;(2)the OVCP patients with qi stagnation and blood stasis syndrome after PVP have spleen and kidney yin deficiency syndrome or spleen and kidney yang deficiency within 6 months after surgery.There are no obvious changes in the two syndromes of qi and blood deficiency;(3)patients with adjacent segmental fracture after PVP are most likely to have liver-kidney yin deficiency syndrome or spleen-kidney yang deficiency syndrome,especially those with spleen-kidney yang deficiency syndrome obvious.