基于证素辨证探讨无锡地区老年性骨质疏松症证型分布与脆性骨折的相关性

Exploration of Correlation of Traditional Chinese Medicine Syndrome Types with Brittle Fracture in Senile Osteoporosis Patients from Wuxi Area Based on Syndrome Element Differentiation

【目的】探讨无锡地区老年性骨质疏松症患者中医证型分布特点与脆性骨折的相关性,为进一步确立骨质疏松中医药早期干预及治则治法提供依据,以减少脆性骨折的发生率。【方法】选择2019年1月~6月以南京中医药大学无锡附属医院为中心联合三家医联体医院作为分中心的骨伤科门诊及住院治疗的老年性骨质疏松症患者,共200例。基于证素辨证学原理进行中医辨证分型,观察不同证型患者脆性骨折的发生次数、发生率及发生部位情况。【结果】200例患者中,有9例因证型的样本量过小予以排除,故实际纳入统计191例。其中脾肾阳虚证68例(35.6%)、肝血亏虚证48例(25.1%)、肾精不足证35例(18.3%)、气滞血瘀证27例(14.1%)、寒凝痹阻证13例(6.8%)。脾肾阳虚证脆性骨折发生率为45.6%,肝血亏虚证为35.4%,肾精不足证为37.1%,气滞血瘀证为22.2%,寒凝痹阻证为15.4%;脾肾阳虚证与气滞血瘀证、寒凝痹阻证比较差异有统计学意义(P<0.05)。脾肾阳虚证2次及以上脆性骨折发生率为54.8%,与肝血亏虚证和肾精不足证比较差异有统计学意义(P<0.05),但与气滞血瘀证比较差异无统计学意义(P>0.05)。脾肾阳虚证的胸腰椎脆性骨折发生率为77.4%,高于其他证型,差异有统计学意义(P<0.05)。【结论】脾肾阳虚证是老年性骨质疏松症的常见证型,也是脆性骨折发生率及骨折发生频次较高的证型。

Objective To explore the correlation between the distribution of traditional Chinese medicine(TCM)syndrome types and brittle fracture in senile osteoporosis from Wuxi area,so as to provide a basis for the establishment of early intervention and treatment of osteoporosis with traditional Chinese medicine,and to reduce the incidence of brittle fracture.Methods From January to June of 2019,200 cases of senile osteoporosis were selected from outpatients and inpatients in Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine and other three affiliated hospitals.Based on the principle of syndrome element differentiation,the incidence,frequency and location of brittle fractures were counted,and then the relationship of TCM syndrome types with bone mineral density,and with the incidence,frequency and location of brittle fractures were investigated.Results Of the 200 cases,9 cases were excluded for the case number of syndrome classification sample was too small,so a total of 191 cases were finally included.A total of 68(35.6%)cases were differentiated as spleen and kidney yang deficiency syndrome,48(25.1%)cases were differentiated as liver blood insufficiency syndrome,35(18.3%)cases were differentiated as kidney essence deficiency syndrome,27(14.1%)cases were differentiated as qi stagnation and blood stasis syndrome,and 13(6.8%)cases were differentiated as cold coagulation obstruction syndrome.The incidence of brittle fracture in the patients with spleen and kidney yang deficiency syndrome was45.6%,in liver blood deficiency syndrome was 35.4%,in kidney essence deficiency syndrome was 37.1%,in qi stagnation and blood stasis syndrome was 22.2%,and in cold coagulation and obstruction syndrome was 15.4%.The incidence of brittle fractures in patients with spleen and kidney yang deficiency syndrome differed from that in patients with qi stagnation and blood stasis syndrome and cold coagulation and obstruction syndrome(P<0.05).The patients with spleen and kidney yang deficiency syndrome suffering brittle fractures two times or above accounted for 54.8%,and the incidence differed from that in patients with liver blood insufficiency syndrome and kidney essence deficiency syndrome(P<0.05),but did not differ from that in patients with qi stagnation and blood stasis syndrome(P>0.05).The incidence of thoracolumbar fractures in the patients with spleen and kidney yang deficiency syndrome accounted for 77.4%,and was significantly higher than that in the patients with other syndrome types(P<0.05).Conclusion The syndrome of spleen and kidney yang deficiency is the common type of senile osteoporosis patients,and is also the type with high incidence and frequency of brittle fracture.