中医益气温阳活血方联合椎体成形术分次灌注骨水泥对骨质疏松性椎体压缩骨折患者脊椎功能评分的影响

Vertebroplasty fractional infusion of bone cement combined with Yiqiwenyang Huoxue prescription for the treatment of osteoporotic vertebral compression fractures: spine function score and its mechanism

目的观察中医益气温阳活血方联合椎体成形术分次灌注骨水泥对骨质疏松性椎体压缩骨折患者脊椎功能评分的影响。方法前瞻性选取2018年8月至2020年4月在西南医科大学附属成都三六三医院骨科接受治疗的老年骨质疏松性椎体压缩骨折(OVCF)患者100例,按随机平行分组法分为对照组和观察组各50例。两组患者均进行椎体成形术分次灌注骨水泥手术治疗,术后对照组服用阿法骨化醇胶丸治疗,观察组则应用阿法骨化醇胶丸+益气温阳活血方治疗。观察两组患者术前、术后3个月以及术后1年视觉模拟评分法(VAS)评分、Oswestry功能障碍指数问卷表(ODI)评分、椎体高度、Cobb角、骨密度值、骨钙素、碱性磷酸酶(ALP)以及Ⅰ型前胶原氨基端前肽(PINP)水平变化情况,并随访1年观察两组再骨折发生情况。结果术后3个月、术后1年,两组患者两组患者VAS评分、ODI评分、Cobb角、PINP水平均较术前有明显下降,观察组上述各指标在各时间点明显低于对照组,差异均有统计学意义(P<0.05)。术后3个月、术后1年,两组患者骨折椎体高度、骨密度值、骨钙素、ALP水平均较术前明显升高,观察组上述各指标在各时间点均明显高于对照组,差异均有统计学意义(P<0.05)。观察组患者的骨水泥渗漏率(10.0%)及再骨折发生(2.0%)明显低于对照组(28.0%,14.0%),差异均有统计学意义(P<0.05)。结论椎体成形术分次灌注骨水泥联合益气温阳活血方治疗骨质疏松性椎体压缩骨折可明显缓解患者疼痛,改善其脊柱功能,并改善骨质疏松,疗效确切。

Objective To observe the spinal function score and its mechanism in patients with osteoporotic vertebral compression fracture treated by vertebroplasty with bone cement infusion combined with Yiqiwenyang Huoxue prescription.Methods A total of 100 elderly patients with osteoporotic vertebral compression fracture(OVCF)who received treatment in the Department of Orthopaedics,Chengdu 363 Hospital,Southwest Medical University from August 2018 to April 2020 were prospectively selected and divided into control group and observation group by random parallel grouping method,with 50 patients in each group.Patients in both groups were treated by vertebroplasty with bone cement infusion.After surgery,the control group was treated with Alfacalcitol capsule,while the observation group was treated with Alfacalcitol capsule+Yiqiwenyang Huoxue prescription.Visual analogue scale(VAS)score and Oswestry dysfunction index questionnaire(ODI)score,vertebral height,Cobb Angle,bone mineral density,BGP,ALP and PINP levels before surgery,3 months after surgery,and 1 year after surgery,and the incidence of re-fracture in both groups during 1-year follow-up were observed.Results VAS score,ODI score,Cobb Angle and PINP levels in 2 groups decreased significantly 3 months and 1 year after surgery compared with those before surgery,the above indexes in the observation group were significantly lower than those in the control group at each time point,and the differences were statistically significant(P<0.05).Vertebral height,bone mineral density,BGP and ALP levels in 2 groups were significantly higher than those before surgery,the above indexes in the observation group were significantly higher than those in the control group at each time point,and the differences were statistically significant(P<0.05).The bone cement leakage rate(10.0%)and refracture rate(2.0%)in the observation group were significantly lower than those in the control group(28.0%and 14.0%),and the differences were statistically significant(P<0.05).Conclusion Vertebroplasty with bone cement infusion combined with Yiqiwenyang Huoxue prescription for the treatment of osteoporotic vertebral compression fracture can significantly relieve pain,improve spinal function,and improve osteoporosis,with definite curative effect.