破瘀行气强骨方联合西医常规治疗对气滞血瘀型骨质疏松性椎体压缩性骨折患者经皮椎体后凸成形术术后康复的影响

Combined Poyu Xingqi Qianggu Formula with Western medicine on postoperative rehabilitation of patients with osteoporotic vertebral body compression fracture of Qi stagnation and blood stasis underwent percutaneous kyphoplasty

目的观察破瘀行气强骨方联合西医常规治疗对气滞血瘀型骨质疏松性椎体压缩性骨折(OVCF)患者经皮椎体后凸成形术(PKP)术后康复的影响。方法将90例OVCF患者按照随机数字表法分为2组,均予PKP。对照组45例PKP术后予西医常规治疗,治疗组45例PKP术后在对照组治疗基础上加用破瘀行气强骨方治疗。2组均治疗8周。比较2组治疗前后中医证候评分变化;比较2组治疗前后疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评分变化;比较2组治疗前后骨代谢指标变化;比较2组治疗前后骨密度(BMD)及伤椎前缘高度变化;比较2组并发症情况及不良反应发生情况。结果2组治疗后中医证候各项评分及总评分均较本组治疗前降低(P<0.05),治疗后治疗组中医证候各项评分及总评分均低于对照组(P<0.05)。2组治疗后疼痛VAS、ODI评分均较本组治疗前降低(P<0.05),治疗后治疗组疼痛VAS、ODI评分均低于对照组(P<0.05)。2组治疗后骨钙素(BGP)均较本组治疗前升高(P<0.05),血清特异性碱性磷酸酶(BALP)、Ⅰ型原胶原C-端前肽(P1CP)、Ⅰ型胶原交联羧基端肽(CTXⅠ)均较本组治疗前降低(P<0.05),治疗后治疗组BGP高于对照组(P<0.05),BALP、P1CP、CTXⅠ低于对照组(P<0.05)。2组治疗后股骨颈BMD、第2~4腰椎(L_(2~4))BMD、全髋BMD及伤椎前缘高度均较本组治疗前升高(P<0.05),治疗后治疗组股骨颈BMD、L_(2~4) BMD、全髋BMD及伤椎前缘高度均高于对照组(P<0.05)。治疗组并发症总发生率8.89%(4/45),对照组并发症总发生率24.44%(11/45),治疗组总发生率低于对照组(P<0.05)。2组用药期间均未发生肝肾功能异常、皮疹等不良反应。结论破瘀行气强骨方联合西医常规治疗,可改善OVCF患者PKP术后症状和腰背功能,减轻疼痛,减少并发症发生,可能与调节骨代谢指标、提高骨密度有关。

Objective To observe the effect of Poyu Xingqi Qianggu Formula combined with Western medicine on postoperative rehabilitation of patients with osteoporotic vertebral compression fractures(OVCF)of Qi stagnation and blood stasis underwent percutaneous kyphoplasty(PKP).Methods Ninety OVCF patients underwent PKP(Qi stagnation and blood stasis)were randomized 1∶1 to receive conventional Western medicine(the control group)or Poyu Xingqi Qianggu Formula+Western medicine(the treatment group)for 8 weeks.The visual analogue(VAS)score,Traditional Chinese Medicine(TCM)syndrome score,Oswestry dysfunction(ODI)index,bone metabolism indexes,bone mineral density(BMD),and anterior edge height of injured vertebra,complications and adverse reactions were included as comparisons.Results After treatment,TCM syndrome scores,VAS and ODI were all significantly reduced in groups,which were significantly lower in the treatment group than in the control group(all P<0.05).Significantly increased osteocalcin(BGP),and significantly decreased bone alkaline phosphatase(BALP),typeⅠcollagen carboxyl-terminal propeptide(P1CP),and C-terminal telopeptide of typeⅠcollagen(CTXⅠ)were detected in groups,which were more pronounced in the treatment group than in the control group(all P<0.05).The height of the anterior edge of the injured vertebra and the BMD of the femoral neck,L_(2~4),and total hip were significantly enhanced in groups,which were significantly higher in the treatment group than in the control group(all P<0.05).The total incidence of complications was significantly lower in the treatment group than that of the control group(8.89%[4/45]vs 24.44%[11/45];[P<0.05],respectively).Liver and kidney dysfunction,rash and other adverse events were not reported.Conclusion For OVCF patients underwent PKP(Qi stagnation and blood stasis),Poyu Xingqi Qianggu Formula combined with Western medicine can alleviate the symptoms and low back function,which significantly relieves pain and reduces the complications by the regulation of bone metabolism indexes and the improvement of BMD.