机器人辅助下经皮椎体成形术联合固肾骨松方治疗骨质疏松性椎体压缩性骨折的疗效观察

Observation on the Therapeutic Effect of Robot-Assisted Percutaneous Vertebroplasty Combined with Gushen Gusong Prescription for the Treatment of Osteoporotic Vertebral Compression Fracture

【目的】观察机器人辅助下经皮椎体成形术(PVP)联合固肾骨松方治疗骨质疏松性椎体压缩性骨折(OVCF)的临床疗效。【方法】采用回顾性分析方法,根据是否使用中药固肾骨松方治疗,将患者分为观察组和对照组,每组各49例。2组患者均接受机器人辅助下PVP,对照组术后给予常规抗骨质疏松治疗(包括口服阿法骨化醇软胶囊、碳酸钙D3片),观察组在对照组的基础上加服经验方固肾骨松方治疗,疗程为3个月。观察2组患者手术前后疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)评分和血清Ⅰ型胶原羧基端肽β特殊序列(β-CTX)、总I型前胶原氨基端前肽(T-PINP)含量以及腰椎骨密度T值的变化情况,并评价2组患者的临床疗效。【结果】(1)术后1 d、1个月、3个月,2组患者的VAS、ODI评分均较术前明显降低(P<0.05);组间比较,观察组术后1个月和3个月的降低幅度均优于对照组,且其术后3个月与术前的差值均高于对照组,差异均有统计学意义(P<0.05或P<0.01)。(2)术后3个月,2组患者的血清β-CTX、T-PINP水平均较术前明显降低,骨密度T值均较术前明显升高,差异均有统计学意义(P<0.05);组间比较,观察组术后3个月对血清β-CTX、T-PINP水平的降低幅度和对骨密度T值的升高幅度均明显优于对照组,差异均有统计学意义(P<0.05或P<0.01)。(3)治疗3个月后,观察组的总有效率为97.96%(48/49),对照组为83.67%(41/49),组间比较,观察组的疗效明显优于对照组,差异有统计学意义(P<0.05)。【结论】机器人辅助下PVP联合固肾骨松方治疗OVCF的临床疗效显著,安全性高,可以有效减轻疼痛,改善腰椎功能和骨质疏松。

Objective To observe the clinical efficacy of robot-assisted percutaneous vertebroplasty(PVP)combined with Gushen Gusong Prescription for the treatment of osteoporotic vertebral compression fracture(OVCF). Methods Retrospective analysis was conducted in 98 patients with OVCF. The 98 patients with OVCF were divided into observation group and control group according to the medication of Gushen Gusong Prescription or not,with 49 cases in each group. Patients in both groups received robotic-assisted PVP. The control group was given conventional anti-osteoporosis treatment(including oral use of Alfacalcidol Soft Capsules and Calcium Carbonate and Vitamin D3 Tablets)after surgery,while the observation group was treated with Gushen Gusong Prescription on the basis of treatment for the control group. Both groups of patients were treated for 3 months. The changes in pain visual analogue scale(VAS)scores,Oswestry dysfunction index(ODI)scores,serum type I collagen carboxy-terminal peptide β special sequence(β-CTX),total procollagen type 1 N-peptide(T-PINP)and lumbar bone mineral density(BMD)T-value of the patients in the two groups were observed before and after the surgery. Furthermore,the clinical efficacy of the two groups was evaluated. Results(1)On the 1stday and the1stand 3rdmonth after surgery, the VAS scores and ODI scores of patients in both groups were significantly decreased compared with those before surgery(P<0.05). The intergroup comparison showed that the decrease in the observation group was superior to that in the control group on the 1stand 3rdmonth after surgery, and the difference of 3 months after surgery and before surgery was higher than that in the control group,the differences being statistically significant(P<0.05 or P<0.01).(2)On the 3rdmonth after surgery,the serum β-CTX and TPINP levels were significantly decreased and the BMD T-value was significantly increased in both groups compared with those before surgery,and the difference was statistically significant(P<0.05). The intergroup comparison showed that the reduction of serum β-CTX and T-PINP levels and the increase of BMD T-value in the observation group were significantly superior to those in the control group three months after surgery,and the differences were statistically significant(P<0.05 or P<0.01).(3)After 3 months of treatment, the overall effective rate of the observation group was 97.96%(48/49), and that in the control group was 83.67%(41/49). The intergroup comparison showed that the efficacy of the observation group was significantly superior to that of the control group,and the difference was statistically significant(P<0.05). Conclusion Robot-assisted PVP combined with Gushen Gusong Prescription exerts significant efficacy and high safety in treating OVCF,and the combined therapy can effectively relieve the pain and improve lumbar function and osteoporosis of the patients.