补肾健脾壮骨汤治疗脊柱压缩性骨折的临床效果

Clinical effect of Bushen Jianpi Zhuanggu Decoction on spinal compression fracture

目的探讨补肾健脾壮骨汤治疗脊柱压缩性骨折的效果。方法选取2019年3月至2021年5月上海市嘉定区中医医院骨伤科住院的单椎体压缩骨折患者60例,将其按随机数字表法分为治疗组(经皮椎体注入骨水泥治疗配合补肾健脾壮骨汤口服,中药连续口服4周)和对照组(仅行经皮椎体注入骨水泥治疗),各30例。观察两组术前及术后1周、3个月的视觉模拟评分法(VAS)评分和日本骨科协会(JOA)腰痛评分及Cobb角的改变,比较两组疗效及治疗前、术后3个月骨代谢指标的变化。记录两组治疗期间发生的不良反应。结果两组术后1周、3个月VAS评分和Cobb角均低于术前,JOA腰痛评分高于术前,术后3个月VAS评分和Cobb角均低于术后1周,JOA腰痛评分高于术后1周,差异有统计学意义(P<0.05)。治疗组术后1周、3个月的VAS评分和Cobb角均低于同期对照组,JOA腰痛评分高于同期对照组,差异有统计学意义(P<0.05)。术后3个月,两组骨钙素(OCN)、骨特异性碱性磷酸酶(BALP)高于术前,人胶原交联羧基末端肽(CTX)低于术前,且治疗组OCN、BALP高于对照组,CTX低于对照组,差异有统计学意义(P<0.05)。治疗组疗效优于对照组,差异有统计学意义(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论补肾健脾壮骨汤联合椎体骨水泥注入治疗脊柱压缩骨折对患者的腰痛及功能改善效果理想,对骨代谢改善较为明显。

Objective To investigate the effect of Bushen Jianpi Zhuanggu Decoction on spinal compression fracture.Methods Sixty patients with single vertebral compression fracture admitted to Department of Orthopedics,Jiading District Hospital of Traditional Chinese Medicine,Shanghai from March 2019 to May 2021 were selected and divided into treatment group(percutaneous vertebral cement injection combined with oral administration of Bushen Jianpi Zhuanggu Decoction,oral administration of traditional Chinese medicine for four weeks)and control group(percutaneous vertebral cement injection only),with 30 cases in each group.Visual analog scale(VAS)score,Japanese Orthopaedic Association(JOA)low back pain score,and Cobb angle of the two groups were observed before surgery and one week,three months after surgery,and the effects of the two groups and the changes of bone metabolism indexes before treatment and three months after surgery were compared.Adverse reactions during treatment were recorded in both groups.Results VAS score and Cobb angle at one week and three months after surgery were lower than those before surgery,JOA low back pain score was higher than that before surgery,VAS score and Cobb angle at three months after surgery were lower than those at one week after surgery,JOA low back pain score was higher than that at one week after surgery,the differences were statistically significant(P<0.05).The VAS score and Cobb angle of the treatment group at one week and three months after surgery were lower than those of the control group at the same points,and the JOA low back pain score was higher than that of the control group at the same time points,the differences were statistically significant(P<0.05).Three months after surgery,the levels of osteocalcin(OCN)and bone alkaline phosphatase(BALP)were higher than those before surgery,and the level of human cross-linked carboxy-terminal peptide(CTX)was lower than that before surgery,the OCN and BALP of treatment group were higher than those of control group,and CTX was lower than that of control group,the differences were statistically significant(P<0.05).The therapeutic effect of the treatment group was better than that of the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Bushen Jianpi Zhuanggu Decoction combined with vertebral bone cement injection in the treatment of spinal compression fracture has an ideal effect on the improvement of lumbago and function,and the improvement of bone metabolism is more obvious.