龟甲健骨胶囊治疗老年骨质疏松性椎体压缩骨折的疗效及影像学评价

Efficacy and imaging Evaluation of Guijia Jiangu Capsule in the Treatment of Senile Osteoporotic Vertebral Compression Fracture

目的探讨龟甲健骨胶囊治疗老年骨质疏松性椎体压缩骨折(Osteoporotic vertebral compression fracture,OVCF)的疗效。方法选取2021年11月—2022年10月期间南充市中医医院收治的206例老年OVCF患者作为研究对象,按随机数字表法分观察组和对照组,每组各103例。两组患者均行经皮椎体成形术,对照组术后给予常规西药用药,观察组西药联合龟甲健骨胶囊。治疗3个月后,观察比较两组患者临床疗效、骨折愈合时间、并发症发生情况,手术前后病椎椎体前缘高度、椎体后缘高度及Cobb角,血清缺氧诱导因子1α(Hypoxia-inducible factor 1α,HIF-1α)、血管内皮生长因子(Vascular endothelial growth factor,VEGF)水平,骨代谢指标[碱性磷酸酶(Alkaline phosphatase,ALP)、骨钙素(Bone gamma-carboxyglutamic-acid-containing proteins,BGP)、骨密度(Bone mineral density,BMD)],Oswestry功能障碍指数(Oswestry Disability Index,ODI)评分。结果术后3个月两组患者椎体前缘高度、椎体后缘高度均较术前明显升高,Cobb角较术前明显缩小,差异有统计学意义(P<0.05);且观察组椎体前缘高度、椎体后缘高度均较对照组明显升高,差异有统计学意义(P<0.05),Cobb角与对照组接近,差异无统计学意义(P>0.05)。术后3个月两组患者血清HIF-1α、VEGF水平均较术前升高,差异有统计学意义(P<0.05);且观察组血清HIF-1α、VEGF水平均明显高于对照组,差异有统计学意义(P<0.05)。术后观察组骨折愈合时间明显短于对照组,差异有统计学意义(P<0.05)。术后3个月两组患者ALP、BGP、BMD水平均较术前升高,差异有统计学意义(P<0.05);且观察组ALP、BGP、BMD水平均较对照组明显升高,差异有统计学意义(P<0.05)。术后3个月两组患者ODI评分均较术前降低,差异有统计学意义(P<0.05);且观察组ODI评分较对照组明显降低,差异有统计学意义(P<0.05)。治疗后观察组总有效率92.23%(95/103)明显高于对照组75.73%(78/103),差异有统计学意义(P<0.05)。治疗期间,两组患者均未发生骨水泥渗漏或硬膜外血肿;治疗后观察组二次骨折发生率1.94%(2/103)明显低于对照组12.62%(13/103),差异有统计学意义(P<0.05)。结论龟甲健骨胶囊辅助治疗老年OVCF可有效调节骨代谢,促进骨生成,提高骨密度,加快骨折愈合及术后椎体功能恢复,降低二次骨折风险。

Objective To explore the efficacy of Guijia Jiangu capsule on senile osteoporotic vertebral compression fracture(OVCF).Methods A toal of 206 elderly OVCF patients admitted to Nanchong Traditional Chinese Medicine Hospital from November 2021 to October 2022 were selected as the research subjects.They were randomly divided into an observation group and a control group using a random number table method,with 103 cases in each group,.Both groups underwent percutaneous vertebroplasty,with the control group receiving conventional Western medicine after surgery,and the observation group receiving a combination of Western medicine and Guijia Jiangu capsules.After 3 months of treatment,the clinical efficacy,fracture healing time,incidence of complications,pre and postoperative vertebral anterior and posterior heights,Cobb angle,and serum levels of hypoxia-inducible factor 1(HIF-1α),vascular endothelial growth factor(VEGF),bone metabolism indicators[alkaline phosphatase(ALP),bone gamma-carboxyglutamic-acid-containing proteins(BGP),bone mineral density(BMD)]and Oswestry Disability Index(ODI)scores were observed and compared between the two groups of patients.Results After 3 months of surgery,the vertebral anterior and posterior heights of the two groups were significantly higher than before surgery,and the Cobb angle was significantly reduced compared to before surgery,with a statistically significant difference(P<0.05).The heights of the vertebral anterior and posterior bodies in the observation group were significantly higher than that in the control group,with statistical significance(P<0.05).The Cobb angle was similar to that in the control group,with no statistical significance(P>0.05).After 3 months,both groups showed a significant increase in serum HIF-1 and VEGF levels compared to before surgery(P<0.05),and the observation group's serum HIF-1αand VEGF levels were significantly higher than those of the control group,and the difference was statistically significant(P<0.05).The fracture healing time in the postoperative observation group was significantly shorter than that in the control group,and the difference was statistically significant(P<0.05).After 3 months of surgery,the levels of ALP,BGP,and BMD in the two groups of patients increased significantly compared to before surgery(P<0.05);And the observation group was significantly higher than the control group,with a statistically significant difference(P<0.05).After 3 months of surgery,the ODI scores in both groups of patients decreased significantly compared to before surgery(P<0.05);The ODI score of the observation group was significantly lower than that of the control group,and the difference was statistically significant(P<0.05).After treatment,the total effective rate of the observation group was 92.23%(95/103),which was significantly higher than that of the control group of 75.73%(78/103),and the difference was statistically significant(P<0.05).During the treatment period,neither group of patients experienced bone cement leakage or epidural hematoma;The incidence of secondary fractures in the observation group after treatment was 1.94%(2/103),which was significantly lower than that in the control group at 12.62%(13/103),and the difference was statistically significant(P<0.05).Conclusion Guijia Jiangu capsule as an adjuvant treatment for elderly OVCF can effectively regulate bone metabolism,promote bone formation,improve bone density,accelerate fracture healing and enhance postoperative recovery of vertebral function,reducing the risk of secondary fracture.