杨天鹏中医正骨手法复位结合PKP治疗合并有肋间神经痛的骨质疏松性胸椎压缩骨折临床疗效评价研究

Clinical Efficacy Evaluation of Yang Tianpeng Traditional Chinese Medicine Bone-Setting Manipulative Reduction Combined with PKP in Osteoporotic Thoracic Compression Fracture with Intercostal Neuralgia

目的 探讨杨天鹏中医正骨手法复位结合经皮椎体后凸成形术(PKP)治疗合并有肋间神经痛的骨质疏松性胸椎骨折患者的可行性及有效性。方法 回顾性分析2018年1月至2020年12月行杨天鹏中医正骨手法复位结合PKP治疗的合并有肋间神经痛的骨质疏松性胸椎骨折患者78例,其中治疗组杨天鹏中医正骨手法复位结合PKP治疗39例,对照组单纯采用PKP治疗的39例。比较两组患者术前、术后1 d、术后6个月、术后12个月背部及肋间神经痛VAS评分、椎体前缘高度、Cobb角,并比较两组患者在骨水泥渗漏、松动等并发症方面的差异,探讨该治疗方式的临床疗效。结果 所有患者术后背部及肋间神经疼痛明显缓解,均无脊髓神经损伤发生,并都随访12个月以上。治疗组较对照组术前、术后1 d、术后6个月、术后12个月背部及肋间神经痛VAS评分、椎体前缘高度、Cobb角比较,差异有统计学意义(P<0.05)。治疗组与对照组在骨水泥渗漏方面比较差异有统计学意义(P<0.05)。结论 杨天鹏中医正骨手法复位结合PKP治疗合并有肋间神经痛的骨质疏松性胸椎骨折,微创且相对安全,疗效肯定,值得临床推广。

Objective To explore the feasibility and effectiveness of Yang Tianpeng traditional Chinese medicine bone-setting manipulative reduction combined with percutaneous kyphoplasty(PKP)in patients of osteoporotic thoracic fractures with intercostal neuralgia.MethodsA retrospective analysis of 78 patients of osteoporotic thoracic fracture with intercostal neuralgia from January 2018 to December 2020 was carried out,among which 39 patients were treated with manual reduction combined with PKP as the treatment group,and 39 patients were treated with PKP as the control group.VAS scores of back and intercostal neuralgia,vertebral anterior margin height and Cobb Angle were compared between the two groups before surgery,1 day after surgery,6 months aersurgery and12 months after surgery,and the differences in bone cement leakage,loosening and other complications were compared between the two groups,so as to explore the clinical efficacy of this treatment.Results All patients had significant relief of back and intercostal nerve pain without spinal cord nerve injury,with 12 months or more follow-up.The VAS scores of back and intercostal neuralgia,vertebral anterior margin height and Cobb Angle in the treatment group were significantly different from those in the control group before surgery,1 day after surgery,6 months afer surgery and 12 months afer surgery(P<0.05).There was significant difference in bone cement leakage between the treatment group and the control group(P<0.05).Conclusion Yang Tianpeng's TCM bone setting manual reduction combined with percutaneous kyphoplasty to treat osteoporotic thoracic vertebra fracture combined with intercostal neuralgia is minimally invasive and relatively safe,with positive curative effect,which is worthy of clinical promotion.