桃红四物汤联合经皮椎体成形术治疗骨质疏松性椎体压缩性骨折疗效及对术后康复、骨代谢、炎症状态的影响

Efficacy of Taohong Siwu Decoction combined with percutaneous vertebroplasty for osteoporotic vertebral compression fracture and its influence on postoperative recovery,bone metabolism and inflammatory state

目的观察桃红四物汤联合经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩性骨折(OVCF)疗效及对术后恢复、骨代谢、炎症反应的影响。方法选取68例OVCF患者,按随机数字表法分为对照组(n=34)、治疗组(n=34),2组均采取PVP治疗,治疗组在术后加用桃红四物汤治疗,连续用药2个月。比较2组临床疗效、术后康复情况,并分析比较2组治疗前后解剖结构、炎症指标[白细胞介素1(IL-1)、IL-6、肿瘤坏死因子α(TNF-α)]、骨折修复细胞因子[骨形态发生蛋白-2(BMP-2)、血管内皮生长因子(VEGF)、转化生长因子β_(1)(TGF-β_(1))]、骨代谢指标[Ⅰ型胶原交联氨基端肽(NTXⅠ)、酒石酸酸性磷酸酶-5b(TRACP-5b)、骨钙素(BGP)]含量。结果治疗组总有效率94.12%(32/34),高于对照组的76.47%(26/34)(P<0.05)。治疗组消肿时间、淤斑消失时间、止痛时间及骨折愈合时间均较对照组明显缩短,比较差异均有统计学意义(P<0.05)。治疗后,2组伤椎Cobb角、椎管侵占率均低于本组治疗前(P<0.05),伤椎前缘高度变化高于本组治疗前(P<0.05),且治疗组伤椎Cobb角、椎管侵占率低于对照组(P<0.05),伤椎前缘高度变化高于对照组(P<0.05)。治疗后,2组血清IL-1、IL-6、TNF-α水平均低于本组治疗前(P<0.05),且治疗组低于对照组(P<0.05)。治疗后,2组骨折修复细胞因子BMP-2、VEGF、TGF-β_(1)水平均高于治疗前(P<0.05),且治疗组高于对照组(P<0.05)。治疗后,2组NTXⅠ、TRACP-5b含量低于本组治疗前(P<0.05),BGP含量高于本组治疗前(P<0.05),且治疗组NTXⅠ、TRACP-5b含量低于对照组(P<0.05),BGP含量高于对照组(P<0.05)。结论桃红四物汤结合PVP可明显提高OVCF患者治疗效果,促进骨折愈合、修复能力,并改善骨代谢,减轻炎症反应。

Objective To explore the efficacy of Taohong Siwu Decoction combined with percutaneous vertebroplasty(PVP)for osteoporotic vertebral compression fracture(OVCF)and its influence on postoperative recovery,bone metabolism and inflammatory response.Methods A total of 68 OVCF patients were assigned into the control group(n=34)and the treatment group(n=34)according to a random number table.All patients were managed by PVP,and those in treatment group were additionally treated with Taohong Siwu Decoction for 2 months.The aim was to compare postoperative recovery,anatomical structure,inflammatory indexes(interleukin[IL]-1,IL-6,tumor necrosis factor-α[TNF-α]),bone fracture healing related-cytokines(bone morphogenetic protein-2[BMP-2],vascular endothelial growth factor[VEGF],transforming growth factor-β_(1)[TGF-β_(1)]),bone metabolism indicators[N-terminal crosslinking telopeptide of typeⅠcollagen[NTXⅠ],tartrate-resistant acid phosphatase 5b[TRACP-5b],and bone Gla protein[BGP]).The clinical efficacy was assessed.Results The overall effective rate in the treatment group was significantly higher than that in the control group(94.12%[32/34]vs 76.47%[26/34],P<0.05).The swelling time,ecchymosis disappearance time,pain relief time and fracture healing time of the treatment group were significantly shorter than those of the control group(P<0.05).Significantly decreased Cobb angle of injured vertebrae,rate of spinal canal encroachment,and significantly increased anterior vertebral height were found in both groups after treatment(all P<0.05),which were significantly pronounced in treatment group(all P<0.05).After treatment,IL-1,IL-6 and TNF-αlevels in both groups were significantly decreased(P<0.05),which decreased notably in the treatment group compared with the control group(P<0.05).BMP-2,VEGF and TGF-β_(1) in both groups were significantly increased(P<0.05),which were significantly increased in the treatment group than in the control group(P<0.05).After treatment,significantly decreased NTXⅠand TRACP-5b contents,and significantly increased BGP content were detected in both groups than those before treatment(all P<0.05),and the different was significant between groups for the above indexes(all P<0.05).Conclusion Taohong Siwu Decoction combined with PVP can significantly improve the therapeutic effect,promote fracture healing and repair,improve bone metabolism,and reduce inflammatory response in OVCF patients.