中药健骨和胃饮预防PKP手术术后椎体再塌陷的临床研究

目的 观察中药健骨和胃饮对骨质疏松性椎体压缩骨折(OVCFs)患者椎体后凸成形术(PKP)后骨密度、骨代谢的影响,探讨中药健骨和胃饮预防PKP术后手术椎体塌陷的临床疗效.方法 将100例OVCFs患者随机分为两组,每组各50例,所有患者均在局部麻醉下行PKP术.术后第1天起对照组给予口服钙尔奇D,1次/d,1片/次,服用6个月.中药组在此基础上加服健骨和胃饮,50ml/次,2次/次.分别于术前、术后6个月时测定两组患者骨密度T值、血清骨钙素(OC)、血清Ⅰ型胶原交联C-末端肽(S-CTX)等指标,并接受椎体X线检查,必要时行CT、MRI检查,观察手术椎体是否出现塌陷等并发症.结果 随访周期内共8例患者退出研究,92例患者中12例发生手术椎体塌陷,手术椎体塌陷的总发生率为13.04%,其中对照组为19.57%,中药组为6.52%,两组手术椎体塌陷发生率的比较差异有统计学意义(P<0.05).对照组术后6个月时骨密度T值、S-CTX值与术前比较无明显差异(P>0.05),对照组术后6个月时OC值低于术前(P<0.05).中药组术后6个月时骨密度T值高于术前(P<0.05),中药组术后6个月时OC、S-CTX值均低于术前(P<0.05).结论 健骨和胃中药通过作用于机体相关骨代谢分子信号通路,抑制增强的成骨细胞、破骨细胞活性,降低骨转换水平,纠正机体骨重建、骨吸收失衡,提高患者骨密度及骨矿含量,从而降低OVCFs 患者PKP术后手术椎体进行性塌陷的发生率.

Objective To observe the effect of the Chinese herbal compound of Hewei Jiangu decoction on bone mineral density and bone metabolism after the balloon kyphoplasty(PKP)in osteoporotic vertebral compression fractures(OVCFs). To investigate the clinical efficacy of the Chinese herbal compound of Hewei Jiangu decoction in preventing collapse of cemented vertebral bodies after PKP. Methods One hundred OVCFs patients were randomly divided into two groups. All the patients received PKP under local anesthesia. The patients in control group received one tablet of Caltrate D tablets per day for consecutive 6 months. On the base of the control group,the patients in the Chinese medicine group received 50ml of the Chinese herbal compound of Hewei Jiangu decoction twice a day for consecutive 6 months. Lumbar spine bone mineral density(BMD),markers of bone turnover(OC,S-CTX),X-ray examination were detected before the operation and 6 months after the operation. Part of the patients were arranged to underwent CT or MRI examination. The rate of collapse of cemented vertebral bodies was recorded during the follow-up period. Results A total of 8 patients were dropped off during the follow-up period. Of the 92 patients,12 cases of the collapse were presented during the follow-up period. The overall incidence rate of collapse was 13.04%,of which 19.57% in the control group and 6.52% in the Chinese medicine group. The difference was significant in the rate of collapse between the two groups(P<0.05). There was no significant difference in BMD and S-CTX between sixth months after operation and before operation in the control group(P>0.05). The OC value was significantly lower at sixth months after operation than before the operation in the control group(P<0.05). The BMD and S-CTX value were significantly higher at sixth months after operation than before the operation in the Chinese medicine group(P<0.05). The OC and S-CTX value were significantly lower at sixth months after operation than before the operation in the Chinese medicine group(P<0.05). Conclusion The Chinese herbal compound of Hewei Jiangu decoction plays a role through the molecular signaling pathways related to bone metabolism. The Chinese herbal compound of Hewei Jiangu decoction can inhibit the activity of the active osteoblasts and osteoclasts,reduce bone turnover rate,correct bone remodeling and bone resorption imbalance,improve bone mineral density and bone mineral content,and reduce the collapse of cemented vertebral bodies effectively.