[1]牛强卫.手法复位联合经皮椎体成形术和中医骨折三期辨证用药治疗骨质疏松性胸腰椎压缩骨折的临床研究[J].中医正骨,2017,29(04):16-22.
　NIU Qiangwei.A clinical study of manipulative reduction combined with percutaneous vertebroplasty and oral application of traditional Chinese medicine according ……[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(04):16-22.
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手法复位联合经皮椎体成形术和中医骨折三期辨证用药治疗骨质疏松性胸腰椎压缩骨折的临床研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期数:
2017年04期
页码:
16-22
栏目:
临床研究
出版日期:
2017-04-20

文章信息/Info

Title:
A clinical study of manipulative reduction combined with percutaneous vertebroplasty and oral application of traditional Chinese medicine according ……
作者:
牛强卫
河南宏力医院,河南 长垣 453400
Author(s):
NIU Qiangwei
Henan Honliv Hospital,Changyuan 453400,Henan,China
关键词:
骨折; 压缩性;  骨质疏松性骨折;  胸椎;  腰椎;  椎体成形术;  正骨手法;  辨证论治;  临床试验
Keywords:
Key words fractures; compression;  osteoporotic fractures;  thoracic vertebrae;  lumbar vertebrae;  vertebroplasty;  bone setting manipulation;  syndrome differ treatment;  clinical
摘要:
目的:探讨手法复位联合经皮椎体成形术(percutaneous vertebm plasty,PVP)和中医骨折三期辨证用药治疗骨质疏松性胸腰椎压缩骨折的临床疗效和安全性。方法:将92例骨质疏松性胸腰椎压缩骨折患者随机分为单纯PVP组和手法复位联合PVP与中医骨折三期辨证用药组,每组46例。分别于术前、术后24 h及术后6个月测定2组患者矢状位伤椎前缘高度、矢状位脊柱后凸Cobb角、腰背部疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswsetry disability index,ODI)评分,并观察并发症发生情况。结果:手术前后不同时间点间矢状位伤椎前缘高度的差异有统计学意义,即存在时间效应(F=13.657,P=0.019); 2组患者矢状位伤椎前缘高度总体比较,组间差异有统计学意义,即存在分组效应(F=13.687,P=0.018); 术前2组患者矢状位伤椎前缘高度比较,差异无统计学意义[(11.70±0.78)mm,(11.70±0.68)mm,t=0.987,P=0.175]; 术后24 h、术后6个月,手法复位联合PVP和中医骨折三期辨证用药组矢状位伤椎前缘高度均高于单纯PVP组[(18.90±0.22)mm,(13.10±1.02)mm,t=13.654,P=0.018;(18.90±0.36)mm,(13.90±0.24)mm,t=18.353,P=0.014]; 时间因素与分组因素存在交互效应(F=13.569,P=0.021)。手术前后不同时间点间矢状位脊柱后凸Cobb角的差异有统计学意义,即存在时间效应(F=14.365,P=0.015); 2组患者矢状位脊柱后凸Cobb角总体比较,组间差异有统计学意义,即存在分组效应(F=21.670,P=0.006); 术前2组患者矢状位脊柱后凸Cobb角比较,差异无统计学意义(18.60°±0.98°,15.70°±0.69°,t=0.887,P=0.145); 术后24 h、术后6个月,手法复位联合PVP和中医骨折三期辨证用药组矢状位脊柱后凸Cobb角均小于单纯PVP组(5.90°±0.62°,12.10°±0.47°,t=16.684,P=0.008; 3.67°±0.56°,11.90°±0.64°,t=20.353,P=0.004); 时间因素与分组因素存在交互效应(F=14.347,P=0.013)。手术前后不同时间点间腰背部疼痛VAS评分的差异有统计学意义,即存在时间效应(F=29.365,P=0.003); 2组患者腰背部疼痛VAS评分总体比较,组间差异有统计学意义,即存在分组效应(F=1.670,P=0.026); 术前2组患者腰背部疼痛VAS评分比较,差异无统计学意义[(8.60±0.98)分,(8.70±0.79)分,t=0.487,P=0.745]; 术后24 h、术后6个月,手法复位联合PVP和中医骨折三期辨证用药组腰背部疼痛VAS评分均低于单纯PVP组[(2.90±0.52)分,(3.10±0.67)分,t=1.684,P=0.028;(2.67±0.56)分,(3.20±0.66)分,t=1.353,P=0.024]; 时间因素与分组因素存在交互效应(F=11.347,P=0.014)。手术前后不同时间点间ODI评分的差异有统计学意义,即存在时间效应(F=33.453,P=0.002); 2组患者ODI评分总体比较,组间差异有统计学意义,即存在分组效应(F=3.670,P=0.036); 术前2组患者ODI评分比较,差异无统计学意义[(42.68±1.06)分,(42.79±0.97)分,t=0.879,P=0.216]; 术后24 h、术后6个月,手法复位联合PVP和中医骨折三期辨证用药组ODI评分均低于单纯PVP组[(20.56±0.58)分,(24.58±0.54)分,t=5.249,P=0.019;(11.67±0.49)分,(19.49±0.51)分,t=4.251,P=0.034]; 时间因素与分组因素存在交互效应(F=34.387,P=0.022)。手法复位联合PVP和中医骨折三期辨证用药组未发生骨水泥渗漏、神经脊髓损伤及感染等并发症。单纯PVP组3例发生骨水泥渗漏,其中1例出现神经压迫症状给予急诊探查减压术治疗后症状消失,2例未出现神经症状给予严密观察而未做处理; 其余患者均未出现神经、脊髓损伤等并发症。2组患者并发症发生率比较,差异无统计学意义(χ2=2.044,P=0.153)。结论:对于骨质疏松性胸腰椎压缩骨折患者,采用手法复位联合PVP和中医骨折三期辨证用药治疗,比单纯PVP治疗更有利于恢复伤椎前缘高度、纠正脊柱后凸畸形、缓解腰背部疼痛和恢复脊柱功能,且安全可靠。
Abstract:
ABSTRACT Objective:To explore the clinical curative effects and safety of manipulative reduction combined with percutaneous vertebroplasty(PVP)and oral application of traditional Chinese medicine(TCM)according to three-stage syndrome differentiation principles for treatment of osteoporotic thoracolumbar vertebral compression fractures.Methods:Ninety-two patients with osteoporotic thoracolumbar vertebral compression fractures were randomly divided into monotherapy group and combination therapy group,46 cases in each group.The patients in monotherapy group were treated with PVP,and the patients in combination therapy group were treated with manipulative reduction combined with PVP and oral application of TCM according to three-stage syndrome differentiation principles.The anterior border height of injured vertebrae and Cobb angle of kyphotic deformity in the sagittal plane,visual analogue scale(VAS)scores and Oswsetry disability index(ODI)scores were evaluated before surgery and at 24 hours and 6 months after the surgery respectively,and the complications were also observed.Results:There was statistical difference in the anterior border height of injured vertebrae in the sagittal plane between different timepoints before and after the surgery,in other words,there was time effect(F=13.657,P=0.019).There was statistical difference in the anterior border height of injured vertebrae in the sagittal plane between the 2 groups in general,in other words,there was group effect(F=13.687,P=0.018).There was no statistical difference in the anterior border height of injured vertebrae in the sagittal plane between the 2 groups before the surgery(11.70+/-0.78 vs 11.70+/-0.68 mm,t=0.987,P=0.175).The anterior border height of injured vertebrae in the sagittal plane was higher in combination therapy group compared to monotherapy group at There was interaction between time factor and group factor(F=13.569,P=0.021).There was statistical difference in the Cobb angle of kyphotic deformity in the sagittal plane between different timepoints before and after the surgery,in other words,there was time effect(F=14.365,P=0.015).There was statistical difference in the Cobb angle of kyphotic deformity in the sagittal plane between the 2 groups in general,in other words,there was group effect(F=21.670,P=0.006).There was no statistical difference in the Cobb angle of kyphotic deformity in the sagittal plane between the 2 groups before the surgery(18.60+/-0.98 vs 15.70+/-0.69 degrees,t=0.887,P=0.145).The Cobb angles of kyphotic deformity in the sagittal plane were less in combination therapy group compared to monotherapy group at 24 hours and 6 months after the surgery respectively(5.90+/-0.62 vs 12.10+/-0.47 degrees,t=16.684,P=0.008; 3.67+/-0.56 vs 11.90+/-0.64 degrees,t=20.353,P=0.004).There was interaction between time factor and group factor(F=14.347,P=0.013).There was statistical difference in lower back pain VAS scores between different timepoints before and after the surgery,in other words,there was time effect(F=29.365,P=0.003).There was statistical difference in lower back pain VAS scores between the 2 groups in general,in other words,there was group effect(F=1.670,P=0.026).There was no statistical difference in the lower back pain VAS scores between the 2 groups before the surgery(8.60+/-0.98 vs 8.70+/-0.79 points,t=0.487,P=0.745).The lower back pain VAS scores were lower in combination therapy group compared to monotherapy group at 24 hours and 6 months after the surgery respectively(2.90+/-0.52 vs 3.10+/-0.67 points,t=1.684,P=0.028; 2.67+/-0.56 vs 3.20+/-0.66 points,t=1.353,P=0.024).There was interaction between time factor and group factor(F=11.347,P=0.014).There was statistical difference in ODI scores between different timepoints before and after the surgery,in other words,there was time effect(F=33.453,P=0.002).There was statistical difference in ODI scores between the 2 groups in general,in other words,there was group effect(F=3.670,P=0.036).There was no statistical difference in the ODI scores between the 2 groups before the surgery(42.68+/-1.06 vs 42.79+/-0.97 points,t=0.879,P=0.216).The ODI scores were lower in combination therapy group compared to monotherapy group at 24 hours and 6 months after the surgery respectively(20.56+/-0.58 vs 24.58+/-0.54 points,t=5.249,P=0.019; 11.67+/-0.49 vs 19.49+/-0.51 points,t=4.251,P=0.034).There was interaction between time factor and group factor(F=34.387,P=0.022).No complications such as bone cement leakage,nerve injury,spinal cord injury and infection were found in combination therapy group.The bone cement leakage was found in 3 patients in monotherapy group,and the nerve compression symptoms were found in one patient and then disappeared after emergency treatment with exploratory surgery and decompression surgery.The other two patients without nerve symptoms were not treated.The spinal cord injuries and infections were not found in other patients of monotherapy group.There was no statistical difference in complication incidences between the two groups(χ2=2.044,P=0.153).Conclusion:The combination therapy of manipulative reduction combined with PVP and oral application of TCM according to three-stage syndrome differentiation principles is more conducive to recovering the anterior board height of injured vertebrae,correcting the kyphotic deformity,alleviating lower back pain and restoring the spinal function compared to monotherapy of PVP in the treatment of osteoporotic thoracolumbar vertebral compression fractures,and it is safe and reliable.

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更新日期/Last Update: 1900-01-01