补肾活血壮骨汤联合椎体后凸成形术对骨质疏松性椎体压缩性骨折的疗效和远期生活质量的影响
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摘要
目的研究补肾活血壮骨汤联合椎体后凸成形术(percutaneous kyphoplasty,PKP)对骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fractures,OVCF)的疗效分析和远期生活质量的影响。方法选取2014年2月—2017年2月期间收治的128例骨质疏松性椎体压缩性骨折患者,按照随机数字表法,将患者分为对照组和治疗组,每组64例,对照组患者采用经皮椎体后凸成形术治疗,治疗组患者在对照组的基础上,于术后第1天开始服用补肾活血壮骨汤,30 d为1个疗程,连续3个疗程。记录比较两组患者治疗前后骨密度(BMD)、疼痛程度(VAS评分)、肢体功能障碍(ODI)评分、生活质量以及并发症发生情况,并评价疗效。结果治疗后3、6个月对照组患者BMD与治疗前无变化(P> 0. 05),治疗组患者BMD升高,且高于对照组,差异有统计学意义(P <0. 05);治疗后,两组患者VAS和DOI评分均降低,其中治疗组均低于对照组,差异有统计学意义(P <0. 05);治疗后,两组患者生活质量各项评分均升高,其中治疗组均高于对照组,差异有统计学意义(P <0. 05);对照组有效率为87. 50%,低于治疗组的96. 88%(P <0. 05);两组并发症发生率无差异(P> 0. 05)。结论采用补肾活血壮骨汤联合椎体后凸成形术治疗骨质疏松性椎体压缩性骨折患者,能够改善患者疼痛程度和肢体功能障碍,并增强骨密度,提高生活质量,疗效显著,安全可靠,值得临床推广。
Objective To observe the effects on osteoporotic vertebral compression fractures( OVCF) treated with bushen huoxue zhuanggu decoction and percutaneous kyphoplasty( PKP) and the long-term influence on quality of life.Methods From February 2014 to February 2017,128 patients of OVCF were collected and divided into a control group and a treatment group,64 cases in each one according to random number table. In the control group,PKP was adopted. In the treatment group,on the base of the treatment as the control group,since the 1 st day after operation,bushen huoxue zhuanggu decoction was taken orally for 30 days as 1 course,consecutively for 3 courses. The body mass density( BMD),VAS score,ODI score and quality of life were recorded and compared before and after treatment in the two groups,as well as the complications. The therapeutic effects were evaluated. Results In 3 and 6 months after treatment,BMD did not change versus before treatment in the control group( P > 0. 05) and it was increased in the treatment group,higher than the control group,indicating the significant difference( P < 0. 05). After treatment,VAS and IDO scores were all reduced in the two groups,and the scores in the treatment group were lower than the control group,indicating the significant difference( P< 0. 05). After treatment,the score of every item for quality of life was increased in the two groups and the score in the treatment group was higher than the control group,indicating the significant difference( P < 0. 05). The effective rate was 87. 50% in the control group,lower than 96. 88% in the treatment group( P < 0. 05). The incidence of complications was not different between the two groups( P > 0. 05). Conclusion The combined treatment with bushen huoxue zhuanggu decoction and PKP relieves pain and motor impairment of limbs and improves BMD and quality of life. This therapy is significant in therapeutic effects and reliable in safety. Hence,it deserves to be promoted in clinical practice.
Objective To observe the effects on osteoporotic vertebral compression fractures( OVCF) treated with bushen huoxue zhuanggu decoction and percutaneous kyphoplasty( PKP) and the long-term influence on quality of life.Methods From February 2014 to February 2017,128 patients of OVCF were collected and divided into a control group and a treatment group,64 cases in each one according to random number table. In the control group,PKP was adopted. In the treatment group,on the base of the treatment as the control group,since the 1 st day after operation,bushen huoxue zhuanggu decoction was taken orally for 30 days as 1 course,consecutively for 3 courses. The body mass density( BMD),VAS score,ODI score and quality of life were recorded and compared before and after treatment in the two groups,as well as the complications. The therapeutic effects were evaluated. Results In 3 and 6 months after treatment,BMD did not change versus before treatment in the control group( P > 0. 05) and it was increased in the treatment group,higher than the control group,indicating the significant difference( P < 0. 05). After treatment,VAS and IDO scores were all reduced in the two groups,and the scores in the treatment group were lower than the control group,indicating the significant difference( P< 0. 05). After treatment,the score of every item for quality of life was increased in the two groups and the score in the treatment group was higher than the control group,indicating the significant difference( P < 0. 05). The effective rate was 87. 50% in the control group,lower than 96. 88% in the treatment group( P < 0. 05). The incidence of complications was not different between the two groups( P > 0. 05). Conclusion The combined treatment with bushen huoxue zhuanggu decoction and PKP relieves pain and motor impairment of limbs and improves BMD and quality of life. This therapy is significant in therapeutic effects and reliable in safety. Hence,it deserves to be promoted in clinical practice.
引文
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[11]谭斌,刘雄文,刘刚,等.经皮椎体后凸与经皮椎体成形术修复骨质疏松椎体压缩性骨折:随机分组比较[J].中国组织工程研究,2016,20(4):539-543.
[12]曾伟权.补肾活血中药联合PVP对老年骨质疏松性椎体压缩性骨折的治疗分析[J].中医临床研究,2016,8(31):57-58.
[13]孔令成,施振宇,姚建亮,等.强骨饮治疗骨质疏松性椎体压缩性骨折的临床研究[J].中国骨质疏松杂志,2016,22(9):1159-1163.
[14]张艳,刘波,朱凯,等.中西医结合治疗骨质疏松性椎体压缩性骨折临床观察[J].长春中医药大学学报,2010,26(5):729-730.
[15]柴仪,李倩,田伟明,等.自拟补肾活血方对压缩性骨折椎体成形术术后骨密度与功能的影响[J].中国药业,2015,24(3):14-16.
[2]韩玲,巴燕·艾克海提,古洁乃特汗·拜克里木,等.祛风除湿补肾法治疗老年类风湿关节炎的疗效及对抗环瓜氨酸多肽抗体、类风湿因子、红细胞沉降率、C反应蛋白、角蛋白抗体水平的影响[J].中国老年学杂志,2016,36(18):4558-4560.
[3]温玉平,徐春梅,罗金梅,等.补肾活血祛风汤治疗骨质增生性疾病98例[J].时珍国医国药,2006,17(10):2035-2036.
[4]张铁良.临床骨科学(上册)[M]. 3版.北京:人民卫生出版社,2012:178-180.
[5]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:126.
[6]Fairblank JC,Pynsenl PB. The 0swestry disahility index[J]. Spine,2000,25(22):2940-2952.
[7]唐东鸣.补肾活血方治疗老年骨质疏松性椎体压缩性骨折29例[J].河南中医,2014,34(4):664-666.
[8]陈佑邦.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:263.
[9]王鋆泉,周海纯.补肾壮骨汤联合椎体成形术治疗老年骨质疏松性胸腰椎压缩性骨折的临床观察[J].中医药信息,2016,33(2):102-104.
[10]王春岭.椎体成形术并补肾壮骨汤治疗骨质疏松性椎体压缩骨折[J].中国骨质疏松杂志,2012,18(8):744-746.
[11]谭斌,刘雄文,刘刚,等.经皮椎体后凸与经皮椎体成形术修复骨质疏松椎体压缩性骨折:随机分组比较[J].中国组织工程研究,2016,20(4):539-543.
[12]曾伟权.补肾活血中药联合PVP对老年骨质疏松性椎体压缩性骨折的治疗分析[J].中医临床研究,2016,8(31):57-58.
[13]孔令成,施振宇,姚建亮,等.强骨饮治疗骨质疏松性椎体压缩性骨折的临床研究[J].中国骨质疏松杂志,2016,22(9):1159-1163.
[14]张艳,刘波,朱凯,等.中西医结合治疗骨质疏松性椎体压缩性骨折临床观察[J].长春中医药大学学报,2010,26(5):729-730.
[15]柴仪,李倩,田伟明,等.自拟补肾活血方对压缩性骨折椎体成形术术后骨密度与功能的影响[J].中国药业,2015,24(3):14-16.