基于BMP-2/BMP-7机制探讨生龙接骨胶囊预防老年骨质疏松性胸腰椎骨折术后再发性骨折的作用  

Exploring the effect of Shenglong Jiegu Capsules on preventing postoperative recurrent fractures in elderly patients with osteoporotic thoracolumbar fractures based on the BMP-2/BMP-7 mechanism

作　　者：邓平征[1] 周龙殿 张斌[3] 胡和军[1] 邓雄伟[4] 徐南云[1] 江共涛[5] DENG Pingzheng;ZHOU Longdian;ZHANG Bin;HU Hejun;DENG Xiongwei;XU Nanyun;JIANG Gongtao(Third Department of Trauma,Nanchang Hongdu Hospital of TCM,Jiangxi Province,Nanchang 330013,China;Third Department of Spinal Surgery,Nanchang Hongdu Hospital of TCM,Jiangxi Province,Nanchang 330013,China;Department of Osteoporosis,Nanchang Hongdu Hospital of TCM,Jiangxi Province,Nanchang 330013,China;Second Department of Foot and Ankle Surgery,Nanchang Hongdu Hospital of TCM,Jiangxi Province,Nanchang 330013,China;First Department of Foot and Ankle Surgery,Nanchang Hongdu Hospital of TCM,Jiangxi Province,Nanchang 330013,China)

机构地区：[1]南昌市洪都中医院创伤三科,江西南昌330013 [2]南昌市洪都中医院脊柱外三科,江西南昌330013 [3]南昌市洪都中医院骨质疏松科,江西南昌330013 [4]南昌市洪都中医院足踝外二科,江西南昌330013 [5]南昌市洪都中医院足踝外一科,江西南昌330013

出　　处：《中国当代医药》2024年第12期4-8,共5页China Modern Medicine

基　　金：江西省中医药管理局科技计划项目(2023B0183)。

摘　　要：目的探讨生龙接骨胶囊对老年骨质疏松性胸腰椎骨折(OTF)术后再发性骨折的作用,并基于骨形态发生蛋白-2/骨形态发生蛋白-7(BMP-2/BMP-7)机制初步分析其作用机制。方法选取2020年1月至2022年10月在南昌市洪都中医院收治的100例行经皮椎体成形术(PVP)的老年OTF患者为研究对象,按随机数字表法分为常规组(50例)和胶囊组(50例)。常规组采用常规的PVP治疗,胶囊组患者在常规组基础上服用生龙接骨胶囊治疗。比较两组患者椎体结构(Cobb角和伤椎椎体前缘高度比)、治疗前后血清BMP-2、BMP-7水平、骨代谢指标[骨特异性碱性磷酸酶(BALP)、Ⅰ型原胶原N端前肽(PⅠNP)、骨钙素(OST)]、骨密度(BMD)、康复情况[Oswestry腰椎功能障碍指数(ODI)]评估、疼痛等级[视觉模拟评分法(VAS)]评分、临床有效率、椎体再骨折发生率和不良反应发生情况。结果治疗后,两组患者Cobb角改善,伤椎椎体前缘高度比优于治疗前,胶囊组均优于常规组,差异有统计学意义(P<0.05);胶囊组的BMP-2、BMP-7表达量高于常规组,差异有统计学意义(P<0.05);患者术后再发性骨折情况均良好,胶囊组愈合速度快于常规组,差异有统计学意义(P<0.05);治疗后,胶囊组的BALP、PⅠNP、OST均高于常规组,差异有统计学意义(P<0.05);两组患者的BMD高于治疗前,且胶囊组高于常规组,ODI评分、VAS评分均低于治疗前,且胶囊组低于常规组,差异有统计学意义(P<0.05);胶囊组的临床总有效率(95.0%)高于常规组(80.0%),胶囊组的再骨折发生率(4%)低于常规组(18%),差异有统计学意义(P<0.05);两组患者均未见明显不良反应。结论生龙接骨胶囊能通过上调患者血清BMP-2、BMP-7水平,改善BMD从而预防老年OTF的术后再发性骨折,其机制可能与生龙接骨胶囊能刺激BMP信号通路,加速成骨细胞分化有关。Objective To explore the effect of Shenglong Jiegu Capsules on postoperative recurrent fractures in elderly patients with osteoporotic thoracolumbar fractures(OTF),and to preliminarily analyze its mechanism of action based on the mechanism of bone morphogenetic protein 2/bone morphogenetic protein 7(BMP-2/BMP-7).Methods A total of 100 elderly OTF patients undergoing percutaneous vertebraplasty(PVP)in Nanchang Hongdu Hospital of TCM from January 2020 to October 2022 were selected as the study objects,and were divided into conventional group(50 cases)and capsule group(50 cases)according to random number table method.The conventional group was treated with conventional PVP,and patients in the capsule group were treated with Shenglong Jiegu Capsules on the basis of the conventional group.The vertebral structure(Cobb angle and anterior margin height ratio),serum BMP-2,BMP-7 levels before and after treatment,bone metabolism indicators(bone specific alkaline phosphatase[BALP],type I procollagen N-terminal peptide[PⅠNP],osteocalcin[OST]),bone mineral density(BMD),rehabilitation status(Oswestry lumbar dysfunction index[ODI])evaluation,Pain rating(visual analogue scale[VAS])score,clinical efficacy rate between,incidence of vertebral refractures and adverse reactions of two groups were compared.Results After treatment,the Cobb Angle of the two groups was improved,the height ratio of the anterior margin of the injured vertebra was better than that before treatment,and the capsule group was better than the conventional group,with statistical significances(P<0.05).The expression levels of BMP-2 and BMP-7 in the capsule group were higher than those in the conventional group,with statistical significances(P<0.05).All patients had good recurrence of fracture after operation,and the healing speed of capsule group was faster than that of conventional group,with statistical significances(P<0.05).After treatment,BALP,PⅠNP and OST in capsule group were higher than those in conventional group,with statistical significances(P<0.05).

关 键 词：骨折 生龙接骨胶囊 骨形态发生蛋白-2 骨形态发生蛋白-7 术后再发性骨折 

分 类 号：R687.3[医药卫生—骨科学]