中医分期辨证论治骨质疏松压缩骨折椎体成形术患者的临床观察  

Application of Traditional Chinese Mledicine SyndromeI Differentiation by Stages Treatment in Patients with Osteoporotic Vertebral Compression Fractures Post Per-cutaneous Vertebroplasty

作　　者：夏尚君 郭际 金浪 张建坡 褚立希[2] 黄正 XIA Shang-jun;GUO Ji;JIN lang;ZHANG Jian-po;CHU Li-xi;HUANG Zheng(Department of Spinal Surgery,Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai 200052;Shanghai University of Traditional Chinese Medicine,Shanghai 201203)

机构地区：[1]上海中医药大学附属光华医院脊柱外科,上海200052 [2]上海中医药大学,上海201203

出　　处：《世界中西医结合杂志》2024年第7期1403-1408,共6页World Journal of Integrated Traditional and Western Medicine

基　　金：上海市科学技术委员会科研计划项目(20Y21903200)。

摘　　要：目的探讨分期辨证施治对骨质疏松压缩骨折(Osteoporotic vertebral compression fracture,OVCF)椎体成形术(Percutaneous vertebro plasty,PVP)后患者骨折愈合进程及骨愈合因子水平的影响。方法选取2021年1月-2022年6月期间上海市光华中西医结合医院收治的78例OVCF患者,依据简单随机数字表法分为对照组和研究组,每组各39例。两组患者均接受PVP手术治疗,术后给予对照组常规干预,研究组在对照组基础上采取中医分期辨证施治,持续治疗1个月。观察比较两组患者骨折愈合情况(骨折愈合效果、骨折愈合时间)、疼痛程度[视觉模拟评分法(Visual analogue scale,VAS)]与腰椎功能[Oswestry功能障碍指数(Oswestry disability index,ODI)]、骨愈合因子[成纤维细胞生长因子-2(Fibroblast growth factor-2,FGF-2)、转化生长因子-β1(Transforming growth factor-β1,TGF-β1)、特异性碱性磷酸酶(Alkaline phosphatase,ALP)、胰岛素样生长因子-1(Insulin-like growth factor 1,IGF-1)、骨形态发生蛋白-2(Bone morphogenetic protein-2,BMP-2)]水平、血液流变学状态(血浆黏度、红细胞聚集指数、全血低切黏度、全血高切黏度)及不良反应情况。结果治疗后研究组骨折愈合优秀率71.79%(28/39)明显高于对照组46.15%(18/39),骨折愈合时间明显短于对照组,差异有统计学意义(P<0.05)。术后1 d、1个月,两组患者VAS、ODI评分均较术前降低,差异有统计学意义(P<0.05);且研究组VAS、ODI评分均明显低于对照组,差异有统计学意义(P<0.05)。术后1周、1个月,两组患者血清FGF-2、TGF-β1、ALP、IGF-1、BMP-2水平均较术前升高,差异有统计学意义(P<0.05);且研究组血清FGF-2、TGF-β1、ALP、IGF-1、BMP-2水平均明显高于对照组,差异有统计学意义(P<0.05)。术后1周、1个月,两组患者血浆黏度、红细胞聚集指数、全血低切黏度、全血高切黏度均较术前降低,差异有统计学意义(P<0.05);且研究组血浆黏度、红细胞聚集Objective To investigate the effect of Traditional Chinese Medicine(TCM)syndrome differentiation by stages treatment on the fracture healing process and bone healing factors levels in patients with osteoporotic vertebral compression fracture(OVCF)post percutaneous vertebroplasty(PVP).Methods From January 2021 to June 2022,78 patients with OVCF admitted to Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine were selected and divided into a control group(n=39)and a study group(n=39)based on the simple random table method.Both groups received PVP surgery,and the control group received routine postoperative intervention.The study group additionally received TCM syndrome differentiation by stages treatment for one month.The fracture healing conditions(fracture healing effect,fracture healing time),pain degree[visual analogue scale(VAS)],lumbar function[oswestry disability index(ODI)],and bone healing factor[fibroblast growth factor-2(FGF-2),transforming growth factor-β1(TGF-β1),alkaline phosphatase(ALP),insulin-like growth factor 1(IGF-1),bone morphogenetic protein-2(BMP-2)]levels,hemorheological status(plasma viscosity,erythrocyte aggregation index,whole blood low shear viscosity,whole blood high shear viscosity),and adverse reactions were observed and compared between the two groups.Results After treatment,the excellent rate of fracture healing in the study group was 71.79%(28/39),significantly higher than 46.15%(18/39)in the control group,and the healing time in the study group was significantly shorter than the control group,with a statistically significant difference(P<0.05).On the first day and one month post-surgery,VAS and ODI scores in both groups were significantly lower than preoperative scores,with a statistically significant difference(P<0.05);the study group showed significantly lower VAS and ODI scores than the control group,with a statistically significant difference(P<0.05).At one week and one month post-surgery,serum levels of FGF-2,TGF-β1,ALP,IGF-1,and BMP-2 in both

关 键 词：中医分期辨证施治 骨质疏松椎体压缩骨折 椎体成形术 骨折愈合进程 骨愈合因子 

分 类 号：R683[医药卫生—骨科学]