补阳还五汤加减分期治疗老年骨质疏松椎体骨折的临床疗效及对骨代谢的影响  

Clinical efficacy of the Buyang Huanwu decoction on senile osteoporotic vertebral body fracture and its effect on bone metabolism

作　　者：徐嘉蔚 孙海岗 张芸 张俊忠[1] 薛景才 XU Jiawei;SUN Haigang;ZHANG Yun;ZHANG Junzhong;XUE Jingcai

机构地区：[1]山东中医药大学,山东济南250012 [2]山东省济南杏林中医医院,山东济南250014 [3]山东中医药大学第二附属医院,山东济南250001

出　　处：《中医临床研究》2024年第21期99-103,共5页Clinical Journal Of Chinese Medicine

基　　金：山东省中医药科技项目(M-2022142);山东中医药大学大学生创新训练计划项目(2023098)。

摘　　要：目的:探讨补阳还五汤加减治疗老年骨质疏松椎体骨折的临床疗效及对骨代谢的影响。方法:50例老年骨质疏松椎体骨折患者纳入研究,均按照标准操作流程予以经皮穿刺椎体成形术治疗。参照中医三期辨证,所有患者随机分为补阳还五汤组和对照组,术前、术后、1周、2周、1个月、3个月进行评价。采用视觉模拟评分法(Visual Analogue Scale,VAS)及Oswestry功能障碍指数问卷表(Oswestry Disability Index,ODI)评价临床疗效,采用血清中I型前胶原氨基末端肽(N-terminal Propeptide of TypeⅠProcollagen Protein,PINP)、β-异构化I型胶原氨基末端肽(β-C-Terminal Cross-Linking Telopeptide of TypeⅠCollagen,β-CTX)、骨钙素(Osteocalcin,OST)、25-羟基维生素D(25OHD)及血清碱性磷酸酶(Alkaline Phosphatase,ALP)监测骨代谢标志物水平。结果:所有患者VAS评分及ODI评分均较术前显著降低(P<0.001),补阳还五汤组明显优于对照组,差异有统计学意义(P<0.05)。与对照组相比,补阳还五汤组骨转换生化标志物(Bone Turnover Markers,BTMs)的血清浓度变化更加明显,差异有统计学意义(P<0.05),但每种BTMs的峰值区间和范围各不相同。其中反映骨形成能力的指标PINP、OST、ALP均于术后1个月达到峰值,组间比较术后1个月、3个月差异有统计学意义(P<0.01,P<0.05)。而反应骨吸收破坏能力的指标β-CTX于术后2周达到峰值,组间比较术后2周、1个月、3个月差异亦有统计学意义(P<0.01,P<0.05,P<0.05)。25OHD则呈持续下降趋势,组间比较术后1个月、3个月差异有统计学意义(P<0.01,P<0.05)。结论:联合补阳还五汤加减治疗老年性骨质疏松椎体骨折临床疗效确切,可明显改善患者骨代谢标志物水平。Objective:To investigate the clinical effect of the Buyang Huanwu decoction(补阳还五汤)on senile osteoporotic vertebral body fracture and bone metabolism.Methods:Fifty elderly patients with osteoporotic vertebral fractures were included in the study,all of whom were treated by percutaneous vertebroplasty according to standard operating procedures.According to the three-stage syndrome differentiation of TCM,all patients were randomly divided into the Buyang Huanwu decoction group and the control group,and evaluated before treatment and 1 week,2 weeks,1 month and 3 months after treatment.the VAS score and ODI score were used to evaluate the clinical efficacy.Serum amino terminal peptide of type I procollagen(PINP),β-isomerized amino terminal peptide of type I collagen(β-CTX),osteocalcin(OST),25-hydroxyvitamin D(25OHD)and serum alkaline phosphatase(ALP)were used to monitor bone metabolism markers.Results:VAS and ODI scores of all patients were significantly lower than those before surgery(P<0.001),Buyang Huanwu decoction group was significantly better than the control group,the difference was statistically significant(P<0.05).Compared with that of the control group,the serum concentration of BTMs in the Buyang Huanwu decoction group was significantly changed(P<0.05),but the peak interval and range of each BTMs were different.Among them,PINP,OST and ALP,which reflected bone formation ability,all reached their peak values 1 month after surgery,and there was statistical significance between groups 1 month and 3 months after surgery(P<0.01,P<0.05).The index ofβ-CTX,which reflected the damage ability of bone resorption,reached its peak value 2 weeks after surgery,and the difference between groups was statistically significant 2 weeks,1 month and 3 months after surgery(P<0.01,P<0.05,P<0.05).25OHD showed a continuous decreasing trend,and the difference between groups was statistically significant 1 month and 3 months after operation(P<0.01,P<0.05).Conclusion:The combination of the Buyang Huanwu ddecoction has defin

关 键 词：骨质疏松椎体压缩骨折 补阳还五汤 骨代谢标志物 

分 类 号：R683[医药卫生—骨科学]