PKP結(jié)合針灸治療骨質(zhì)疏松性椎體壓縮性骨折的臨床研究
發(fā)布時(shí)間：2018-07-17 08:08
【摘要】：目的:比較PKP與PKP結(jié)合針灸治療骨質(zhì)疏松性椎體壓縮性骨折(OVCF)的療效差異,以探討PKP結(jié)合針灸治療的優(yōu)越性,為選擇最合適的OVCF治療方案提供理論依據(jù)。方法:收集自2013年3月到2014年10月湖北省中醫(yī)院骨傷科收治的OVCF患者62例。其中男性17例,女性45例。年齡63歲~85歲,平均74歲。損傷椎體主要集中在T11~L4,其中T11 7例,T12 24例,L1 20例,L2 8例,L3 1例,L4 2例。綜合患者的病情和自身的訴求分為兩組:①對(duì)照組32例:PKP手術(shù)組。②治療組30例:PKP手術(shù)配合針灸治療組。治療組在PKP術(shù)后按照術(shù)后早期,中期,后期時(shí)間的不同選擇不同的穴位進(jìn)行針灸治療。完善相關(guān)的術(shù)前檢查,評(píng)估手術(shù)的風(fēng)險(xiǎn),兩組手術(shù)均由同一組術(shù)者完成。兩組均給予術(shù)后常規(guī)處理,抗骨質(zhì)疏松治療及相關(guān)康復(fù)指導(dǎo)。術(shù)后3天,1、3及6個(gè)月隨訪。視覺模擬量表(VAS)評(píng)分被用來評(píng)估腰背部痛,ODI指數(shù)被用作評(píng)估恢復(fù)情況,健康調(diào)查簡表(SF-36)被用來評(píng)估生活質(zhì)量。最后分別從VAS評(píng)分,ODI指數(shù),SF-36得分,骨密度,骨水泥推注量,cobb角及椎體前緣丟失率等7個(gè)方面進(jìn)行療效差異性的比較,對(duì)對(duì)照組和治療組進(jìn)行統(tǒng)計(jì)學(xué)分析,分析PKP結(jié)合針灸治療OVCF的優(yōu)越性。結(jié)果:對(duì)照組和治療組在性別、年齡、受傷椎體分布、術(shù)前VAS評(píng)分,術(shù)前ODI指數(shù),術(shù)前骨密度及椎體前緣丟失率,cobb角等方面,統(tǒng)計(jì)學(xué)上無明顯差異(P0.05),具有可比性。對(duì)照組及治療組在術(shù)后3天的VAS評(píng)分和術(shù)后1月的ODI指數(shù)與術(shù)前比較,均明顯降低,說明了PKP手術(shù)的止痛效果和功能障礙改善情況上快速且顯著,術(shù)后1個(gè)月的VAS評(píng)分和ODI指數(shù)兩組間比較無明顯差異,術(shù)后3個(gè)月和6月治療組的VAS評(píng)分低于對(duì)照組,SF-36量表在生理功能、疼痛、健康自評(píng)、活力、社會(huì)功能等5個(gè)維度得分均高于對(duì)照組,可能提示針灸聯(lián)合PKP手術(shù)在患者遠(yuǎn)期的疼痛管理及生活質(zhì)量上有積極的作用。PKP術(shù)后3月兩組的骨密度較術(shù)前均無明顯變化,提示兩組短期內(nèi)未能在骨質(zhì)疏松原發(fā)癥上有效治療,直到術(shù)后6月,兩組才出現(xiàn)骨密度的有效提升,這可能與長期口服抗骨質(zhì)疏松藥物有關(guān),并且術(shù)后6個(gè)月,治療組骨密度T值比對(duì)照組骨密度T值減小,且減小有統(tǒng)計(jì)學(xué)意義,提示針灸治療聯(lián)合PKP對(duì)骨質(zhì)疏松癥遠(yuǎn)期療效優(yōu)于行PKP手術(shù)。PKP術(shù)后1,3及6個(gè)月,兩組的cobb角及椎體前緣丟失率與術(shù)前比較均顯著下降,但組間無明顯差異。且隨著術(shù)后時(shí)間的推進(jìn)這兩個(gè)值會(huì)有一定程度的反彈,提示針灸聯(lián)合PKP治療骨質(zhì)疏松性椎體壓縮性骨折在影像學(xué)改變上意義不大。結(jié)論:PKP手術(shù)可以快速且明顯改善OVCF患者的疼痛狀況及生活質(zhì)量,PKP手術(shù)聯(lián)合針灸治療在患者術(shù)后遠(yuǎn)期的疼痛管理、生活質(zhì)量及對(duì)骨質(zhì)疏松癥的遠(yuǎn)期治療效果均優(yōu)于一般的PKP治療,但對(duì)cobb角及椎體高度丟失率影響不明顯。
[Abstract]:Objective: to compare the therapeutic effects of PKP and PKP combined with acupuncture in the treatment of osteoporotic vertebral compression fracture (OVCF) in order to explore the advantages of PKP combined with acupuncture in order to provide theoretical basis for selecting the most suitable OVCF regimen. Methods: from March 2013 to October 2014, 62 patients with OVCF were treated in Department of Orthopedics and Trauma, Hubei Provincial Hospital of traditional Chinese Medicine. There were 17 males and 45 females. The age was 63 years old to 85 years old, the average was 74 years old. The injured vertebrae were mainly located in T11L 4, of which T117 cases were T12 cases and 24 cases were L1 20 cases L 28 cases and L 31 cases and L 41 cases. The patients were divided into two groups: control group (n = 32), treatment group (n = 2) and treatment group (n = 30). In the treatment group, acupuncture was performed at different points in the early, middle and late period after PKP. Improve the relevant preoperative examination and evaluate the risk of the operation, both groups were performed by the same group. Both groups were given routine postoperative treatment, anti-osteoporosis treatment and related rehabilitation guidance. All patients were followed up for 3 days and 6 months after operation. Visual analogue scale (VAS) scores were used to evaluate the Lumbar and back pain ODI index was used to assess recovery and the Health Survey Summary (SF-36) was used to assess the quality of life. Finally, VAS score and ODI index (SF-36), bone mineral density (BMD), bone cement injection volume (CBB) and the loss rate of the anterior edge of vertebral body were compared respectively. The control group and the treatment group were statistically analyzed. To analyze the advantages of PKP combined with acupuncture in the treatment of OVCF. Results: there were no significant differences in sex, age, distribution of injured vertebral body, preoperative VAS score, preoperative ODI index, preoperative bone mineral density (BMD) and anterior loss rate of vertebral body (cobb angle) between control group and treatment group (P0.05). The VAS score and ODI index of the control group and the treatment group were significantly decreased 3 days after operation and 1 month after the operation, which indicated that the pain relief effect and the improvement of the dysfunction of PKP operation were rapid and remarkable. There was no significant difference in VAS score and ODI index between the two groups at one month after operation. The VAS scores in the treatment group were lower than those in the control group in physiological function, pain, health self-assessment and vitality 3 months and 6 months after operation. The scores of five dimensions of social function were higher than those of the control group, which may suggest that acupuncture combined with PKP has a positive effect on long-term pain management and quality of life. It was suggested that the two groups could not treat the primary osteoporosis effectively in a short period of time. It was not until 6 months after operation that the two groups had an effective increase in bone mineral density, which may be related to long-term oral anti-osteoporosis drugs and 6 months after operation. The T value of bone mineral density in the treatment group was lower than that in the control group, and the decrease was statistically significant. It suggested that the long-term effect of acupuncture and moxibustion combined with PKP on osteoporosis was better than that after PKP operation (1 and 6 months after PKP). The cobb angle and the loss rate of the anterior edge of vertebral body in the two groups were significantly decreased compared with those before operation, but there was no significant difference between the two groups. These two values will rebound to a certain extent with the advance of postoperative time, suggesting that acupuncture combined with PKP in the treatment of osteoporotic vertebral compression fracture has little significance in imaging changes. Conclusion the pain status and quality of life of patients with OVCF can be improved rapidly and obviously by the operation of 1: PKP. The long-term pain management, quality of life and long-term treatment of osteoporosis of patients treated with PKP combined with acupuncture and moxibustion are superior to those of common PKP. However, the loss rate of cobb angle and vertebral height was not significantly affected.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3
[Abstract]:Objective: to compare the therapeutic effects of PKP and PKP combined with acupuncture in the treatment of osteoporotic vertebral compression fracture (OVCF) in order to explore the advantages of PKP combined with acupuncture in order to provide theoretical basis for selecting the most suitable OVCF regimen. Methods: from March 2013 to October 2014, 62 patients with OVCF were treated in Department of Orthopedics and Trauma, Hubei Provincial Hospital of traditional Chinese Medicine. There were 17 males and 45 females. The age was 63 years old to 85 years old, the average was 74 years old. The injured vertebrae were mainly located in T11L 4, of which T117 cases were T12 cases and 24 cases were L1 20 cases L 28 cases and L 31 cases and L 41 cases. The patients were divided into two groups: control group (n = 32), treatment group (n = 2) and treatment group (n = 30). In the treatment group, acupuncture was performed at different points in the early, middle and late period after PKP. Improve the relevant preoperative examination and evaluate the risk of the operation, both groups were performed by the same group. Both groups were given routine postoperative treatment, anti-osteoporosis treatment and related rehabilitation guidance. All patients were followed up for 3 days and 6 months after operation. Visual analogue scale (VAS) scores were used to evaluate the Lumbar and back pain ODI index was used to assess recovery and the Health Survey Summary (SF-36) was used to assess the quality of life. Finally, VAS score and ODI index (SF-36), bone mineral density (BMD), bone cement injection volume (CBB) and the loss rate of the anterior edge of vertebral body were compared respectively. The control group and the treatment group were statistically analyzed. To analyze the advantages of PKP combined with acupuncture in the treatment of OVCF. Results: there were no significant differences in sex, age, distribution of injured vertebral body, preoperative VAS score, preoperative ODI index, preoperative bone mineral density (BMD) and anterior loss rate of vertebral body (cobb angle) between control group and treatment group (P0.05). The VAS score and ODI index of the control group and the treatment group were significantly decreased 3 days after operation and 1 month after the operation, which indicated that the pain relief effect and the improvement of the dysfunction of PKP operation were rapid and remarkable. There was no significant difference in VAS score and ODI index between the two groups at one month after operation. The VAS scores in the treatment group were lower than those in the control group in physiological function, pain, health self-assessment and vitality 3 months and 6 months after operation. The scores of five dimensions of social function were higher than those of the control group, which may suggest that acupuncture combined with PKP has a positive effect on long-term pain management and quality of life. It was suggested that the two groups could not treat the primary osteoporosis effectively in a short period of time. It was not until 6 months after operation that the two groups had an effective increase in bone mineral density, which may be related to long-term oral anti-osteoporosis drugs and 6 months after operation. The T value of bone mineral density in the treatment group was lower than that in the control group, and the decrease was statistically significant. It suggested that the long-term effect of acupuncture and moxibustion combined with PKP on osteoporosis was better than that after PKP operation (1 and 6 months after PKP). The cobb angle and the loss rate of the anterior edge of vertebral body in the two groups were significantly decreased compared with those before operation, but there was no significant difference between the two groups. These two values will rebound to a certain extent with the advance of postoperative time, suggesting that acupuncture combined with PKP in the treatment of osteoporotic vertebral compression fracture has little significance in imaging changes. Conclusion the pain status and quality of life of patients with OVCF can be improved rapidly and obviously by the operation of 1: PKP. The long-term pain management, quality of life and long-term treatment of osteoporosis of patients treated with PKP combined with acupuncture and moxibustion are superior to those of common PKP. However, the loss rate of cobb angle and vertebral height was not significantly affected.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3
【參考文獻(xiàn)】
相關(guān)期刊論文 前9條
1 鞠大宏;李鴻泓;劉紅;王少君;潘靜華;李艷;趙宏艷;于崢;付小衛(wèi);宋長恒;劉梅潔;;補(bǔ)腎健脾方對(duì)大鼠脾腎兩虛型骨質(zhì)疏松癥的治療作用[J];中華中醫(yī)藥雜志;2012年12期
2 林立佳,肖承，
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