摘要
目的:探讨经皮椎体后凸成形术(PKP)结合颈腰痛Ⅱ号方治疗老年骨质疏松性胸腰椎压缩性骨折的临床疗效。方法:2008年12月——2010年12月老年骨质疏松性椎体压缩性骨折住院患者89例,对纳入病例行中医辨证,选择肾虚血瘀型患者,术前均有腰背部疼痛、局部疼痛如刺、痛处不移、不能持重。采用随机数字表法分成两组,A组46例患者,其中男14例,女32例,年龄60～88岁,平均70.7岁;B组43例患者,其中男12例,女31例,年龄60～88岁,平均70.9岁。所有患者术前均行X线片、CT扫描、MRI检查及相关体格检查,排除其他原因引起的胸腰椎压缩性骨折,无脊髓和神经根受损,椎体后壁完整。A组用PKP并颈腰痛Ⅱ号方治疗,B组用PKP治疗。分别在术前、术后3天、6个月、12个月采用直观疼痛模拟量表(VAS)对患者进行疼痛评价,计算椎体前缘与中部高度丢失百分数,同时测量Cobb's角。所有数据使用SPSS10.0统计软件进行统计分析。结果:所有病例完成PKP手术,A组病例均完成颈腰痛Ⅱ号方治疗。A组和B组术后VAS评分较术前均有显著性差异(P<0.05);两组之间术后第3天、第12个月差异有统计学意义(P<0.05);两组之间术后第6个月差异无统计学意义(P>0.05)。A组和B组术后椎体前缘高度丢失百分数较术前差异均有统计学意义(P<0.05);两组之间术后第3天、第6个月差异无统计学意义(P>0.05);两组之间术后第12个月差异有统计学意义(P<0.05)。A组和B组术后椎体中央高度丢失百分数较术前差异均有统计学意义(P<0.05);两组之间术后第3天、第6个月、第12个月差异均无统计学意义(P>0.05)。A组和B组术后Cobb's角较术前差异均有统计学意义(P<0.05);两组之间术后第3天、第6个月差异无统计学意义(P>0.05);两组之间术后第12个月差异有统计学意义(P<0.05)。两组患者经过1年的随访,两组间的总有效率差异有统计学意义(P<0.05)。结论:PKP治疗老年骨质疏松性胸腰椎压缩性骨折止痛效果显著,可恢复椎体高度及矫正后凸畸形,但随访发现,其保持椎体前缘高度及Cobb's角效果欠佳,而颈腰痛Ⅱ号方可增强PKP的止痛效果,并能减少伤椎高度丢失。
Objective ： To study the effect of Percutaneous kyphoplasty （ PKP ） in combination with the prescription of Jingyaotong II on treating thoracolumbar compressed fractures in aged patients with osteoprosis. Methods： From 2008.12 to 2010.12,89 patients with osteoprosis thoracolumbar compressed fractures in aged were reviewed. The patients had the syndrome of kidney deficiency and blood stasis. All patients had pain of low back, partial ache such as sting and the pain place not moving; all patients couldnot hold to weigh. All patients were randomly divided into two groups. In group A there were 46 cases including 14 males and 32 females, the age was 60-88 years old, with an average age of 70.7 ; in group B there were 43 cases including 12 males and 31 females, the age was 60-88 years old, with an average age of 70.9. All patients went a X-ray slice, CT scanning and MRI and related physical examination before operation. The thoraeolumber compressed fractures were expelled in all patients aroused by other reasons, the spinal cord and nerve roots were damaged, and the posterior walls in vertebral bodies should be integrity. The patients in group A were treated with PKP in combination with the prescription of Jingyaotong II, and the patients in group B with PKP. The treatment efficacy was assessed by observing the percentage change of anterior and middle vertebral height loss, Cobb＇s angle and visual analogue scale （ VAS ） respectively after preoperation and postoperation （ 3 days, 6 months, 12 months ）. All data was statistical ananlyzed by package SPSS10.O. Results ： All cases were completed by PKP, and the cases of A group were completed by prescription of Jingyaotong II. The differences of A group and B group were statistically significant compared preoperati0n with postoperation about VAS score, two groups were statistically significant after 3 days and 12 months, and weren＇t statistically significant after 6 months ; the differences of A group and B group were statistically significant compared preoperation with postoperation about percentage of anterior vertebral height loss, two groups weren＇t statistically significant after 3 days and 6 months, and statistically significant after 12 months; the differences of A group and B group were statistically significant compared preoperation with postoperation about percentage of middle vertebral height loss, two groups were statistically significant after 3 days and 6 months and 12 months ; the differences of A group and B group were statistically significant compared preoperation with postoperation about Cobb＇s angle, two groups weren＇t statistically significant after 3 days and 6 months, that was statistically significant after 12 months. A year After treatment of two groups, the total effective rates of two groups were statistically significant. Conclusion ： PKP can efficently relieve back pain of the wounded, restore the vertebral height and correct the kyphosis in the treatment of thoracolumbar compressed fractures in aged patients with osteoprosis. But long-term follow-up result illustrates that PKP cannot maintain anterior vertebral height and Cobb＇s angle. Prescription of Jingyaotong II can enhance the analgesic effect of PKP, and reduce vertebral height loss.
出处
《辽宁中医药大学学报》
CAS
2012年第10期15-18,共4页
Journal of Liaoning University of Traditional Chinese Medicine
基金
福建省卫生厅中医药临床基地资助项目(ZLcgs03)
关键词
骨质疏松
胸腰椎压缩性骨折
PKP
颈腰痛Ⅱ号方
中药疗法
osteoporosis
thoracolumbar compressed fractures
PKP
prescription of Jingyaotong II
Chinese medicine therapy
