PKP联合针灸治疗原发性骨质疏松性椎体骨折的疗效分析

发布时间：2018-06-08 10:35

本文选题：PKP + 针灸　；参考：《湖北中医药大学》2017年硕士论文

【摘要】：目的:分析研究椎体后凸成形(PKP)术结合传统针灸疗法治疗与单纯行椎体后凸成形术比较治疗原发性骨质疏松性椎体压缩性骨折(OVCF)的疗效分析,探讨在临床上治疗OVCF的最有效治疗方案。方法:收集武汉市第一医院自2014年2月至2015年2月完整治疗处理的OVCF患者,一共72例,所有患者都为单一椎体骨折。患者主要表现为脊柱背部疼痛,翻身、起身等活动受限,咳嗽、打喷嚏症状加重。将所有处理的患者随机进行分组比较,分为两组,治疗组(A组)为PKP结合针灸治疗骨质疏松性椎体压缩性骨折患者,平均年龄(75.08±4.48)岁,对照组(B组)为单纯PKP治疗骨质疏松性椎体压缩性骨折患者,平均年龄(75.03±4.41)岁。其中A组男11例,女性25例,受伤椎体包括包括T71个,T82个,T91个,T103个,T117个,T128个,L17,L23,L32,L42。B组男性9例,女性27例,受伤椎体包括T61个,T72个,T81个,T92个,T103个,T116个,T128个,L17,L21,L32,L43。A组在PKP术后根据患者情况进行针灸治疗。B组不做任何处理。所有患者在术前均完善相关检查,排除手术绝对禁忌症,降低手术风险。术后均予以对症治疗,卧床休息,抗炎抗感染,佩戴腰围,指导功能锻炼,补钙抗骨质疏松治疗。分析对照比较两组患者年龄、性别、受伤椎体分布、VAS评分、ODI指数、Cobb角,比较两组患者在术前、术后3天、术后1个月、术后6个月、术后12个月区别,并对治疗组和对照组进行统计学分析研究。结果:手术及针灸治疗都顺利完成,都获得12个月的随访。A组和B组在性别、年龄、受伤椎体、Cobb角,术前VAS评分、ODI指数等方面比较,无统计学差异(P0.05),说明两组在术前基本情况上无明显差异性,两组患者具有可比性。两组在术前与术后Cobb角比较上,差异有统计学意义(P0.05),两组在术后各个时间点上相比,差异无统计学意义(P0.05),说明两组患者PKP手术治疗效果有效,但针灸疗法并不能改善患者Cobb角。在VAS评分及ODI指数的对比上,A组、B组两组患者术后与术前比较,差别有统计学意义(P0.05),在术后1个月到术后6个月的VAS评分上对比,A组明显优于B组,差异有统计学意义(P0.05),而在术后6个月之后的随访收集中,两组之间的VAS评分相比,差别无统计学意义(P0.05),说明针灸疗法在短期内有助于患者缓解疼痛,减少疼痛刺激,也可以帮助患者在短期内进行康复,符合当前快速康复理念;在Oswestry功能障碍指数比较上,术后各个时间点上A组都要优于B组,差别有统计学意义(P0.05),说明PKP结合针灸疗法相比单纯行PKP更能有效减轻患者疼痛,改善患者的生活质量,有助于患者早起康复,减轻家庭负担。结论:PKP结合针灸治疗原发性骨质疏松椎体压缩性骨折效果效明显,能极大减轻患者腰背部疼痛,尤其在早期效果明显,能使患者早期开展功能锻炼,尽早改善患者生活质量,是一种值得推荐的中西结合治疗方法。
[Abstract]:Objective: to study the effect of kyphoplasty combined with traditional acupuncture and moxibustion in the treatment of primary osteoporotic vertebral compression fracture (OVCFF). To explore the most effective treatment for OVCF. Methods: a total of 72 patients with OVCF were collected from February 2014 to February 2015 in the first Hospital of Wuhan. All the patients were single vertebral fracture. The main symptoms of the patients were spinal back pain, turning over, rising and other restricted activities, cough, sneezing symptoms aggravated. All the patients were randomly divided into two groups. The treatment group was treated with PKP combined with acupuncture and moxibustion in the treatment of osteoporotic vertebral compression fracture. The average age was 75.08 卤4.48 years old. Control group B (mean age of 75.03 卤4.41) was treated with PKP alone. In group A, there were 11 males and 25 females. The injured vertebrae included T71, T82, T91, T91, T117, T117, T128, L17, L23, L32, L42.B, 9 males and 27 females. The injured vertebrae included T61, T72, T81, T92, T103, T116, T128, L17, L21, L32, L43.A, which were treated with acupuncture and moxibustion according to the patient's condition after PKP. Group B did not do any treatment. All patients were examined before operation to eliminate the absolute contraindication and reduce the risk of operation. All patients were treated with symptomatic treatment, bed rest, anti-inflammatory and anti-infection, waist circumference, functional exercise, calcium supplement and anti-osteoporosis treatment. Age, sex, VAS score and ODI (Cobb angle) were compared between the two groups before, 3 days after operation, 1 month after operation, 6 months after operation and 12 months after operation. And the treatment group and the control group were statistically analyzed. Results: the operation and acupuncture treatment were successfully completed, and 12 months follow-up was obtained between group A and group B in terms of sex, age, Cobb angle of injured vertebral body, preoperative VAS score and ODI index. There was no statistical difference between the two groups (P 0.05), which indicated that there was no significant difference between the two groups in the basic condition before operation, and the two groups were comparable. The difference between the two groups in preoperative and postoperative Cobb angle was statistically significant (P 0.05). There was no significant difference between the two groups at different time points after operation, which indicated that PKP operation was effective in the two groups, but acupuncture therapy could not improve the Cobb angle. The VAS score and ODI index in group A were significantly higher than those in group B after operation (P 0.05). The VAS scores in group A were significantly better than those in group B from 1 month to 6 months after operation. The difference was statistically significant (P 0.05). In the follow-up collection after 6 months, there was no significant difference in VAS score between the two groups, indicating that acupuncture therapy can help patients with pain relief and pain stimulation in a short period of time. It can also help patients recover in the short term, in line with the current concept of rapid recovery. Group A is better than group B at every time point in the Oswestry disability index. The difference was statistically significant (P 0.05), which indicated that PKP combined with acupuncture and moxibustion therapy could effectively relieve pain, improve the quality of life of patients, help patients recover early and lighten the burden of their families. Conclusion the effect of the treatment of vertebral compression fracture with 10% PKP combined with acupuncture and moxibustion is obvious, which can greatly reduce the pain in the back and waist of the patients, especially in the early stage. It can make the patients develop functional exercise early and improve the quality of life of the patients as early as possible. It is a recommended combination of Chinese and Western treatment.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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