PKP结合针灸治疗骨质疏松性椎体压缩性骨折的临床研究
发布时间：2018-07-17 08:08
【摘要】：目的:比较PKP与PKP结合针灸治疗骨质疏松性椎体压缩性骨折(OVCF)的疗效差异,以探讨PKP结合针灸治疗的优越性,为选择最合适的OVCF治疗方案提供理论依据。方法:收集自2013年3月到2014年10月湖北省中医院骨伤科收治的OVCF患者62例。其中男性17例,女性45例。年龄63岁~85岁,平均74岁。损伤椎体主要集中在T11~L4,其中T11 7例,T12 24例,L1 20例,L2 8例,L3 1例,L4 2例。综合患者的病情和自身的诉求分为两组:①对照组32例:PKP手术组。②治疗组30例:PKP手术配合针灸治疗组。治疗组在PKP术后按照术后早期,中期,后期时间的不同选择不同的穴位进行针灸治疗。完善相关的术前检查,评估手术的风险,两组手术均由同一组术者完成。两组均给予术后常规处理,抗骨质疏松治疗及相关康复指导。术后3天,1、3及6个月随访。视觉模拟量表(VAS)评分被用来评估腰背部痛,ODI指数被用作评估恢复情况,健康调查简表(SF-36)被用来评估生活质量。最后分别从VAS评分,ODI指数,SF-36得分,骨密度,骨水泥推注量,cobb角及椎体前缘丢失率等7个方面进行疗效差异性的比较,对对照组和治疗组进行统计学分析,分析PKP结合针灸治疗OVCF的优越性。结果:对照组和治疗组在性别、年龄、受伤椎体分布、术前VAS评分,术前ODI指数,术前骨密度及椎体前缘丢失率,cobb角等方面,统计学上无明显差异(P0.05),具有可比性。对照组及治疗组在术后3天的VAS评分和术后1月的ODI指数与术前比较,均明显降低,说明了PKP手术的止痛效果和功能障碍改善情况上快速且显著,术后1个月的VAS评分和ODI指数两组间比较无明显差异,术后3个月和6月治疗组的VAS评分低于对照组,SF-36量表在生理功能、疼痛、健康自评、活力、社会功能等5个维度得分均高于对照组,可能提示针灸联合PKP手术在患者远期的疼痛管理及生活质量上有积极的作用。PKP术后3月两组的骨密度较术前均无明显变化,提示两组短期内未能在骨质疏松原发症上有效治疗,直到术后6月,两组才出现骨密度的有效提升,这可能与长期口服抗骨质疏松药物有关,并且术后6个月,治疗组骨密度T值比对照组骨密度T值减小,且减小有统计学意义,提示针灸治疗联合PKP对骨质疏松症远期疗效优于行PKP手术。PKP术后1,3及6个月,两组的cobb角及椎体前缘丢失率与术前比较均显著下降,但组间无明显差异。且随着术后时间的推进这两个值会有一定程度的反弹,提示针灸联合PKP治疗骨质疏松性椎体压缩性骨折在影像学改变上意义不大。结论:PKP手术可以快速且明显改善OVCF患者的疼痛状况及生活质量,PKP手术联合针灸治疗在患者术后远期的疼痛管理、生活质量及对骨质疏松症的远期治疗效果均优于一般的PKP治疗,但对cobb角及椎体高度丢失率影响不明显。
[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.
【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】：2015
【分类号】：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.
【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】：2015
【分类号】：R687.3
【参考文献】
相关期刊论文 前9条
1 鞠大宏;李鸿泓;刘红;王少君;潘静华;李艳;赵宏艳;于峥;付小卫;宋长恒;刘梅洁;;补肾健脾方对大鼠脾肾两虚型骨质疏松症的治疗作用[J];中华中医药杂志;2012年12期
2 林立佳,肖承，
本文编号：2129734
本文链接：https://www.wllwen.com/yixuelunwen/waikelunwen/2129734.html
最近更新
教材专著
