壮骨强筋片对骨质疏松患者腰椎融合术后骨融合的影响

发布时间：2019-02-16 20:11

【摘要】：目的:研究壮骨强筋片对骨质疏松(Oeteoporosis,OP)患者腰椎融合术后骨转换标记物(Bone Turnover Markers,BTMs)水平、症状缓解、融合率的影响情况,评价壮骨强筋片对OP患者腰椎融合术后骨融合的疗效。方法:本研究拟设病例总数80例,所选病例均来源于2015年3月-2016年3月在东莞市中医院骨三科住院患者,均施行后路腰椎椎间融合术(Posterior Lumbar Interbody Fusion,PLIF),把80名患者随机分配到对照组和中药组,对照组则予基础钙剂治疗,中药组予基础治疗加壮骨强筋片。按照纳入标准、排除标准,将合格病例按照随机数字表分配到对照组和中药组,各40例。其中对照组术后开始口服钙剂治疗;中药组则在对照组的治疗上,加服东莞中医院院内制剂壮骨强筋片。结果:(1)两组患者的基本情况包括年龄、性别、体重指数、骨密度值、手术节段比较差异均无统计学意义(P0.05),具有可比性。2组病例术后均随访半年,对照组1例患者术后6个月复查CT可疑终板塌陷、融合器下沉,其他均无出现螺钉松动、钉棒断裂、终板塌陷、融合器下沉等不良情况。(2)在骨转换标志物PINP水平方面,在术前、术后3个月及术后6个月三个时间点的组间和组内的比较,差异均无统计学意义(P0.05)。在骨吸收标志物β-CTX水平方面,中药组的总体均值低于对照组,差异有统计学意义(P0.05);比较对照组三个时间段上β-CTX水平,差异均无统计学意义(P0.05)。中药组术后6个月的β-CTX水平均低于其术前及术后3个月,统计学差异性显著(P0.01,P0.05);术后3个月与术前比较,差异无统计学意义(P0.05)。(3)分别比较两组间术前、术后1周、术后3个月、术后6个月JOA评分差异,差异均无统计学意义(P0.05);比较两组组内的术前术后JOA评分差异,结果显示两组组内术后1周均比术前评分高(P0.01),术后3个月、术后6个月评分均比术后1周要高,差异均有统计学意义(P0.05);两组术后3个月与术后6个月相比均无统计学差异(P0.05)。(4)比较两组组内术后3个月、术后6个月改良Brantigan评分,两组术后6个月高于术后3个月,差异有统计学意义(P0.01);比较两组术后3个月时评分,差异无统计学意义(P0.05);比较两组术后6个月时评分,中药组高于对照组,差异有统计学意义(P0.05)。(5)在融合率方面,中药组在术后3个月及6个月时的椎间融合率为27.9%和65.9%,均高于对照组9.3%和44.2%,其差异有统计学意义(P0.05);两组病例术后6个月的椎间融合率均高于其术后3个月时在椎间融合率,且差异有统计学意义(P0.05)。结论:壮骨强筋片可降低β-CTX水平、调节骨代谢,并提高骨质疏松患者腰椎融合术后骨融合率,缩短融合时间,故可认为壮骨强筋片能为优化骨质疏松患者行腰椎融合术后骨融合的治疗方案提供选择。
[Abstract]:Objective: to study the effect of Zhuang Gu Qiang Jin tablet on the level of bone conversion marker (Bone Turnover Markers,BTMs), symptom relief and fusion rate after lumbar fusion in patients with osteoporosis (Oeteoporosis,OP). To evaluate the effect of Zhuanggu Qiangjin tablet on bone fusion after lumbar fusion in patients with OP. Methods: the total number of patients in this study was 80. All the patients were selected from March 2015 to March 2016 in Department of Bone of Dongguan Hospital of traditional Chinese Medicine. All patients were treated with posterior lumbar interbody fusion (Posterior Lumbar Interbody Fusion,PLIF). 80 patients were randomly assigned to the control group and the Chinese medicine group, the control group was treated with basic calcium, and the traditional Chinese medicine group was given basic treatment plus Zhuanggu Qiangjin tablet. According to the inclusion criteria and exclusion criteria, the eligible cases were assigned to the control group and the traditional Chinese medicine group according to the random digital table, 40 cases each. The control group began to take oral calcium after operation, while the traditional Chinese medicine group took Dongguan Chinese medicine hospital preparation Zhuanggu Qiangjin tablet on the treatment of the control group. Results: (1) there were no significant differences in age, sex, body mass index, bone mineral density and operative segment between the two groups (P0.05). In the control group, 6 months after operation, the suspected end-plate collapse of CT and the sinking of the fusion cage were examined. There were no complications such as screw loosening, screw rod breaking, end-plate collapse, and fusion cage sinking. (2) the level of bone conversion marker PINP was not found in the control group. There was no significant difference between the three time points before operation, 3 months after operation and 6 months after operation (P0.05). In the bone resorption marker 尾-CTX level, the total mean value of the Chinese medicine group was lower than the control group, the difference was statistically significant (P0.05); compared with the control group three time period 尾-CTX level, the difference was not statistically significant (P0.05). The levels of 尾-CTX in the Chinese medicine group 6 months after operation were lower than those before and 3 months after operation, the statistical difference was significant (P 0.05). There was no significant difference in JOA scores between the two groups 3 months after operation (P0.05). (3), 1 week after operation, 3 months after operation and 6 months after operation (P0.05). The difference of preoperative and postoperative JOA scores between the two groups was compared. The results showed that the scores in the first week after operation in both groups were higher than those in the preoperative group (P0.01), and the scores in 3 months and 6 months after operation were higher than those in the first week after operation. The difference was statistically significant (P0.05). There was no significant difference between the two groups in 3 months after operation and 6 months after operation (P0.05). (4). The modified Brantigan score was higher in the two groups at the 6th month than in the third month after operation (P0.05). (4). The difference was statistically significant (P0.01). There was no significant difference between the two groups at 3 months after operation (P0.05). The score of the two groups at 6 months after operation was higher than that of the control group (P0.05). (5). The fusion rate of the Chinese medicine group was 27.9% and 65.9% at the 3rd and 6th month after operation. Compared with the control group (9.3%) and the control group (44.2%), the difference was statistically significant (P0.05). The intervertebral fusion rate of the two groups at 6 months after operation was higher than that at 3 months after operation, and the difference was statistically significant (P0.05). Conclusion: Zhuanggu Qiangjin tablet can reduce 尾-CTX level, regulate bone metabolism, increase bone fusion rate and shorten fusion time after lumbar fusion in patients with osteoporosis. It is suggested that Zhuanggu Qiangjin tablet can be used to optimize the treatment of bone fusion after lumbar fusion in patients with osteoporosis.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R274.9

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