| 摘要: |
| 目的：评价复元活血汤配合脏腑点穴治疗骨质疏松性胸腰椎压缩骨折（osteoporotic vertebral compression fracture， OVCF）的临床研究，并探讨治疗机理及血清 CRP、TNF-α 水平变化对病情的影响。方法：将纳入标准的 OVCF 患者 114 例。采用随机数字表法分为手法组和对照组各 57 例。在治疗过程中因各种原因不能坚持治疗者，治疗组 2 例退出，对照组 5 例退出，最后完成试验的病例数为 107 例（手法组 55 例，对照组 52 例，脱落率为6.14%），手法组给予复元活血汤加减 + 脏腑点穴；对照组给予常规腹部按摩手法 + 仙灵骨葆片，2 周为 1 疗程，共治疗 2 疗程。分别对两组治疗前、治疗 2 疗程后、随访半年后 VAS 评分、椎体前缘高度及后凸角变化、血清 CRP、TNF-α 检测和两组平均肿痛消失时间、平均腹胀消失时间进行对比分析。结果：手法组和对照组治疗 2 疗程后、随访半年后 VAS 评分与治疗前比较，差异均有统计学意义，P=0.000<0.01 ；手法 VAS 评分治疗 2 疗程后 [(3.04±1.02) vs (4.26±1.03)，t ＝ –2.531]、随访半年后 [(0.92±0.25)vs (2.55±0.37)，t ＝ –2.862] 均低于对照组（P<0.05）；手法组和对照组治疗 2 疗程后、随访半年后椎体前缘高度、后凸角变化与治疗前比较，差异均有统计学意义，P=0.000<0.01 ；手法组治疗 2 疗程后椎体前缘高度、后凸角变化与对照组比较，差异无统计学意义（P>0.05）；随访半年后椎体前缘高度手法组 [(1.57±0.13) mm vs (1.13±0.12) mm，t ＝ –2.993]、后凸角变化 [(4.35±1.02)° vs (6.63±1.28)°，t ＝ –3.586] 均高于对照组（P<0.05）；手法组平均肿痛消失时间 [(7.33±2.42)d vs (11.28±5.69) d，t ＝ –3.884]、平均腹胀消失时间 [(2.67±1.73) d vs (5.31±2.02) d，t ＝ –3.142] 均低于对照组，差异有统计学意义（P<0.05）；手法组和对照组治疗 2 疗程后、随访半年后 CRP、TNF-α 水平与治疗前比较，差异均有统计学意义（P<0.05）；治疗 2 疗程后、随访半年后手法组 CRP、TNF-α 水平与对照组比较，差异有统计学意义（P<0.05）； 结论：复元活血汤配合脏腑点穴治疗 OVCF 安全性高、临床疗效满意，患者依从性高，能够降低血清 CRP 及 TNF-α炎性因子水平。 |
| 关键词: 骨质疏松性胸腰椎压缩骨折 复元活血汤 脏腑点穴 临床研究 CRP TNF-α |
| DOI：10.3969/j.issn.1007-6948.2019.05.015 |
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| 基金项目:陕西省中医管理局中医药科研课题（15-LC064） |
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| Clinical Study on Fuyuan Huoxue Decoction Combined with Visceral Acupoint Massage in Treatment of Osteoporotic Vertebral Compression Fracture |
| LIU Bo,SU Xiao-qiang,WANG Xiang-yang,HU Xing-lv,GUAN Hai-ying,JIANG Chun-feng,WANG Jing-bo |
| Department of Spinal Surgery, Xi' an Traditional Chinese Medicine Hospital, Xi' an (710000), China |
| Abstract: |
| Objective To evaluate the clinical study of Fuyuan Huoxue Decoction (FHD) combined with visceral acupoint massage in treatment of osteoporotic vertebral compression fracture (OVCF), furthermore, to discuss the therapeutic mechanism of the disease and the effect of serum CRP and TNF-α on the condition. Methods The patients with OVCF ( 114 cases) that accorded with the inclusion criteria were selected randomly and divided into treatment group and control group (n=57). For various reasons in the process of treatment, 2 cases quit in treatment group, 5 cases quit in control group, and 107 cases ?nally completed the test (55 cases in treatment group, 52 cases in control group, loss rate of 6.14%). The patients in treatment group were given FHD combined with visceral acupoint massage, the patients in control group were given general abdominalmassage combined with Xianling Gubao Tablets, 2weeks for a course and 2 courses of treatment. The VAS score, anterior vertebral height and kyphosis angle, serum CRP, TNF-α levels and the averagetime of pain disappearance and abdominal distension disappearance were compared between the two groups before treatment, after 2 courses of treatment and half a year of follow-up. Results After 2 courses, VAS score after six months of follow-up was compared with that before treatment, and the difference was statistically signi?cant, P=0.000<0.01; the VAS score in treatment group after two courses of treatment was [(3.04±1.02)vs ( 4 . 26± 1 . 03), t = – 2 . 531], and that after six months follow-up was [( 0 . 92± 0.25) vs (2.55 ± 0 . 37), t =–2.862], which was lower than the control group (P<0.05). The changes of anterior vertebral height and kyphosis angle in treatment and control groups after 2 courses of treatment and 6 months of follow-up were signi?cantly different from those before treatment (P = 0 . 000< 0 . 01). There was no significant difference in the changes of anterior vertebral height and kyphosis angle between the two groups after 2 courses (P>0.05). After 6 months of follow-up, the changes of anterior vertebral height in treatment group [(1.57±0.13) mm vs (1.13±0.12) mm, t=–2.993] and posterior convex angle changes [(4.35±1.02)? vs (6.63±1.28)?，t=–3.586] were higher than control group; the average time of pain disappearance in manipulation group[(7.33±2.42) d vs (11.28±5.69) d，t =–3.884], and the average time of abdominal distension disappearance [(2.67±1.73) d vs (5.31±2.02) d， t=–3.142] were lower than that of the control group (P < 0.05). The levels of CRP and TNF-α in the treatment and control groups after 2 courses of treatment and 6 months of follow-up were signi?cantly different from those before treatment (P <0.05).Conclusion FHD combined with visceral acupoint massage to treat OVCF have higher safety, satisfactory clinical ef?cacy, high compliance with patients, and can reduce the levels of serum CRP and TNF-α in?ammatory factors. |
| Key words: Osteoporotic vertebral compression fracture Fuyuan Huoxue Decoction visceral acupoint massage clinical study CRP TNF-α |
