發(fā)布時(shí)間：2019-02-16 20:11

【摘要】：目的:研究壯骨強(qiáng)筋片對(duì)骨質(zhì)疏松(Oeteoporosis,OP)患者腰椎融合術(shù)后骨轉(zhuǎn)換標(biāo)記物(Bone Turnover Markers,BTMs)水平、癥狀緩解、融合率的影響情況,評(píng)價(jià)壯骨強(qiáng)筋片對(duì)OP患者腰椎融合術(shù)后骨融合的療效。方法:本研究擬設(shè)病例總數(shù)80例,所選病例均來源于2015年3月-2016年3月在東莞市中醫(yī)院骨三科住院患者,均施行后路腰椎椎間融合術(shù)(Posterior Lumbar Interbody Fusion,PLIF),把80名患者隨機(jī)分配到對(duì)照組和中藥組,對(duì)照組則予基礎(chǔ)鈣劑治療,中藥組予基礎(chǔ)治療加壯骨強(qiáng)筋片。按照納入標(biāo)準(zhǔn)、排除標(biāo)準(zhǔn),將合格病例按照隨機(jī)數(shù)字表分配到對(duì)照組和中藥組,各40例。其中對(duì)照組術(shù)后開始口服鈣劑治療;中藥組則在對(duì)照組的治療上,加服東莞中醫(yī)院院內(nèi)制劑壯骨強(qiáng)筋片。結(jié)果:(1)兩組患者的基本情況包括年齡、性別、體重指數(shù)、骨密度值、手術(shù)節(jié)段比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。2組病例術(shù)后均隨訪半年,對(duì)照組1例患者術(shù)后6個(gè)月復(fù)查CT可疑終板塌陷、融合器下沉,其他均無出現(xiàn)螺釘松動(dòng)、釘棒斷裂、終板塌陷、融合器下沉等不良情況。(2)在骨轉(zhuǎn)換標(biāo)志物PINP水平方面,在術(shù)前、術(shù)后3個(gè)月及術(shù)后6個(gè)月三個(gè)時(shí)間點(diǎn)的組間和組內(nèi)的比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。在骨吸收標(biāo)志物β-CTX水平方面,中藥組的總體均值低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);比較對(duì)照組三個(gè)時(shí)間段上β-CTX水平,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。中藥組術(shù)后6個(gè)月的β-CTX水平均低于其術(shù)前及術(shù)后3個(gè)月,統(tǒng)計(jì)學(xué)差異性顯著(P0.01,P0.05);術(shù)后3個(gè)月與術(shù)前比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(3)分別比較兩組間術(shù)前、術(shù)后1周、術(shù)后3個(gè)月、術(shù)后6個(gè)月JOA評(píng)分差異,差異均無統(tǒng)計(jì)學(xué)意義(P0.05);比較兩組組內(nèi)的術(shù)前術(shù)后JOA評(píng)分差異,結(jié)果顯示兩組組內(nèi)術(shù)后1周均比術(shù)前評(píng)分高(P0.01),術(shù)后3個(gè)月、術(shù)后6個(gè)月評(píng)分均比術(shù)后1周要高,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);兩組術(shù)后3個(gè)月與術(shù)后6個(gè)月相比均無統(tǒng)計(jì)學(xué)差異(P0.05)。(4)比較兩組組內(nèi)術(shù)后3個(gè)月、術(shù)后6個(gè)月改良Brantigan評(píng)分,兩組術(shù)后6個(gè)月高于術(shù)后3個(gè)月,差異有統(tǒng)計(jì)學(xué)意義(P0.01);比較兩組術(shù)后3個(gè)月時(shí)評(píng)分,差異無統(tǒng)計(jì)學(xué)意義(P0.05);比較兩組術(shù)后6個(gè)月時(shí)評(píng)分,中藥組高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(5)在融合率方面,中藥組在術(shù)后3個(gè)月及6個(gè)月時(shí)的椎間融合率為27.9%和65.9%,均高于對(duì)照組9.3%和44.2%,其差異有統(tǒng)計(jì)學(xué)意義(P0.05);兩組病例術(shù)后6個(gè)月的椎間融合率均高于其術(shù)后3個(gè)月時(shí)在椎間融合率,且差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:壯骨強(qiáng)筋片可降低β-CTX水平、調(diào)節(jié)骨代謝,并提高骨質(zhì)疏松患者腰椎融合術(shù)后骨融合率,縮短融合時(shí)間,故可認(rèn)為壯骨強(qiáng)筋片能為優(yōu)化骨質(zhì)疏松患者行腰椎融合術(shù)后骨融合的治療方案提供選擇。
[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.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R274.9

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