补肾活血汤联合经皮椎体成形术治疗骨质疏松性胸腰椎压缩骨折的疗效分析

摘要

目的 探讨补肾活血汤联合经皮椎体成形术治疗骨质疏松性胸腰椎压缩骨折(osteoporotic thoracolumbar compression fracture,OTCF)的疗效及对患者血清骨保护素(osteoprotegerin,OPG)和核因子κB受体活化因子配体(receptor activator of nuclear factor kappa-Β ligand,RANKL)含量的影响.方法 本研究共筛选OTCF患者92例,按数字表法随机分为对照组和治疗组,每组均46例.对照组予经皮椎体成形术.在对照组基础上治疗组予补肾活血汤干预,每天1剂,每日两次.比较两组治疗前后腰背痛Oswestry功能障碍指数、疼痛VAS评分及腰椎正位(L2~L4)和右股骨颈的骨密度(bone density determination,BMD).根据中国人骨质疏松症生存质量简明量表(Chinese osteoporosis quality of life short-form questionnaire,COQOL)评定两组治疗前后生存质量积分.检测两组血清中OPG和RANKL水平.结果 与对照组相比,治疗组治疗后Oswestry功能障碍指数和VAS评分减少更显著,腰椎正位(L2~L4)和右股骨颈的 BMD 水平升高更明显(P ＜0.01).治疗后,治疗组患者的COQOL积分显著少于对照组(P＜0.01).与对照组相比,治疗组患者血清OPG含量显著高于对照组,而RANKL明显低于对照组(P＜0.01).结论 补肾活血汤联合经皮椎体成形术治疗OTCF疗效显著,调节患者体内OPG和RANKL含量可能是其疗效途径之一.%Objective To investigate the efficacy of Bushenhuoxue decoction combined with percutaneous vertebroplasty in treating osteoporotic thoracolumbar compression fracture(OTCF),and its effect on serum levels of osteoprotegerin(OPG)and receptor activator of nuclear factor kappa-Β ligand(RANKL).Methods 92 cases with OTCF were chosen and randomly divided into control group(46 cases)and treatment group(46 cases)using random number table.Cases of control group were given percutaneous vertebroplasty.Cases in the treatment group were additionally treated with Bushenhuoxue decoction(1 dose/d and bid).Scores of oswestry disability index and VAS and bone mineral density(BMD)of L2-L4and right femoral neck were compared between two groups.Chinese osteoporosis quality of life short-form questionnaire(COQOL)was used to evaluate quality of life.Serum levels of OPG and RANKL were detected in the two groups at pre-and post-treatment.Results After treatment,compared with the control group,the treatment group had significantly greater reduction in scores of oswestry index and VAS,and greater increase in BMD of L2-L4and right femoral neck(P ＜0.01).After treatment,COQOL score of treatment group was significantly decreased compared to control group(P＜0.01).After treatment,serum level of OPG in the treatment group was significantly higher,while RANKL level was significantly lower than that of the control group(P＜0.01).Conclusion Efficacy of Bushenhuoxue decoction combined with percutaneous vertebroplasty is effective in treating OTCF,and one of the mediation pathways could be through the regulation of OPG and RANKL levels.