84年鼠女哪年财运最旺,857comvvv色九欧美激情|85PO_87国产精品欲av国产av资源

[1]牛強衛(wèi).手法復位聯(lián)合經(jīng)皮椎體成形術和中醫(yī)骨折三期辨證用藥治療骨質(zhì)疏松性胸腰椎壓縮骨折的臨床研究[J].中醫(yī)正骨,2017,29(04):16-22.
　NIU Qiangwei.A clinical study of manipulative reduction combined with percutaneous vertebroplasty and oral application of traditional Chinese medicine according ……[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(04):16-22.
點擊復制

手法復位聯(lián)合經(jīng)皮椎體成形術和中醫(yī)骨折三期辨證用藥治療骨質(zhì)疏松性胸腰椎壓縮骨折的臨床研究()
分享到：

《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期數(shù):
2017年04期
頁碼:
16-22
欄目:
臨床研究
出版日期:
2017-04-20

文章信息/Info

Title:
A clinical study of manipulative reduction combined with percutaneous vertebroplasty and oral application of traditional Chinese medicine according ……
作者:
牛強衛(wèi)
河南宏力醫(yī)院,河南 長垣 453400
Author(s):
NIU Qiangwei
Henan Honliv Hospital,Changyuan 453400,Henan,China
關鍵詞:
骨折; 壓縮性;  骨質(zhì)疏松性骨折;  胸椎;  腰椎;  椎體成形術;  正骨手法;  辨證論治;  臨床試驗
Keywords:
Key words fractures; compression;  osteoporotic fractures;  thoracic vertebrae;  lumbar vertebrae;  vertebroplasty;  bone setting manipulation;  syndrome differ treatment;  clinical
摘要:
目的:探討手法復位聯(lián)合經(jīng)皮椎體成形術(percutaneous vertebm plasty,PVP)和中醫(yī)骨折三期辨證用藥治療骨質(zhì)疏松性胸腰椎壓縮骨折的臨床療效和安全性。方法:將92例骨質(zhì)疏松性胸腰椎壓縮骨折患者隨機分為單純PVP組和手法復位聯(lián)合PVP與中醫(yī)骨折三期辨證用藥組,每組46例。分別于術前、術后24 h及術后6個月測定2組患者矢狀位傷椎前緣高度、矢狀位脊柱后凸Cobb角、腰背部疼痛視覺模擬量表(visual analogue scale,VAS)評分、Oswestry功能障礙指數(shù)(Oswsetry disability index,ODI)評分,并觀察并發(fā)癥發(fā)生情況。結果:手術前后不同時間點間矢狀位傷椎前緣高度的差異有統(tǒng)計學意義,即存在時間效應(F=13.657,P=0.019); 2組患者矢狀位傷椎前緣高度總體比較,組間差異有統(tǒng)計學意義,即存在分組效應(F=13.687,P=0.018); 術前2組患者矢狀位傷椎前緣高度比較,差異無統(tǒng)計學意義[(11.70±0.78)mm,(11.70±0.68)mm,t=0.987,P=0.175]; 術后24 h、術后6個月,手法復位聯(lián)合PVP和中醫(yī)骨折三期辨證用藥組矢狀位傷椎前緣高度均高于單純PVP組[(18.90±0.22)mm,(13.10±1.02)mm,t=13.654,P=0.018;(18.90±0.36)mm,(13.90±0.24)mm,t=18.353,P=0.014]; 時間因素與分組因素存在交互效應(F=13.569,P=0.021)。手術前后不同時間點間矢狀位脊柱后凸Cobb角的差異有統(tǒng)計學意義,即存在時間效應(F=14.365,P=0.015); 2組患者矢狀位脊柱后凸Cobb角總體比較,組間差異有統(tǒng)計學意義,即存在分組效應(F=21.670,P=0.006); 術前2組患者矢狀位脊柱后凸Cobb角比較,差異無統(tǒng)計學意義(18.60°±0.98°,15.70°±0.69°,t=0.887,P=0.145); 術后24 h、術后6個月,手法復位聯(lián)合PVP和中醫(yī)骨折三期辨證用藥組矢狀位脊柱后凸Cobb角均小于單純PVP組(5.90°±0.62°,12.10°±0.47°,t=16.684,P=0.008; 3.67°±0.56°,11.90°±0.64°,t=20.353,P=0.004); 時間因素與分組因素存在交互效應(F=14.347,P=0.013)。手術前后不同時間點間腰背部疼痛VAS評分的差異有統(tǒng)計學意義,即存在時間效應(F=29.365,P=0.003); 2組患者腰背部疼痛VAS評分總體比較,組間差異有統(tǒng)計學意義,即存在分組效應(F=1.670,P=0.026); 術前2組患者腰背部疼痛VAS評分比較,差異無統(tǒng)計學意義[(8.60±0.98)分,(8.70±0.79)分,t=0.487,P=0.745]; 術后24 h、術后6個月,手法復位聯(lián)合PVP和中醫(yī)骨折三期辨證用藥組腰背部疼痛VAS評分均低于單純PVP組[(2.90±0.52)分,(3.10±0.67)分,t=1.684,P=0.028;(2.67±0.56)分,(3.20±0.66)分,t=1.353,P=0.024]; 時間因素與分組因素存在交互效應(F=11.347,P=0.014)。手術前后不同時間點間ODI評分的差異有統(tǒng)計學意義,即存在時間效應(F=33.453,P=0.002); 2組患者ODI評分總體比較,組間差異有統(tǒng)計學意義,即存在分組效應(F=3.670,P=0.036); 術前2組患者ODI評分比較,差異無統(tǒng)計學意義[(42.68±1.06)分,(42.79±0.97)分,t=0.879,P=0.216]; 術后24 h、術后6個月,手法復位聯(lián)合PVP和中醫(yī)骨折三期辨證用藥組ODI評分均低于單純PVP組[(20.56±0.58)分,(24.58±0.54)分,t=5.249,P=0.019;(11.67±0.49)分,(19.49±0.51)分,t=4.251,P=0.034]; 時間因素與分組因素存在交互效應(F=34.387,P=0.022)。手法復位聯(lián)合PVP和中醫(yī)骨折三期辨證用藥組未發(fā)生骨水泥滲漏、神經(jīng)脊髓損傷及感染等并發(fā)癥。單純PVP組3例發(fā)生骨水泥滲漏,其中1例出現(xiàn)神經(jīng)壓迫癥狀給予急診探查減壓術治療后癥狀消失,2例未出現(xiàn)神經(jīng)癥狀給予嚴密觀察而未做處理; 其余患者均未出現(xiàn)神經(jīng)、脊髓損傷等并發(fā)癥。2組患者并發(fā)癥發(fā)生率比較,差異無統(tǒng)計學意義(χ2=2.044,P=0.153)。結論:對于骨質(zhì)疏松性胸腰椎壓縮骨折患者,采用手法復位聯(lián)合PVP和中醫(yī)骨折三期辨證用藥治療,比單純PVP治療更有利于恢復傷椎前緣高度、糾正脊柱后凸畸形、緩解腰背部疼痛和恢復脊柱功能,且安全可靠。
Abstract:
ABSTRACT Objective:To explore the clinical curative effects and safety of manipulative reduction combined with percutaneous vertebroplasty(PVP)and oral application of traditional Chinese medicine(TCM)according to three-stage syndrome differentiation principles for treatment of osteoporotic thoracolumbar vertebral compression fractures.Methods:Ninety-two patients with osteoporotic thoracolumbar vertebral compression fractures were randomly divided into monotherapy group and combination therapy group,46 cases in each group.The patients in monotherapy group were treated with PVP,and the patients in combination therapy group were treated with manipulative reduction combined with PVP and oral application of TCM according to three-stage syndrome differentiation principles.The anterior border height of injured vertebrae and Cobb angle of kyphotic deformity in the sagittal plane,visual analogue scale(VAS)scores and Oswsetry disability index(ODI)scores were evaluated before surgery and at 24 hours and 6 months after the surgery respectively,and the complications were also observed.Results:There was statistical difference in the anterior border height of injured vertebrae in the sagittal plane between different timepoints before and after the surgery,in other words,there was time effect(F=13.657,P=0.019).There was statistical difference in the anterior border height of injured vertebrae in the sagittal plane between the 2 groups in general,in other words,there was group effect(F=13.687,P=0.018).There was no statistical difference in the anterior border height of injured vertebrae in the sagittal plane between the 2 groups before the surgery(11.70+/-0.78 vs 11.70+/-0.68 mm,t=0.987,P=0.175).The anterior border height of injured vertebrae in the sagittal plane was higher in combination therapy group compared to monotherapy group at There was interaction between time factor and group factor(F=13.569,P=0.021).There was statistical difference in the Cobb angle of kyphotic deformity in the sagittal plane between different timepoints before and after the surgery,in other words,there was time effect(F=14.365,P=0.015).There was statistical difference in the Cobb angle of kyphotic deformity in the sagittal plane between the 2 groups in general,in other words,there was group effect(F=21.670,P=0.006).There was no statistical difference in the Cobb angle of kyphotic deformity in the sagittal plane between the 2 groups before the surgery(18.60+/-0.98 vs 15.70+/-0.69 degrees,t=0.887,P=0.145).The Cobb angles of kyphotic deformity in the sagittal plane were less in combination therapy group compared to monotherapy group at 24 hours and 6 months after the surgery respectively(5.90+/-0.62 vs 12.10+/-0.47 degrees,t=16.684,P=0.008; 3.67+/-0.56 vs 11.90+/-0.64 degrees,t=20.353,P=0.004).There was interaction between time factor and group factor(F=14.347,P=0.013).There was statistical difference in lower back pain VAS scores between different timepoints before and after the surgery,in other words,there was time effect(F=29.365,P=0.003).There was statistical difference in lower back pain VAS scores between the 2 groups in general,in other words,there was group effect(F=1.670,P=0.026).There was no statistical difference in the lower back pain VAS scores between the 2 groups before the surgery(8.60+/-0.98 vs 8.70+/-0.79 points,t=0.487,P=0.745).The lower back pain VAS scores were lower in combination therapy group compared to monotherapy group at 24 hours and 6 months after the surgery respectively(2.90+/-0.52 vs 3.10+/-0.67 points,t=1.684,P=0.028; 2.67+/-0.56 vs 3.20+/-0.66 points,t=1.353,P=0.024).There was interaction between time factor and group factor(F=11.347,P=0.014).There was statistical difference in ODI scores between different timepoints before and after the surgery,in other words,there was time effect(F=33.453,P=0.002).There was statistical difference in ODI scores between the 2 groups in general,in other words,there was group effect(F=3.670,P=0.036).There was no statistical difference in the ODI scores between the 2 groups before the surgery(42.68+/-1.06 vs 42.79+/-0.97 points,t=0.879,P=0.216).The ODI scores were lower in combination therapy group compared to monotherapy group at 24 hours and 6 months after the surgery respectively(20.56+/-0.58 vs 24.58+/-0.54 points,t=5.249,P=0.019; 11.67+/-0.49 vs 19.49+/-0.51 points,t=4.251,P=0.034).There was interaction between time factor and group factor(F=34.387,P=0.022).No complications such as bone cement leakage,nerve injury,spinal cord injury and infection were found in combination therapy group.The bone cement leakage was found in 3 patients in monotherapy group,and the nerve compression symptoms were found in one patient and then disappeared after emergency treatment with exploratory surgery and decompression surgery.The other two patients without nerve symptoms were not treated.The spinal cord injuries and infections were not found in other patients of monotherapy group.There was no statistical difference in complication incidences between the two groups(χ2=2.044,P=0.153).Conclusion:The combination therapy of manipulative reduction combined with PVP and oral application of TCM according to three-stage syndrome differentiation principles is more conducive to recovering the anterior board height of injured vertebrae,correcting the kyphotic deformity,alleviating lower back pain and restoring the spinal function compared to monotherapy of PVP in the treatment of osteoporotic thoracolumbar vertebral compression fractures,and it is safe and reliable.

參考文獻/References:

[1] 國家中醫(yī)藥管理局.中醫(yī)病證診斷療效標準[M].南京:南京大學出版社,1994:176.
[2] 蔣協(xié)遠,王大偉.骨科臨床療效評價標準[M].北京:人民衛(wèi)生出版社,2005:123-124.
[3] FAIRBANK JC,PYNSENT PB.The oswestry disability index[J].Spine(Phila Pa 1976),2000,25(22):2940-2952.
[4] KADO DM,DUONG T,STONE KL,et al.Incident vertebral fractures and mortality in older women:a prospective study[J].Osteoporosis International,2003,14(7):589-594.
[5] 譚志宏,魯鵬,林涌鵬,等.中西醫(yī)結合治療高齡重癥胸腰椎壓縮骨折臨床觀察[J].新中醫(yī),2012,44(4):47-49.
[6] 葛付濤,趙松,牛豐,等.磷酸鈣骨水泥球囊撐開椎體成形術治療骨質(zhì)疏松性椎體骨折[J].中國骨傷,2014,27(2):128-132.
[7] 許兵,葉小雨,王蕭楓,等.小管徑經(jīng)皮椎體后凸成形術治療骨質(zhì)疏松性椎體重度壓縮骨折[J].中醫(yī)正骨,2015,27(11):29-31.
[8] BAERLOCHER MO,SAAD WE,DARIUSHNIA S,et al.Quality improvement guidelines for percutaneous vertebroplasty[J].J Vasc Interv Radiol,2014,25(2):165-170.
[9] 智新力,趙麗娟,霍霽.椎體成形術在骨質(zhì)疏松性椎體骨折不愈合中的應用[J].實用骨科雜志,2015,21(12):1062-1064.
[10] 李格,梅偉,劉沛霖,等.骨質(zhì)疏松性椎體壓縮骨折經(jīng)皮椎體成形術后鄰近椎體再骨折的危險因素探討[J].中醫(yī)正骨,2016,28(6):18-20.
[11] TENG MM,WEI CJ,WEI LC,et al.Kyphosis correction and height restoration effects of percutaneous vertebroplasty[J].AJNR Am J Neuroradiol,2003,24(9):1893-1900.
[12] 鄧亦奇,趙峰,李國華,等.中粘度與高粘度骨水泥治療骨質(zhì)疏松性椎體壓縮骨折的療效對比[J].頸腰痛雜志,2016,37(1):17-22.
[13] 李楠,張貴林,何達,等.經(jīng)皮椎體成形術治療新鮮與陳舊不愈合骨質(zhì)疏松性椎體壓縮骨折療效比較[J].臨床骨科雜志,2016,19(1):1-3.
[14] 楊富國,楊波,尹飚,等.椎體成形結合抗骨質(zhì)疏松治療減少再骨折發(fā)生率[J].中國組織工程研究,2016,20(33):4905-4912.
[15] MOLLOY S,MATHIS JM,BELKOFF SM.The effect of vertebral body percentage fill on mechanical behavior during percutaneous vertebroplasty[J].Spine(Phila Pa 1976),2003,28(14):1549-1554.
[16] 李慶龍,吳愛憫,倪文飛,等.經(jīng)皮椎體后凸成形術治療骨質(zhì)疏松性椎體骨折的常見并發(fā)癥分析[J].中醫(yī)正骨,2014,26(3):40-43.
[17] 鄭毓嵩,張勇,林金丁,等.椎體成形術骨水泥滲漏的相關危險因素分析[J].中華創(chuàng)傷雜志,2015,31(4):312-316.

相似文獻/References:

[1]許兵,葉小雨,王蕭楓,等.小管徑經(jīng)皮椎體后凸成形術治療 骨質(zhì)疏松性椎體重度壓縮骨折[J].中醫(yī)正骨,2015,27(11):29.
[2]茆軍,張惠法,嚴培軍,等.Ilizarov外固定支架結合克氏針固定治療Pilon骨折[J].中醫(yī)正骨,2015,27(10):32.
[3]伍輝國,江克羅,張文正,等.手法復位杉樹皮小夾板固定治療兒童閉合性指骨骨折[J].中醫(yī)正骨,2015,27(10):63.
[4]孫群周.組合式外固定器固定結合有限內(nèi)固定治療 GustiloⅢ型脛骨開放性骨折[J].中醫(yī)正骨,2015,27(09):25.
[5]朱旭偉,萬春友,張濤,等.外固定架固定結合髓腔內(nèi)異體骨支撐治療四肢粉碎性骨折[J].中醫(yī)正骨,2015,27(12):68.
[6]楊少輝,許紅霞,邢健昆.正骨伸筋膠囊在膝關節(jié)周圍骨折術后康復中的應用[J].中醫(yī)正骨,2015,27(02):43.
[7]譚新歡,畢宏政,聶偉志,等.SandersⅡ型跟骨骨折手法復位克氏針 內(nèi)固定術中植骨的臨床研究[J].中醫(yī)正骨,2015,27(06):6.
　TAN Xinhuan,BI Hongzheng,NIE Weizhi,et al.Clinical research on bone grafting after manipulative reduction and kirschner wire internal fixation for treatment of sandersⅡcalcaneal fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(04):6.
[8]孫德舜,王小鶴,王曉燕,等.氣囊托板復位配合骨傷復元湯口服治療 胸腰椎單純壓縮骨折[J].中醫(yī)正骨,2015,27(05):65.
[9]林全藝,丁振貝,陳慶運,等.彈性髓內(nèi)釘內(nèi)固定治療兒童四肢長骨干骨折[J].中醫(yī)正骨,2015,27(03):52.
[10]董樂樂,連建強.生物學內(nèi)固定原則在手術治療長骨骨折不愈合中的應用[J].中醫(yī)正骨,2013,25(03):73.
[11]馮樹生,孫波,張凌,等.牽引結合中藥外敷治療老年腰椎壓縮性骨折臨床研究[J].中醫(yī)正骨,2011,23(02):18.
　FENG Shu-sheng*,SUN Bo,ZHANG Ling,et al.Combination of external Chinese herb and traction for senile lumbar vertebral compression fracture[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2011,23(04):18.
[12]賈川,黎俊,趙洪,等.單側經(jīng)橫突-椎弓根入路與雙側經(jīng)椎弓根入路經(jīng)皮椎體成形術治療重度骨質(zhì)疏松性椎體壓縮性骨折合并脊柱側彎的比較研究[J].中醫(yī)正骨,2018,30(12):23.
　JIA Chuan,LI Jun,ZHAO Hong,et al.Percutaneous vertebroplasty through unilateral transverse process-pedicle approach versus bilateral transpedicular approach for treatment of severe osteoporotic vertebral compression fractures and scoliosis:a comparative study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(04):23.
[13]唐振坤,俞桂松,范奕松,等.骨填充網(wǎng)袋椎體成形術與經(jīng)皮椎體后凸成形術治療骨質(zhì)疏松性椎體壓縮性骨折的Meta分析[J].中醫(yī)正骨,2019,31(10):31.
　TANG Zhenkun,YU Guisong,FAN Yisong,et al.Comparison of bone filling mesh container vertebroplasty versus percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fracture:a meta analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(04):31.
[14]茹云,喬宏宇,李新苗.MRI水-脂分離Dixon技術與彌散加權成像技術在良惡性椎體壓縮性骨折診斷中的應用[J].中醫(yī)正骨,2021,33(10):47.

更新日期/Last Update: 1900-01-01