补肾活血汤加味辅助促进骨质疏松椎体压缩性骨折术后骨愈合的疗效

胡敬暖 孙晓娜 张宝峰

摘要 目的：觀察补肾活血汤加味联合唑来膦酸促进骨质疏松性椎体压缩性骨折（OVCF）术后骨愈合的疗效。方法：选取2018年1月至2019年1月济南市中医医院收治的OVCF术后恢复期患者78例作为研究对象，按照随机数字表法随机分为对照组和观察组，每组39例。2组患者术后均给予常规处理，对照组患者在此基础上给予唑来膦酸静脉输注;观察组患者在对照组基础上给予补肾活血汤加味方。通过腰背痛感程度、腰部功能障碍程度、椎体后凸角度（Cobb）、伤椎前缘高度变化观察2组患者的术后骨折愈合程度，比较骨密度、骨代谢生化指标、血液流变学、血清中相关因子水平。结果：与对照组比较，术后1个月观察组患者骨折愈合情况更好，腰背疼痛程度疼痛视觉模拟评分（VAS）、腰部功能障碍Oswestry功能障碍指数（ODI）评分更低，Cobb角下降，伤椎前缘高度增加，差异有统计学意义（P<0.05）;股骨颈骨密度、腰椎骨密度均更高，差异有统计学意义（P<0.05），成骨细胞活性增强更明显，血清骨代谢指标骨钙素（OC/BGP）、骨特异性碱性磷酸酶（BALP）水平升高更明显，抗酒石酸盐酸性磷酸酶异构体-5b（TRACP-5b）、全甲状腺旁腺素（iPTH）、Ⅰ型胶原C端肽（CTX-Ⅰ）水平、血液流变学指标降低更明显，差异有统计学意义（P<0.05）;血清中可溶性细胞间黏附分子-1（sICAM-1）、降钙素原（PCT）水平均较对照组明显降低，血管内皮生长因子（VEGF）、转化生长因子-β1（TGF-β1）水平则明显升高，差异有统计学意义（P<0.05）。结论：补肾活血汤加味方联合唑来膦酸利于促进OVCF患者术后骨愈合，提高骨密度，其机制可能与改善骨代谢、增加局部血供、减轻术后炎性反应、促进血管生成有关。

关键词 骨质疏松性椎体压缩性骨折;补肾活血汤;唑来膦酸;骨折愈合;骨密度;骨代谢;血液流变学;炎性反应因子;血管生成

Abstract Objective：To observe modified Bushen Huoxue Decoction on the curative effects of promoting postoperative bone healing of patients with osteoporotic vertebral compression fracture （OVCF）. Methods：A total of 78 cases of patients during postoperative recovery period admitted to Jinan Hospital of Traditional Chinese Medicine from Jan. 2018 to Jan. 2019 were selected as the research objects and were randomly divided into a control group and an observation group， with 39 cases in each group. Patients in both groups were given routine postoperative treatment. Patients in the control group were given intravenous zoledronic acid infusion on the basis of routine treatment， and while those in the observation group were given Bushen Huoxue Decoction on the basis of the control group. The degree of postoperative fracture healing of patients in the 2 groups was observed through the degree of lumbar back pain， the degree of lumbar dysfunction， the angle of vertebral kyphosis （Cobb）， and the height change of injured vertebral anterior edge. The bone mineral density， biochemical indexes of bone metabolism， hemorheology and serum levels of relevant factors were compared. Results：1 month after surgery， compared with the control group， the fracture healing was superior to the observation group. The VAS score of lumbar back pain and the ODI score of lumbar dysfunction were lower， the Cobb Angle decreased， and the height of the anterior edge of the injured vertebra increased （P<0.05）. The bone mineral density of femoral neck and lumbar spine were higher （P<0.05）， and the osteoblast activity was enhanced more significantly. The serum bone metabolism indexes of BGP， OC and BLAP were increased more significantly， and the TRACP-5b， iPTH and CTX-I levels and hemorheological indexes were decreased more significantly （P<0.05）. The serum levels of SICAM-1 and PCT were significantly lower than those of the control group， while the levels of TGF-β1 and VEGF were significantly increased （P<0.05）. Conclusion：Modified Bushen Huoxue Decoction can promote postoperative bone healing and improve bone density OVCF patients. The mechanism may be related to improving bone metabolism， increasing local blood supply， reducing postoperative inflammatory reaction and promoting angiogenesis.

Keywords Osteoporotic vertebral compression fracture; Bushen Huoxue Decoction; Zoledronic acid; Fracture healing; Bone mineral density; Bone metabolism; Hemorheology; Inflammatory cytokines; Angiogenesis

中图分类号：R289.5;R684文献标识码：Adoi：10.3969/j.issn.1673-7202.2020.17.017

骨质疏松是一种以骨钙含量减少、骨量下降、骨质结构发生破坏为主要表现的慢性骨代谢异常疾病，患者骨骼脆性明显升高，极易发生骨折。骨质疏松性椎体压缩性骨折（Osteoporotic Vertebral Compression Fractures，OVCF）是临床常见类型，以老年患者居多，患者常表现为疼痛、功能障碍及椎体高度下降[1]。目前，手术是临床治疗OVCF的主要手段，经皮椎体成形术（Percutaneous Vertebroplasty，PVP）是一类微创手术，于临床广泛应用，其虽然见效快、创伤小，但是不能纠正后凸畸形[2]。……