中国组织工程研究

中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (22): 4105-4108.doi: 10.3969/j.issn.1673-8225.2012.22.027

• 骨与关节损伤基础实验 basic experiments of bone and joint injury • 上一篇    下一篇

胸腰椎骨质疏松性压缩骨折手法复位治疗的有效性☆

邓轩赓，熊小明，万  趸，石华刚，曹万金，宋偲茂   

  1. 四川省骨科医院脊柱骨科，四川省成都市  610000
  • 收稿日期:2012-02-02 修回日期:2012-04-04 出版日期:2012-05-27 发布日期:2012-05-27
  • 作者简介:邓轩赓☆，男，1974年生，四川省南部县人，汉族，2008年南方医科大学毕业，博士，主治医师，主要从事脊柱外科、骨质疏松临床及研究工作。tigerd@163.com

Effectiveness of manipulative reduction on osteoporotic thoracolumbar compression fracture 

Deng Xuan-geng, Xiong Xiao-ming, Wan Dun, Shi Hua-gang, Cao Wan-jin, Song Cai-mao   

  1. Department of Spinal Orthopedics, Sichuan Orthopedic Hospital, Chengdu  610000, Sichuan Province, China
  • Received:2012-02-02 Revised:2012-04-04 Online:2012-05-27 Published:2012-05-27
  • About author:Deng Xuan-geng☆, Doctor, Attending physician, Department of Spinal Orthopedics, Sichuan Orthopedic Hospital, Chengdu 610000, Sichuan Province, China tigerd@163.com

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摘要：

背景：手法复位是传统非手术治疗骨质疏松性胸腰椎压缩骨折的一个重要手段，其作用主要是恢复椎体高度和纠正后凸角，但其有效性存在争议。目前有关手法复位的疗效评估及临床意义更多是一种经验判断，尚缺乏手法复位的客观研究。
目的：分析手法复位治疗骨质疏松性胸腰椎压缩骨折的有效性。
方法：采用随机、空白对照研究，选择60~75岁胸腰椎新鲜骨质疏松性压缩骨折(椎体压缩程度1/3~1/2，后凸角≤30°)患者，手法组采用腰后伸位徒手按压复位，对照组不加复位主动干预，其余治疗方案两组相同。分别比较入院时、复位后、下床站立时以及随访时X射线片测得的伤椎高度比和后凸角。
结果与结论：共纳入病例67例，其中手法组36例，男13例，女23例，平均年龄(65.4±10.8) 岁，对照组31例，男11例，女20例，平均年龄(67.2±9.7)岁，两组性别、年龄、伤椎高度、后凸角基线差异无显著性意义。相对于对照组，手法组复位后可即刻显著恢复伤椎高度(P=0.016)，后凸角差异无显著性意义(P=0.089)。但3周后下床站立时和随访时两组椎体高度比和后凸角差异均无显著性意义(P > 0.05)，并与入院时水平相近(P > 0.05)。结果提示，手法复位治疗骨质疏松性胸腰椎压缩骨折仅可在卧床期间改善伤椎高度，对于后凸角无明显改善作用，在短疗程下远期未表现出手法复位的作用，临床价值有限。
 

关键词: 手法复位, 骨质疏松, 脊柱骨折, 压缩, 胸腰椎, 伤椎高度, 后凸角

Abstract:

BACKGROUND: Manipulative reduction is an important conventional non-surgical means for the treatment of osteoporotic thoracolumbar compression fracture (OTLCF). Its main function is to restore vertebral height and correct kyphosis, but its effectiveness is controversial. At present, the clinical assessment and clinical significance of the manipulative reduction are usually an empirical judgment, so there still lacks an objective study.
OBJECTIVE: To research the effect of manipulative reduction on the treatment of OTLCF.
METHODS: A random and control study was employed. The cases should be osteoporotic patients with thoracolumbar compression fracture in the ages of 60-75 years old (compression degree: 1/3-1/2, kyphosis angle≤30°). Patients with OTLCF were randomly divided into manipulative group and control group. Manipulative group received manipulative reduction in pronate stretch station, and the control group did not receive manipulative reduction. The other treatments were same between the two groups. The height ratio and kyphosis angle of fracture vertebra were compared between the two groups, measured from the X-ray films at the time of admission, after reduction, standing and follow-up.
RESULTS AND CONCLUSION: Sixty-seven patients were enrolled, 36 cases in manipulatine group (13 males and 23 females, mean age: 65.4±10.8 years old) and 31 cases in control group (11 males and 20 females, mean age: 67.2±9.7 years old). There was no significant difference about sex, age, the height ratio and kyphosis angle of fracture vertebra. Compared with control group, manipulative group gained obvious improvement on the height ratio after reduction (P=0.016), and no statistic difference was found between two groups about kyphosis angle at any time point (P=0.089). However, it failed to show any additional significance at the time of standing and follow-up (P > 0.05) and similar to that at the time of admission (P > 0.05). Manipulative reduction has a temporary effect on improvement of the compressed vertebral height in the period of bed-rest, and shows no obvious improvement on kyphosis angle in a short course of treatment. And so, manipulative reduction has little value in treating OTLCF.

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