Effects of percutaneous kyphoplasty assisted by Huoxue Yigu Decoction on the bone healing and postoperative recovery of lumbar function in elderly patients with osteoporotic vertebral compression fractures / 国际中医中药杂志

ABSTRACT

Objective:To explore the effects of percutaneous kyphoplasty (PKP) assisted by Huoxue Yigu Decoction on bone healing and postoperative recovery of lumbar function in elderly patients with osteoporotic vertebral compression fractures (OVCF).Methods:Randomized controlled trial. A total of 79 elderly patients with OVCF admitted to Zhongshan Hospital Affiliated to Fudan University were enrolled as the research objects between October 2017 and February 2021. According to random number table method, they were divided into observation group (40 cases) and control group (39 cases). The patients in the control group were treated with PKP, then they were given off-bed activities with thoracolumbar braces at 2 d after surgery and the braces were removed at 1 month after surgery, while the observation group was treated with Huoxue Yigu Decoction for 7 d on the basis of control group treatment. Before surgery and at 3 months after surgery, TCM syndromes were scored. The lumbar function was evaluated by Japanese Orthopedic Association (JOA). The pain degree was evaluated by visual analogue scale (VAS) at 7 d and 1 month after surgery. Before surgery and at 7 d after surgery, levels of serum osteocalcin and bone alkaline phosphatase (BALP) were detected by radioimmunoassay. The levels of serum IL-1, IL-6 and TNF-α were detected by ELISA. The erythrocyte aggregation index, whole blood viscosity and plasma viscosity were detected by full-automatic blood rheometer. Before and at 3 months after surgery, loss rate of anterior margin vertebral height and sagittal kyphosis Cobb angle were detected by X-ray films. The bone mineral density (BMD) of femoral shaft was measured by dual-energy bone densitometer. The occurrence of postoperative complications was recorded.Results:There was no significant difference in total response rate between the observation group and control group [97.5% (39/40) vs. 92.3% (36/39); χ2=0.29, P=0.590]. At 3 months after surgery, scores of TCM syndromes in observation group were significantly lower than that of the control group ( t=5.63, P<0.01), and JOA score was significantly higher than that of the control group ( t=3.93, P<0.01). At 1 month after surgery, VAS score in observation group was significantly lower than that of the control group ( t=6.90, P<0.01). At 7d after surgery, levels of osteocalcin [(4.19±0.65) μg/L vs. (3.21±0.61) μg/L, t=6.91] and BMD [(0.86±0.17) g/cm 2vs. (0.71±0.15) g/cm 2, t=4.16] in observation group were significantly higher than those in the control group ( P<0.01), while BALP [(20.07±3.19) U/L vs. (22.16±3.52) U/L, t=2.77] was significantly lower than that of the observation group ( P<0.01). At 3 months after surgery, loss rate of anterior margin vertebral height and sagittal kyphosis Cobb angle in observation group were significantly lower than those in the control group ( t=2.59, 2.81, P<0.01). At 7d after surgery, erythrocyte aggregation index, whole blood viscosity and plasma viscosity in observation group were significantly lower than those in the control group ( t=2.92, 6.33, 4.64, P<0.01), and levels of serum IL-1, IL-6 and TNF-α were significantly lower than those in the control group ( t=2.33, 2.47, 3.45, P<0.01). There was no significant difference in incidence of postoperative complications between observation group and control group [2.50% (1/40) vs. 10.26% (4/39); χ2=2.00, P>0.05]. Conclusion:Huoxue Yigu Decoction can alleviate postoperative pain, promote bone healing and recovery of lumbar function, improve blood circulation and reduce inflammation level in elderly OVCF patients undergoing PKP.