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[目的]比较西药、中西药联合、太极拳结合中西药联合及药膳饮食等不同干预方案预防骨质疏松性胸腰椎骨折PVP术后再次发生胸腰椎骨折的效果,探索适合骨质疏松性胸腰椎骨折PVP术后再骨折的预防策略。[方法]PVP手术患者120例,分为西药组、中西药联合组、综合组(太极拳结合中西药联合及药膳饮食)共3组,每组40例,分别给予不同的干预方案,其中西药组予以鲑鱼降钙+阿法骨化醇软胶囊+碳酸钙D3咀嚼片+阿伦磷酸钠片进行治疗干预;中西药联合组:西药组方案加用壮药经验方固本疏肝壮骨方内服(每月服用10~15服,术后连续服用3个月以上)。综合组:中西药联合组加上统一进行太极拳培训,指导研究对象有规律地打太极拳,同时指导其调整膳食结构。观测并比较各组椎体骨折发生情况、VAS骨痛评分改变、腰椎椎体QCT值及跌倒发生等情况。[结果]随访1年内各组胸腰椎体再发骨折组间比较西药组与其他两组间差异有统计学意义(P<0.05),中西药联合组与综合组比较差异无统计学意义(P>0.05)。随访1年后各组内骨痛VAS评分均较干预前显著降低(P<0.05),组间骨痛VAS评分显示三组间差异均有统计学意义(P<0.05)。术前及随访1年腰椎QCT比较显示三组间差异无统计学意义(P>0.05),但每组随访1年与术前对比QCT较前显著提高,差异有统计学意义(P<0.05);随访1年内各组跌倒发生情况,西药组与其他两组间比较差异有统计学意义(P<0.05),中西药联合组与综合组比较差异无统计学意义(P>0.05)。[结论]采用太极拳结合中西药联合及药膳饮食干预能够有效降低VAS骨痛评分、减少跌倒次数及再发骨折。但跌倒次数及新发骨折方面与中西药联合干预比较未见显著差别,有待扩大样本量进一步研究。
[Objective] To compare the effects of western medicine, traditional Chinese and western medicine, Taijiquan combined with traditional Chinese and western medicine and medicated diet on the prevention of thoracolumbar fractures after osteoporotic thoracolumbar fractures treated by different interventions, and to explore the suitable thoracolumbar vertebral fractures for osteoporotic thoracolumbar vertebrae Prevention strategy of fracture after PVP surgery. [Methods] 120 patients with PVP surgery were divided into three groups: Western medicine group, combination group of Chinese and western medicine, combination group (combination of Taijiquan with traditional Chinese and western medicine and medicated diet), with 40 cases in each group. Group salmon calcification + alfacalcidin soft capsule + calcium carbonate D3 chewable tablets + alendronate sodium tablets for treatment intervention; Western medicine group: Western medicine group plus strong Zhuang medicine prescription experience side Shugan Zhuanggu Fang Oral (10 to 15 servings per month, after taking more than 3 months of continuous). Comprehensive Group: Chinese and Western medicine combined with unified Tai Chi training, to guide the study of regular Taijiquan, at the same time to guide the adjustment of diet. The incidence of vertebral fractures, changes of VAS pain scores, QCT value of lumbar vertebrae and the occurrence of falls were observed and compared. [Results] There was significant difference between Western medicine group and the other two groups (P <0.05) in the group of recurrence of thoracolumbar vertebral body fractures within one year after follow-up, there was no significant difference between the combination group and the comprehensive group (P > 0.05). The VAS score of bone pain in each group was significantly lower than that before intervention (P <0.05) after one year of follow-up. VAS score of pain between groups showed statistically significant differences among the three groups (P <0.05). Preoperative and follow-up 1-year QCT showed no significant difference among the three groups (P> 0.05), but the QCT of one year follow-up was significantly higher than that before operation (P 0.05) (P <0.05). There was no significant difference between the combination group and the comprehensive group (P> 0.05). The incidence of fall in each group within one year after follow-up was statistically significant (P <0.05). [Conclusion] The use of Taijiquan combined with traditional Chinese and western medicine combined with medicated diet can effectively reduce VAS pain scores, reduce the number of falls and recurrence fractures. However, there were no significant differences in the number of falls and new fractures compared with the combined intervention of western medicine and Chinese medicine. The sample size needs further study.