振动疗法对骨质疏松骨折患者骨矿含量、骨钙素及骨折愈合的影响

Effect of vibration therapy on bone mineral content, osteocalcin, and fracture healing in patients with osteoporotic fractures

摘要:

目的 研究振动疗法对骨质疏松骨折患者骨矿含量、骨钙素及骨折愈合的影响。方法 选取2018年1月—2021年5月苏州大学附属第一医院和苏州明基医院康复医学科收治的60例骨质疏松性椎体压缩性骨折（OVCF）患者为研究对象，按照随机数字表法分为观察组和对照组，每组30例。患者入院后均行经皮椎体成形术治疗。对照组术后口服碳酸钙（600 mg/d）与强骨胶囊（2粒/次，3次/d）；观察组在对照组基础上给予振动疗法。两组均治疗6个月。比较两组患者临床疗效，比较两组患者治疗前后骨密度、甲状旁腺素（PTH）、25-羟维生素D₃［25（OH）D₃］、骨钙素（BGP）、骨碱性磷酸酶（BALP）、I型前胶原羧基端肽（PICP）、抗酒石酸酸性磷酸酶（TRAP）、视觉模拟评分法（VAS）、Fugel-Meyer运动功能评估量表（FMAS）、Barthel指数、骨痂生长评分的差值。两组均随访6个月，记录随访期间两组患者跌倒、再次骨折及并发症发生率。结果 观察组临床疗效优良率高于对照组（P <0.05）。观察组治疗前后腰椎、股骨颈、大转子、全髋的骨密度差值高于对照组（P <0.05）。观察组治疗前后PTH、25（OH）D₃、BGP差值高于对照组（P <0.05）。观察组治疗前后BALP、PICP差值高于对照组，TRAP差值低于对照组（P <0.05）。观察组治疗前后VAS评分差值低于对照组（P <0.05），FMA评分、Barthel指数差值高于对照组（P <0.05）。观察组治疗前后骨痂量、骨痂密度、骨痂边缘、断端边缘评分差值高于对照组（P <0.05）。两组跌倒、再次骨折及并发症发生率比较，差异无统计学意义（P >0.05）。结论 振动疗法治疗OVCF可促进患者骨折愈合，提高骨密度，改善骨代谢，促进骨形成，提高肢体运动功能及日常生活能力，促进骨痂生长，值得临床推广应用。

Abstract:

Objective To study the effect of vibration therapy on bone mineral content, osteocalcin, and fracture healing in patients with osteoporotic fractures.Methods A total of 60 patients with osteoporotic vertebral compression fracture (OVCF) admitted to the Department of Rehabilitation Medicine, The First Affiliated Hospital of Soochow University and Suzhou Benji Hospital from January 2018 to May 2021 were selected and divided into observation group (n = 30) and control group (n = 30) by random number table method. The two groups were treated with percutaneous vertebroplasty after admission. The control group was treated with calcium carbonate (600 mg/d) and Qianggu capsules (2 capsules/time, 3 times/day). On the basis of the control group, the observation group was given vibration therapy and used vibration therapeutic apparatus. Both groups were treated for 6 months. The clinical efficacy of the two groups was compared. Before and after treatment, bone mineral density, calcium and phosphorus metabolism [parathyroid hormone (PTH), 25(OH) vitamin D₃ (25(OH)D₃) ], osteocalcin (BGP), osteoblast markers bone alkaline phosphatase (BALP), type I procollagen carboxyl terminal peptide (PICP), osteoclast markers [tartrate-resistant acid phosphatase (TRAP) ], visual Sensory analogue pain (VAS) score, Fugel-Meyer (FMA) scale of limb motor function, Barthel index, callus growth score, and the incidence of falls, re-fractures and complications in the two groups were recorded during the follow-up period of 6 months.Results The excellent and good rate of observation group was higher than that of control group (P < 0.05). The BMD differences of lumbar spine, femoral neck, greater trochanter, and total hip in the observation group before and after treatment were higher than those in the control group (P < 0.05). The differences of PTH, 25(OH)D₃, and BGP in the observation group before and after treatment were higher than those in the control group after treatment (P < 0.05). The difference of BALP and PICP before and after treatment in the observation group was higher than that in the control group, and the difference of TRAP was lower than that in the control group (P < 0.05). The VAS score difference before and after treatment in the observation group was lower than that in the control group, and the FMAS score and Barthel index difference were higher than those in the control group (P < 0.05). The differences in callus volume, callus density, callus edge, and broken end edge scores before and after treatment in the observation group were higher than those in the control group (P < 0.05). There was no significant difference in the incidence of falls, re-fractures, and complications between the two groups (P > 0.05).Conclusion Vibration therapy for OVCF patients can accelerate fracture healing, improve bone mineral density, improve bone metabolism and limb motor function as well as daily living ability, promote callus growth, and is worthy of application.