| BackgroundOsteoporotic vertebral compression fracture(OVCF)usually occurs in the thoracolumbar spine,especially in the elderly.With the development of the aging population,the prevalence of the disease is gradually increasing.Thoracolumbar OVCF is easy to cause vertebral height loss,kyphotic deformity,and often combined with spinal cord and nerve root injury.All these symptoms seriously affect patients’ daily life and rehabilitation.In response to these problems,treatment is always based on restoration of vertebral height,correction of kyphosis,prevention or repair of spinal cord and nerve root injury.At present,whether physical therapy,traditional Chinese medicine chiropractic and other conservative treatments,may play a certain role in restoring vertebral height,improving kyphosis deformity,preventing progressive spinal cord and nerve root injury,as well as improving patients’pain and lumbar movement limitation symptoms,etc.,however the stability of vertebral height and kyphosis deformity is difficult to determine.Various surgical methods used in modern medicine can certainly improve the patients’vertebral compression and kyphosis deformity.However,as a kind of local invasive treatment,surgical treatment ignores the understanding of the overall view of the spine,can not solve the problems such as loss of vertebral height from the overall cognition of the spine,and often faces the problems of surgical complications.In recent years,Professor Wei Yi-zong,a famous chiropractor,creatively proposed four-dimensional traction based on the ancient "suspension traction method" combined with the knowledge of human anatomy and biomechanics of Western medicine.Four-dimensional traction emphasizes that traction exercises the sequence of muscles on both sides of the waist at the same time,stimulates the internal stress of the muscles to restore the normal curvature of the lumbar spine,and then hopefully restores the normal height of the vertebral body,and uses the strength of the lumbar muscle groups to stabilize the physiological position of the vertebral body and normal vertebral curvature.At present,there are few relevant studies in clinic.Based on this,this study creatively proposes a four-dimensional traction combined with vertebroplasty for the treatment of thoracolumbar OVCF to observe its clinical efficacy and short-term effects.ObjectiveIn this study,we used four-dimensional traction combined with vertebroplasty to treat thoracolumbar OVCF.According the clinical outcomes,we objectively evaluated its efficacy and safety,analyzed its effectiveness in stabilizing vertebral height and kyphosis deformity,so that we can better promote the chiropractic treatment to the clinical work of integrated traditional Chinese and Western medicine in the treatment of vertebral fracture,to improve the effectiveness,safety and quality of life of patients.MethodsSixty patients who met the diagnostic criteria and inclusion criteria for osteoporotic compression fractures of thoracolumbar spine and were hospitalized in the Department of Orthopaedics of Fangcun,Guangdong Hospital of Traditional Chinese Medicine were selected.According to the principle of randomized control,60 patients were divided into four-dimensional traction+vertebroplasty group(observation group)and vertebroplasty group(control group).Visual Analogue Score(VAS)and Oswestry Disability Index(ODI)were used as clinical efficacy index to record the patients’ condition before treatment,after treatment,and after three months of follow-up.The changes of anterior margin height of injured vertebrae and Cobbb’s angle of kyphosis were compared between the two groups before treatment,after treatment and at three months of follow-up to evaluate the stability effect of treatment on vertebral height and kyphosis deformity.All complications and adverse reactions of the two groups from inclusion to the end of follow-up were recorded to evaluate the safety of the treatment regimen.Statistical methods were carried out by SPSS 26.0 analysis software,and paired design data t-test was used to compare the mean before and after the group,and independent sample data t-test was used to compare the mean between groups.ResultsIn terms of clinical efficacy,the VAS and ODI of the two groups were significantly improved after treatment and three months of follow-up compared with before treatment(P<0.05,with statistical significance);the ODI of the observation group was better than that of the control group after treatment(P<0.05,with statistical significance);however the VAS of the observation group after treatment and three months of follow-up,the ODI of the observation group after three months of follow-up,have no statistical significance compared with the control group(P>0.05).In terms of imaging changes,the height of the anterior margin of the injured vertebrae and the Cobbb’ s angle of kyphosis in both groups recovered significantly after treatment and three months of follow-up compared with before treatment(P<0.05,with statistical significance);the height of the injured vertebrae and the Cobbb’s angle of kyphosis in the observation group were significantly better than those in the control group after treatment and three months of follow-up(P<0.05,with statistical significance).The height of the anterior margin of the injured vertebra in the two groups decreased significantly after treatment at three months of follow-up,and the Cobbb’s angle of kyphosis increased significantly after treatment at three months of follow-up,all these differences were statistically significant(P<0.05).In terms of complications and adverse reactions,there were no significant complications and adverse reactions in both groups from the time of inclusion in the study to the end of follow-up.ConclusionInterventions in both groups could significantly improve the symptoms of thoracolumbar OVCF,restore the height of some anterior vertebral bodies,and correct kyphosis,but the differences in the height of injured vertebrae and the Cobbb’s angle of kyphosis between the two groups suggested that four-dimensional traction combined with vertebroplasty had a better therapeutic effect.The height of injured vertebrae in the two groups decreased at follow-up compared with that after treatment,and the Cobb’s angle increased at follow-up compared with that after treatment,suggesting that four-dimensional traction combined with vertebroplasty may not effectively avoid the loss of vertebral height again,which may be related to the small sample size,the lack of comprehensive analysis of factors such as the degree of osteoporosis and body weight index of patients,and needs further exploration. |
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