| Objective: With increasing of old people,large number of patients with osteoporotic vertebral fracture is growing.As to the adverse effect of drugs,the advantages of traditional Chinese medicine(TCM)enlarged the treatment of osteoporosis.Xianlinggubao capsule with PKP operation is the recommended treatment for elderly patients with osteoporotic vertebral fracture.The clinical effect of combined percutaneous kyphoplasty with Xianlinggubao capsule for osteoporotic vertebral fractures provides a practical basis,and confirms the effect and safety of PKP.Methods: In the experimental part,the mice were divided into three groups,the blank group was under no special treatment,the model group was treated with ovariectomy for osteoporosis model,and the drug group was given intragastric administration of Icariin on the basis of model group treatment.Then,we analyzed the results through micro CT,he staining,immunohistochemistry,q PCR and WB.In the clinical research,60 OVCF patients satisficing the inclusion criteria and exclusion criteria were retrospective collected in the Department of spinal surgery in Wuhan first hospital from January 2015 to October 2019.Patients were randomly divided into control group(1-30)and treatment group(31-60).In the control group,patients were treated by PKP,anti-osteoporosis drug therapy and routine rehabilitation training.Patients in the treatment group took the Xianling Gubao capsule based on therapy in the control group.Regularly rechecking the safety indicators include blood,urine,stool,liver and kidney function,electrolyte.The general data of age,sex,fracture location,fracture type,VAS pain score,ODI scale score and bone density(hip joint and lumbar spine)were recorded before operation.The scores of VAS and ODI,bone density,and postoperative complications were collected.All the data were analyzed by SPSS23.0 statistical software.Result:1.Micro CT: In the model group,Tb.N,BMC and TMD were decreased significantly,Tb.Sp was increased(P < 0.05).In the drug group,the density of trabecular bone increased and trabecular bone became more regular,Tb.N,BMC and TMD were increased significantly,Tb.Sp was lower significantly(P<0.05).2.HE staining: The area and width of bone trabeculae in the model group were significantly reduced(P<0.05);The bone trabeculae in the drug group were full,and the area and width of bone trabeculae were significantly increased(P<0.05).3.Immunohistochemistry: The expression of Ephrin B2 in the model group was higher than that in the blank group,and the expression of Ephrin B2 in the drug group was significantly lower than that in the model group(P<0.05).The expression of Eph B4 in the model group was lower than that in the blank group,and the expression of Eph B4 in the drug group was higher than that in the model group(P<0.05).4.q PCR: The expression of relative osteogenic genes Dlx5,MT1-MMP1,Eph B4,Rho A and Runx2 in the model group was decreased;the expression of Dlx5,MT1-MMP1,Eph B4,Rho A and Runx2 in the drug group was increased(P<0.05).5.Western blotting: The expression of Eph B4 in model group was decreased,and the expression of Ephrin B2 was increased(P<0.05).The expression of Eph B4 was increased,and the expression of Ephrin B2 was decreased in drug group(P<0.05).6.The general data(sex,age,fracture location,fracture type,etc.)were analyzed by SPSS23.0 statistical software,the difference was not statistically significant(P>0.05).7.(1)The VAS scores of all patients decreased in the treatment group and there was significant difference in the fourth week after operation(P<0.05).There was no significance difference in VAS pain scores before and after operation in 12 weeks and 24 weeks(P>0.05).(2)After PKP operation,the ODI scores reduced with no significant difference in 4 weeks and 8 weeks(P>0.05)and the ODI scores of all patients decreased in the treatment group with significant difference in the 24 weeks(P<0.05).(3)The waist and hip bone mineral density in the treatment group was significance higher than that in the control group(P<0.05).(4)The incidence of postoperative vertebral refracture was 3.33% in the treatment group,and20% in the control group respectively with statistical significance(P<0.05).Conclusion:1.Icariin is the main component of Xianlinggubao.In osteoporosis mice model,icariin can play an anti-osteoporosis role by affecting a variety of bone metabolism genes and proteins.2.Xianlinggubao capsule combined with PKP has significant advantage in the treatment of OVCF patients,which can effectively improve the pain and other clinical indexes,the symptoms of osteoporosis,and the quality of life of patients.PKP with Xianlinggubao capsule could enhance bone mineral density and reduce postoperative complications.3.Guided by the thought of syndrome differentiation and treatment,the Xianlinggubao capsule combined with PKP is safe and there was no adverse reaction which provided a safe and feasible treatment for the choice of clinical comprehensive treatment for OVCF. |
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