| ObjectiveThis study used clustering analysis and other statistical methods to observe the distributions of TCM syndrome type in osteoporotic patients with lower extremity nerve symptoms,in order to provide theoretical basis for im-provements of the accuracy of TCM differentiations and clinical efficacy for the suffers.The characteristics of osteoporotic and degenerative changes of lumbar spine in these cases were also investigated to explore further the relationship between osteoporosis and lumbocrural pain.MethodsWe collected the clinical data in 120 confirmed cases of osteoporosis who visited the Department of orthopedics of Third Affiliated Hospital of Guang zhou University of Chinese Medicine.These patients were grouped according to whether or not with neurological symptoms in their lower limbs:A group(confo-rmed to the diagnostic criteria of both osteoporosis and neurological symptoms of lower limbs)and B group(met the diagnostic criteria of osteoporosis sta-ndard only);their general information,mineral density of lumbar bone(L1,L2,L3 and L4)and femoral neck,lumbar intervertebral height,lumbar vertebral heightand lumbar osteophyte degrees were gathered.By using the related quest-ionnaire of TCM symptomatology,the data obtained by means of the four diagno-stic methods of TCM(observation,auscultation and olfaction,interrogation;pulse feeling and palpation)were also amassed.Finally all of the data were analyzed statistically by using SPSS19.0 statistical in the software to ana-lyze all the data.Results1.Women seemed more susceptible to OP than men,but the sex differences between the two groups were not statistically(P>0.05).2.Comparison of age between the two groups:patients of Group A with an average age of 70.86±4.90 years old,and that in the Group B was 60.16±5.58 years old,The difference of average ages between the two groups was statistically significant(P<0.01).3.Comparison of height between the two groups:patients of Group A with an average height of 157.31±5.53cm,and that in the Group B was 158.70±5.69cm.The difference of height between the two groups was not statistically significant(P>0.05).4.Comparison of weight between the two groups:patients of Group A with an average weight of 50.20±5.48kg,and that in the Group B was 51.97±4.57kg.The difference of weight between the two groups was not statistically significant(P>0.05).5.The cluster analysis of the TCM symptoms and signs and the distribution of TCM syndrome types.The diagnostic data of both Group A and Group B were dealt by cluster analysis.The TCM symptoms and signs of the 60 patients in Group A could be divided into four types.The specific distribution was as follows:the Type of Qi stagnation and blood stasis related to 20 cases,occu-ping 33.3%of totals of the group;the Type of Kidney-Yang Deficiency involved 15 patients,accounting for 25%;the Type of Cold Dampness Blocking Collaterals refered to 13 cases,reaching 21.7%;and the Type of Damp Heat Obstructing Collaterals concerned 12 sufferers,having a proportion of 20%.Nevertheles-s,the TCM symptoms and signs of the 60 patients in Group B might be marked off into three types,the concrete distribution was like that:the Type of Spleen-Kidney-Yang Deficiency refered to 28 cases,accounting for 46.7%of totals of the group;the Type of Liver-Kidney-Yin Deficiency involved 20 pat-ients,occuping 33.3%;and the Type of Qi stagnation and blood stasis concerned 12 sufferers,reaching 20%.6.Measurement of bone mineral density(BMD)of lumber vertebrae and femoral necks.In the Group A,the average BMD of first lumbar vertebra was 0.75±0.07 g/cm2;that of second lumbar vertebra 0.82±0.10g/cm2;the third 0.85±0.08g/cm2;and,the fourth 0.91±0.08g/cm2.Yet in the Group B,the average BMD of first lumbar vertebra was 0.61±0.09 g/cm2;that of second lumbar vertebra was 0.64±0.11g/cm2;the third 0.60±0.10g/cm2;the fourth 0.70±0.09g/cm2.The differe-nee of corresponding average BMDs between the two groups were of statistical significant significance(P<0.01).In the Group A,the average BMD of femoral necks was 0.50±0.06 g/cm2;While in the Group B,that was 0.58±0.07 g/cm2,the independent sample t test showed that there was statistical difference between the two groups(P<0.01).7.The comparison of segmental lumbar intervertebral height(SLIH),lumbar vertebral height(LVH)and segmental lumbar osteophyte degree(SLOD)between the two groups.Corresponding average SLIHs of the two groups was compared with independe-nt sample t test and found that SLIHs of Group A were less than those of Group B with statistical significance(P<0.01).Corresponding average LVHs of the two groups was compared with independent sample t test and the results suggested that LVHs of Group A were lower than those of Group B with statistical signific-ance(P<0.01);and the differences of LVHs were mainly manifested in the ratio of Ha/Hp as well as the ratio of Hm/Hp;however,there was no statistically significant differences between the ratio of Hp/Hpi?1 of the two groups.Corresponding average SLOD of the two groups was compared with rank-sum test and the results showed that SLOD of Group A were higher than those of Group B with statistical significance(P<0.01).The SLOD in A group mainly concentr-ated on the fourth degree,while the SLOD in B group mainly focused on degree I and II,that is to say,the severity of SLOD in group A was larger than that in group B.Conclusion1.TCM syndrome type of neurological symptoms associated with osteoporosis can be divided into four ones:qi stagnation and blood stasis,kidney yang deficiency and the syndrome of cold dampness and damp heat stasis type.In which,the first one is the most common type in osteoporotic patients with lower extremity nerve symptoms.Therefore,in clinical treatment,more attention should be paid to activating blood circulation to dissipate blood stasis and activating meridians to stop pain.However,TCM syndrome types of osteoporosis without neurological symptoms can be classified into three sorts:spleen kidney yang deficiency,yin deficiency of liver and kidney,qi stagnation and blood stasis,and the most common type is spleen kidney yang deficiency;and forasmu-ch,in clinical practice,more stress should be laid on tonifying the spleen and kidney.2.Osteoporotic patients presenting with lower limb neurological symptoms are often the manifestations of the progress of osteoporosis,suggesting that more severe lesions have occurred on the bone mass and configuration of lumbar spine and spinal canal.3.There may not be a noticeable decline of BMD of lumbar spine bone when osteoporosis patients with lower limb neurological symptoms.Under these circ-umstances,special attention should be paid to BMD of proximal femurs to ident-ify osteoporosis. |
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