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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2024, Vol. 10 ›› Issue (01) : 39 -45. doi: 10.3877/cma.j.issn.2096-0263.2024.01.007

康复

低频脉冲电磁场对骨质疏松性胸腰椎骨折内固定术后康复的促进作用
冉仁国1, 罗政1,†(), 廖鑫1, 张付民1   
  1. 1. 445000　恩施土家族苗族自治州中心医院脊柱外科
  • 收稿日期:2023-05-18 出版日期:2024-02-05
  • 通信作者: 罗政
  • 基金资助:
    湖北省科技厅自然科学基金项目(2019CFB615)

Promoting effect of low-frequency pulsed electromagnetic field on postoperative rehabilitation of osteoporotic thoracolumbar fractures treated with internal fixation

Renguo Ran1, Zheng Luo1,†(), Xin Liao1, Fumin Zhang1   

  1. 1. Department of Spinal Surgery, Enshi Tujia and Miao Autonomous Prefecture Central Hospital, Enshi 445000, China
  • Received:2023-05-18 Published:2024-02-05
  • Corresponding author: Zheng Luo
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引用本文：

冉仁国, 罗政, 廖鑫, 张付民. 低频脉冲电磁场对骨质疏松性胸腰椎骨折内固定术后康复的促进作用[J]. 中华老年骨科与康复电子杂志, 2024, 10(01): 39-45.

Renguo Ran, Zheng Luo, Xin Liao, Fumin Zhang. Promoting effect of low-frequency pulsed electromagnetic field on postoperative rehabilitation of osteoporotic thoracolumbar fractures treated with internal fixation[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2024, 10(01): 39-45.

目的

探讨低频脉冲电磁场对骨质疏松性胸腰椎骨折内固定术后康复的促进作用。

方法

将118例骨质疏松性胸腰椎骨折内固定术后患者采用随机数字表分两组。对照组给予唑来膦酸治疗，观察组给予低频脉冲电磁场联合唑来膦酸治疗。对比两组患者疼痛程度，骨折愈合时间，治疗前后的骨密度，骨代谢指标水平与腰椎功能评分变化。

结果

111例患者均获得完整随访，随访率94.07%，随访时间6~12个月，平均（9.00±1.08）个月。其中观察组男20例、女37例，年龄50~83岁，平均（64.50±5.65）岁；对照组男18例、女36例，年龄50~83岁，平均（64.05±5.82）岁。观察组和对照组不同时刻疼痛评分进行重复测量设计的方差分析显示，观察组和对照组组间差异有统计学意义[观察组：（8.51±0.79）分、（5.72±0.65）分、（2.86±0.41）分，对照组：（8.96±0.91）分、（6.38±0.72）分、（4.77±0.53）分]（F=12.451，P<0.001），组别与时间点间存在交互作用（F=11.338，P<0.001），各时间点两组差异均有统计学意义（F=2.786、5.074、21.301，P=0.006、<0.001、<0.001）；观察组在各时间点间差异均有统计学意义（F=18.967，P<0.001）；观察组骨折愈合时间短于对照组[（12.31±2.07）周比（14.76±2.25）周]（t=6.125，P<0.001）；观察组和对照组治疗前与治疗6个月后在腰椎（L1~L4）骨密度、N-MID、β-CTx和PINP水平及腰椎功能障碍评分[观察组：（0.65±0.07）g/cm2与（0.71±0.08）g/cm2、（15.58±3.01）ng/mL与（8.82±1.23）ng/mL、（0.32±0.06）ng/mL与（0.13±0.02）ng/mL、（32.89±4.33）ng/mL与（54.56±7.37）ng/mL、（60.18±5.20）分与（15.88±3.01）分；对照组：（0.64±0.06）g/cm2与（0.67±0.07）g/cm2、（15.43±2.96）ng/mL与（11.24±1.74）ng/mL、（0.31±0.06）ng/mL与（0.19±0.04）ng/mL、（33.02±4.41）ng/mL与（41.23±6.06）ng/mL、（59.25±5.43）分与（24.35±4.20）分]，进行重复测量设计的方差分析显示，观察组和对照组组间差异有统计学意义（F=12.401、15.468、18.742、16.229、18.924，均P<0.001），组别与时间点间存在交互作用（F=8.065、12.224、18.965、22.467、14.881，均P<0.001），治疗前两组差异均无统计学意义，治疗6个月后两组差异均有统计学意义（F=2.894、8.750、10.318、10.738、10.330，均P<0.05）；观察组在治疗前与治疗6个月后差异均有统计学意义（F=2.924、19.286、22.569、36.385、12.387，均P<0.05）。

结论

低频脉冲电磁场在骨质疏松性胸腰椎骨折内固定术后能够有效缓解患者骨质疏松疼痛，缩短骨折愈合时间，提高骨密度，改善骨代谢，还可提高腰椎功能。

关键词: 低频脉冲电磁场, 骨质疏松症, 胸腰椎骨折, 内固定术, 骨密度
Objective

To promoting effect of low-frequency pulsed electromagnetic field on postoperative rehabilitation of osteoporotic thoracolumbar fractures treated with internal fixation.

Methods

118 patients with osteoporotic thoracolumbar fractures undergoing internal fixation were divided into 2 groups by a random digital table. The control group was given zoledronic acid, while the observation group was given low-frequency pulsed electromagnetic field combined with zoledronic acid. The pain degree, fracture healing time, the levels of bone density, indicators of bone metabolism and lumbar function before and after treatment were compared between the two groups.

Results

111 patients received complete follow-up, with a follow-up rate of 94.07%. The follow-up time was 6-12 months, with an average of (9.00±1.08) months. The analysis of variance of repeated measurement design for pain scores at different time points between the observation group and the control group showed statistically significant differences between the observation group and the control group [observation group: (8.51±0.79) scores, (5.72±0.65) scores, (2.86±0.41) scores, control group: (8.96±0.91) scores, (6.38±0.72) scores, (4.77±0.53) scores] (F=12.451, P<0.001). There was an interaction between the groups and time points (F=11.338, P<0.001), and the differences between the two groups at each moment were statistically significant (F=2.786, 5.074, 21.301, P=0.006, <0.001, <0.001). The differences in the observation group between each two moments were statistically significant (F=18.967, P<0.001). The fracture healing time in the observation group was shorter than that in the control group [(12.31±2.07) weeks vs (14.76±2.25) weeks] (t=6.125, P<0.001). The analysis of variance of repeated measurement design for the bone density, N-MID, β-CTx and PINP levels and lumbar dysfunction scores showed statistically significant differences between the observation group and the control group [observation group: (0.65±0.07) g/cm2 and (0.71±0.08) g/cm2, (15.58±3.01) ng/mL and (8.82±1.23) ng/mL, (0.32±0.06) ng/mL and (0.13±0.02) ng/mL, (32.89±4.33) ng/mL and (54.56±7.37) ng/mL, (60.18±5.20) scores and (15.88±3.01) scores; control group: (0.64±0.06) g/cm2 and (0.67±0.07) g/cm2, (15.43±2.96) ng/mL and (11.24±1.74) ng/mL, (0.31±0.06) ng/mL and (0.19±0.04) ng/mL, (33.02±4.41) ng/mL and (41.23±6.06) ng/mL, (59.25±5.43) scores and (24.35±4.20) scores](F=8.065, 12.224, 18.965, 22.467, 14.881, all P<0.001), and there was interaction between the groups and moments (F=12.401, 15.468, 18.742, 16.229, 18.924, all P<0.001). There was no statistically significant difference between the two groups before treatment, while there was a statistically significant difference between the two groups after 6 months of treatment (F=2.894, 8.750, 10.318, 10.738, 10.330, all P<0.05). The observation group showed statistically significant differences before and after 6 months of treatment (F=2.924, 19.286, 22.569, 36.385, 12.387, all P<0.05).

Conclusion

Low-frequency pulsed electromagnetic field can effectively relieve osteoporosis pain pain, shorten fracture healing time, increase bone density and improve bone metabolism after internal fixation of osteoporotic thoracolumbar fractures, which can also improve lumbar function.

Key words: Low-frequency pulsed electromagnetic field, Osteoporosis, Osteoporotic thoracolumbar fractures, Internal fixation, Bone density
图1~3 患者男性，图1术前X线示右侧股骨粗隆下粉碎性骨折，图2术后X线正位和图3术后X线侧位片示股骨骨折闭合复位PFNA内固定术，术后在对照组基础上结合低频脉冲电磁场治疗，显示骨折复位良好，内固定稳定。
表1 两组骨质疏松性胸腰椎骨折内固定术后患者不同时间点的疼痛评分（±s）
组别 例数 治疗后1个月 治疗后3个月 治疗后6个月 F值 P值
观察组 57 8.51±0.79 5.72±0.65a 2.86±0.41a* 18.967 <0.001
对照组 54 8.96±0.91 6.38±0.72a 4.77±0.53a* 11.245 <0.001
F值   2.786 5.074 21.301    
P值   0.006 <0.001 <0.001    
表2 两组骨质疏松性胸腰椎骨折患者治疗前后骨密度水平变化（g/cm2，±s）
组别 例数 腰椎（L1～L4）骨密度 F值 P值
治疗前 治疗后6个月
观察组 57 0.65±0.07 0.71±0.08 2.924 0.004
对照组 54 0.64±0.06 0.67±0.07 2.275 0.041
F值   0.842 2.894    
P值   0.401 0.005    
表3 两组骨质疏松性胸腰椎骨折患者治疗前后骨代谢相关指标对比（ng/mL，±s）
组别 例数 N-MID F值 P值 β-CTx F值 P值
治疗前 治疗后6个月 治疗前 治疗后6个月
观察组 57 15.58±3.01 8.82±1.23 19.286 <0.001 0.32±0.06 0.13±0.02 22.569 <0.001
对照组 54 15.43±2.96 11.24±1.74 14.553 <0.001 0.31±0.06 0.19±0.04 17.741 <0.001
F值   0.281 8.750     0.935 10.318    
P值   0.779 <0.001     0.354 <0.001    
组别 例数 PINP F值 P值
治疗前 治疗后6个月
观察组 57 32.89±4.33 54.56±7.37 36.385 <0.001
对照组 54 33.02±4.41 41.23±6.06 22.074 <0.001
F值   0.176 10.738    
P值   0.855 <0.001    
表4 两组骨质疏松性胸腰椎骨折患者治疗前后腰椎功能评分对比（分，±s）
组别 例数 腰椎功能评分 F值 P值
治疗前 治疗后6个月
观察组 57 60.18±5.20 15.88±3.01 12.387 <0.001
对照组 54 59.25±5.43 24.35±4.20 8.195 <0.001
F值   0.747 10.330    
P值   0.256 <0.001    
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