摘要
脊柱转移瘤多见于40岁以上人群,病理性骨折是脊柱转移瘤常见的并发症,是肿瘤进入晚期的信号之一,多数为稳定的压缩性骨折,少数为椎体爆裂性骨折,依次好发于胸椎、腰椎、颈椎及骶椎。脊柱转移瘤病理性骨折临床表现为腰背部剧烈疼痛、起床翻身活动受限,甚至脊柱畸形、脊髓神经损害,严重影响患者的生存率及生活质量。现代医学主要采取镇痛药物、放化疗、传统开放融合术及微创椎体成形术等手段治疗,存在一定的局限性。中医药在缓解肿瘤骨折患者症状、降低复发率等方面逐渐显现出实用性优势。根据脊柱转移瘤病理性骨折成因及特点,其可归属于中医学“骨病”“骨瘤”“骨痿”的范畴。曾朝辉教授认为正气不足、肝肾亏虚是本病发生的主要原因,而气滞、瘀血、痰浊阻滞督脉是致病的必要条件,亦为病情进展的关键要素。曾朝辉教授临证以护肾养肝、扶正求本为核心治法,采用除痰破瘀、调养气血法畅督脉,用药选方根据病证变化化裁自如,同时注重内外兼治,疗效确切。文章分析曾朝辉教授以补肝肾、除痰瘀、调气血、畅督脉法治疗脊柱转移瘤病理性骨折经验,并附病案1例,以期为临床相关诊治提供借鉴。
Spine metastatic tumor is more common in individuals over 40 years old.Pathological fracture is a common complication of spinal metastatic tumor,serving as one of the signs indicating the advanced stage of the tumor.The majority of these fractures is stable compression type,while a minority is vertebral burst fracture,with a predilection of the thoracic,lumbar,cervical,and sacral vertebrae in that order.Clinically,pathological fractures due to spinal metastatic tumor present with severe lumbosacral pain,restricted mobility during activities such as getting out of bed or turning over,and even spinal deformity and spinal cord nerve damage,which seriously impact the patients’survival rate and quality of life.Modern medical treatments primarily include analgesics,radiotherapy and chemotherapy,traditional open fusion surgery,minimally invasive vertebroplasty,etc.,each with its limitations.Traditional Chinese medicine(TCM)is increasingly demonstrating its practical advantages in alleviating symptoms in patients with tumor-induced fractures,and reducing the recurrence rates.According to the causes and characteristics of pathological fractures due to spinal metastatic tumor,it can be classified into the categories of“bone disease”“osteoma”and“osteoporosis”in TCM.Professor ZENG Zhaohui believes that the insufficient vital energy and liver-kidney deficiency are the main causes of the disease,and that Qi(气)stagnation,blood stasis,and phlegm turbidity obstructing Du meridian(督脉)are the necessary conditions for the onset of the disease and also the key elements in the progression of the disease.Professor ZENG Zhaohui takes protecting kidney and nourishing liver,and supporting vital energy as the core treatment method,and the methods of removing phlegm and resolving blood stasis,and regulating Qi and nourishing blood to unblock Du meridian are used clinically.In terms of prescription,medication is adjusted according to the changes of the disease,and attention is paid to the internal and external treatment simultaneously,with definite curative effects.Professor ZENG Zhaohui’s experience in treating pathological fractures of spinal metastatic tumors by the method of tonifying liver and kidney,removing phlegm and blood stasis,regulating Qi and blood,and smoothing Du meridian is analyzed in this article now,with one case report as evidence,providing a reference for clinical diagnosis and treatment of this disease.
出处
《中医临床研究》
2025年第1期61-66,共6页
Clinical Journal Of Chinese Medicine
基金
湖南省中医药科研计划项目(D2022113)。
关键词
肿瘤
脊柱转移瘤
病理性骨折
名医经验
Cancer
Spinal metastatic tumor
Pathological fracture
Expert physician experience
作者简介
周全(1999-),湖北黄冈人,2022级硕士研究生,从事中医骨伤临床研究;通讯作者:曾朝辉(1976-),湖南株洲人,硕士研究生导师,主任医师,株洲市名中医,全国中医临床特色技术传承骨干人才,从事中医骨伤临床研究。
