骨质疏松症物理治疗的研究进展

doi:10.3969/j.issn.1674-490X.2021.06.006

摘要/Abstract

摘要： 骨质疏松症是一种中老年人易患的骨骼性疾病,其特点是骨密度下降,骨微结构破坏,骨脆性增加,易发生骨折。药物疗法是有效防治骨质疏松、降低骨折的一个重要手段,但存在治疗周期长、药物不良反应等问题。而物理治疗兼具疗效突出且不良反应少的优点,现主要阐述物理治疗在骨质疏松治疗中的应用,旨在为临床制定出高质量的防治骨质疏松的康复策略提供依据。

关键词: 骨质疏松症, 发病机制, 脉冲电磁场, 超声波, 体外冲击波, 运动疗法

Abstract: Osteoporosis is a skeletal disease which is susceptible to middle-aged and elderly people. It is characterized by decreased bone density, destruction of bone microstructure, increased bone fragility, and prone to fractures.Drug therapy is an important means to effectively prevent osteoporosis and reduces fractures, but there are problems such as long treatment period and adverse drug reactions. However, physical therapy has the advantages of outstanding curative effect and low side effects. This review mainly describes the application of physical therapy in the treatment of osteoporosis, aiming to provide a basis for clinically formulating high-quality rehabilitation strategies for prevention and treatment of osteoporosis.

Key words: osteoporosis, pathogenesis, pulsed electromagnetic field, ultrasound, extracorporeal shock wave, kinesitherapy

中图分类号:

黄雨青,王艳萌,王宁,隗麒轩, 杨信才. 骨质疏松症物理治疗的研究进展[J]. 医学研究与教育, 2021, 38(6): 36-43.

参考文献

[1] CANO A, CHEDRAUI P, GOULIS D G, et al. Calcium in the prevention of postmenopausal osteoporosis: EMAS clinical guide[J]. Maturitas, 2018, 107: 7-12. DOI: 10.1016/j.maturitas.2017.10.004.
[2] 郭世绂. 骨质疏松症的药物治疗及其理论基础[J]. 中华骨科杂志, 2004, 24(11): 54-58. DOI: 10.3760/j.issn:0253-2352.2004.11.014.
[3] 夏维波, 章振林, 林华, 等. 原发性骨质疏松症诊疗指南(2017)[J]. 中国骨质疏松杂志, 2019, 25(3): 281-309. DOI: 10.3969/j.issn.1007-9572.2017.00.118.
[4] 谭文捷, 周宏图. 脉冲电磁场并紫外线照射治疗骨质疏松症234例[J]. 中国临床康复,2003, 7(15): 2223. DOI: 10.3321/j.issn:1673-8225.2003.15.062.
[5] 王洁, 张鹏, 代庆刚, 等. 雌激素对大鼠骨髓间充质干细胞增殖及成骨分化的影响[J].上海口腔医学, 2014, 23(6): 654-660.
[6] 吴立鹏, 郑巍, 王石, 等. 大鼠正畸牙移动过程中胰岛素样生长因子-Ⅰ(IGF-Ⅰ)在牙周膜中的表达[J]. 黑龙江医药科学, 2006, 29(2): 42-43. DOI: 10.3969/j.issn.1008-0104.2006.02.016.
[7] SONG L G, LIU M L, ONO N, et al. Loss of wnt/β-catenin signaling causes cell fate shift of preosteoblasts from osteoblasts to adipocytes[J]. J Bone Miner Res, 2012, 27(11): 2344-2358. DOI: 10.1002/jbmr.1694.
[8] 苏红丽. 骨质疏松症的临床治疗进展[J]. 医药论坛杂志, 2018, 39(3): 175-177.
[9] 王娟, 艾显江. 低频脉冲磁疗结合电针治疗骨质疏松47例[J]. 首都医药, 2008, 15(2): 34. DOI: 10.3969/j.issn.1005-8257.2008.02.021.
[10] 武政, 冯阳阳, 阴彦斌. 微聚焦高能冲击波治疗骨质疏松性骨折的疗效评价[J]. 创伤外科杂志, 2017, 19(2): 135-138. DOI: 10.3969/j.issn.1009-4237.2017.02.016.
[11] 徐明义, 张平. 骨质疏松症的物理治疗研究进展[J]. 中国骨质疏松杂志, 2017, 23(9): 1245-1249. DOI: 10.3969/j.issn.1006-7108.2017.09.026.
[12] LEI T, LIANG Z, LI F, et al. Pulsed electromagnetic fields(PEMF)attenuate changes in vertebral bone mass, architecture and strength in ovariectomized mice[J]. Bone, 2018, 108: 10-19. DOI: 10.1016/j.bone.2017.12.008.
[13] TOPAL O, ÇINA AKSOY M, CIRI??塁ĪM, et al. Assessment of the effect of pulsed electromagnetic field application on the healing of bone defects in rats with heparin-induced osteoporosis[J]. Electromagn Biol Med, 2020, 39(3): 206-217. DOI: 10.1080/15368378.2020.1762636.
[14] CAI J, SHAO X, YANG Q J, et al. Pulsed electromagnetic fields modify the adverse effects of glucocorticoids on bone architecture, bone strength andporous implant osseointegration by rescuing bone-anabolic actions[J]. Bone, 2020, 133: 115266. DOI: 10.1016/j.bone.2020.115266.
[15] GORDON G A. Designed electromagnetic pulsed therapy: clinical applications[J]. J Cell Physiol, 2007, 212(3): 579-582. DOI: 10.1002/jcp.21025.
[16] 刘颖, 张萌萌, 郭忠, 等. 低频脉冲电磁场联合二膦酸盐和活性维生素D治疗骨质疏松的临床观察[J]. 中国老年学杂志, 2010, 30(8): 1133-1134. DOI: 10.3969/j.issn.1005-9202.2010.08.050.
[17] VAN DER JAGT O P, VAN DER LINDEN J C, WAARSING J H, et al. Systemic treatment with pulsed electromagnetic fields do not affect bone microarchitecturein osteoporotic rats[J]. Int Orthop, 2012, 36(7): 1501-1506. DOI: 10.1007/s00264-011-1471-8.
[18] 郭霜, 满江位, 姜春倩, 等. 低强度脉冲超声的生物物理学效应及相关机制的研究进展[J]. 中国医学物理学杂志, 2019, 36(5): 605-609. DOI: 10.3969/j.issn.1005-202X.2019.05.022.
[19] 刘东顺, 菅喜岐. 高强度聚焦超声波治疗的现状及其展望[J]. 生物医学工程与临床, 2006, 10(6): 395-398. DOI: 10.3969/j.issn.1009-7090.2006.06.019.
[20] CHEUNG W H, CHIN W C, QIN L, et al. Low intensity pulsed ultrasound enhances fracture healing in both ovariectomy-induced osteoporotic and age-matched normal bones[J]. J Orthop Res, 2012, 30(1): 129-136. DOI: 10.1002/jor.21487.
[21] UDDIN S M, QIN Y X. Dynamic acoustic radiation force retains bone structural and mechanical integrity in a functional disuse osteopenia model[J]. Bone, 2015, 75: 8-17. DOI: 10.1016/j.bone.2015.01.020.
[22] MANSJUR K Q, KURODA S, IZAWA T, et al. The effectiveness of human parathyroid hormone and low-intensity pulsed ultrasound on the fracture healing in osteoporotic bones[J]. Ann Biomed Eng, 2016, 44(8): 2480-2488. DOI: 10.1007/s10439-015-1533-y.
[23] OZDEMIR F, ZATERI C, MURAT S. Evaluation of the efficacy of therapeutic ultrasound on bone mineral density in postmenopausal period[J]. Rheumatol Int, 2008, 28(4): 361-365. DOI: 10.1007/s00296-007-0450-2.
[24] WU S L, KAWAHARA Y, MANABE T, et al. Low-intensity pulsed ultrasound accelerates osteoblast differentiation and promotes bone formation in an osteoporosis rat model[J]. Pathobiology, 2009, 76(3): 99-107. DOI: 10.1159/000209387.
[25] LI B F, HUANG G Y, MA Z H, et al. Ultrasound-assisted transdermal delivery of alendronate for the treatment of osteoporosis[J]. Acta Biochim Pol, 2020, 67(2): 173-179. DOI: 10.18388/abp.2020_5162.
[26] 陶泉, 杜青. 体外冲击波治疗骨质疏松症研究进展[J]. 中国康复, 2011, 26(1): 61-62.DOI: 10.3870/zgkf.2011.01.0033.
[27] SHI L, GAO F, SUN W, et al. Short-term effects of extracorporeal shock wave therapy on bone mineral density in postmenopausal osteoporotic patients[J]. Osteoporos Int, 2017, 28(10): 2945-2953. DOI: 10.1007/s00198-017-4136-7.
[28] MACKERT G A, SCHULTE M, HIRCHE C, et al. Low-energy extracorporeal shockwave therapy(ESWT)improves metaphyseal fracture healing in an osteoporotic rat model[J]. PLoS One, 2017, 12(12): e0189356. DOI: 10.1371/journal.pone.0189356.
[29] LAMA A, SANTORO A, CORRADO B, et al. Extracorporeal shock waves alone or combined with raloxifene promote bone formation and suppress resorption in ovariectomized rats[J]. PLoS One, 2017, 12(2): e0171276. DOI: 10.1371/journal.pone.0171276.
[30] GOLLWITZER H, GLOECK T, ROESSNER M, et al. Radial extracorporeal shock wave therapy(rESWT)induces new bone formation in vivo: results of an animalstudy in rabbits[J]. Ultrasound Med Biol, 2013, 39(1): 126-133. DOI: 10.1016/j.ultrasmedbio.2012.08.026.
[31] VAN DER JAGT O P, PISCAER T M, SCHADEN W, et al. Unfocused extracorporealshock waves induce anabolic effects in rat bone[J]. J Bone Joint Surg Am,2011, 93(1): 38-48. DOI: 10.2106/jbjs.i.01535.
[32] KOOLEN M K E, KRUYT M C, ÖNER F C, et al. Effect of unfocused extracorporeal shockwave therapy on bone mineral content of twelve distal forearms ofpostmenopausal women: a clinical pilot study[J]. Arch Osteoporos, 2019, 14(1): 113. DOI: 10.1007/s11657-019-0650-x.
[33] GERDESMEYER L, DIEHL P, GOLLWITZER H, et al. Radiale extrakorporale Stoβwellentherapie in der Orthop die[J]. J MINER STOFFWECHS, 2004, 11(4): 36-39.
[34] 王兴泽. 振动负荷训练研究进展[J]. 中国运动医学杂志, 2012, 31(7): 648-653. DOI: 10.16038/j.issn.1000-6710.2012.07.016.
[35] LI H M, WU W C, HE X L, et al. Applying vibration in early postmenopausalosteoporosis promotes osteogenic differentiation of bone marrow-derived mesenchymal stem cells and suppresses postmenopausal osteoporosis progression[J]. Biosci Rep, 2019, 39(9): BSR20191011. DOI: 10.1042/BSR20191011.
[36] RAMOS L A X, RODRIGUES F T M, SHIRAHIGE L, et al. A single whole body vibration session influences quadriceps muscle strength, functional mobility and balance of elderly with osteopenia and/or osteoporosis? Pragmatic clinical trial[J]. J Diabetes Metab Disord, 2019, 18(1): 73-80. DOI: 10.1007/s40200-019-00392-4.
[37] YAO R H, NISHII K, KITO T, et al. A novel device to prevent osteoporosis by promoting bone metabolism using a newly developed double-loading stimulation with vibration and shaking[J]. Okajimas Folia Anat Jpn, 2019, 96(1): 13-21. DOI: 10.2535/ofaj.96.13.
[38] ALIKHANI M, ALIKHANI M, ALANSARI S, et al. Therapeutic effect of localized vibration on alveolar bone of osteoporotic rats[J]. PLoS One, 2019, 14(1): e0211004. DOI: 10.1371/journal.pone.0211004.
[39] MATSUMOTO T, SATO D, HASHIMOTO Y. Individual and combined effects of noise-like whole-body vibration and parathyroid hormone treatment on bone defect repair in ovariectomized mice[J]. Proc Inst Mech Eng Part H J Eng Med,2016, 230(1): 30-38. DOI: 10.1177/0954411915616987.
[40] JEPSEN D B, RYG J, JØRGENSEN N R, et al. The combined effect of Parathyroid hormone(1-34)and whole-body Vibration exercise in the treatment of OSteoporosis(PaVOS)—study protocol for a randomized controlled trial[J].Trials, 2018, 19(1): 186. DOI: 10.1186/s13063-018-2551-5.
[41] HOFFMANN D B, SEHMISCH S, HOFMANN A M, et al. Comparison of parathyroid hormone and strontium ranelate in combination with whole-body vibration ina rat model of osteoporosis[J]. J Bone Miner Metab, 2017, 35(1): 31-39. DOI: 10.1007/s00774-016-0736-0.
[42] 张丽, 瓮长水. 全身振动训练治疗骨质疏松症的临床和基础研究进展[J]. 中国康复理论与实践, 2014, 20(10): 935-939. DOI: 10.3969/j.issn.1006-9771.2014.10.010.
[43] POLLOCK R D, WOLEDGE R C, MILLS K R, et al. Muscle activity and acceleration during whole body vibration: effect of frequency and amplitude[J]. Clin Biomech(Bristol, Avon), 2010, 25(8): 840-846. DOI: 10.1016/j.clinbiomech.2010.05.004.
[44] GOMES R M, JUNIOR M D F, FRANCISCO F A, et al. Strength training reversesovariectomy-induced bone loss and improve metabolic parameters in female Wistar rats[J]. Life Sci, 2018, 213: 134-141. DOI: 10.1016/j.lfs.2018.10.032.
[45] PASQUALINI L, MINISTRINI S, LOMBARDINI R, et al. Effects of a 3-month weight-bearing and resistance exercise training on circulating osteogenic cells and bone formation markers in postmenopausal women with low bone mass[J]. Osteoporos Int, 2019, 30(4): 797-806. DOI: 10.1007/s00198-019-04908-9.
[46] RAZZAK Z A, KHAN A A, FAROOQUI S I. Effect of aerobic and anaerobic exercise on estrogen level, fat mass, and muscle mass among postmenopausal osteoporotic females[J]. Int J Health Sci(Qassim), 2019, 13(4): 10-16.
[47] YU P A, HSU W H, HSU W B, et al. The effects of high impact exercise intervention on bone mineral density, physical fitness, and quality of life inpostmenopausal women with osteopenia: a retrospective cohort study[J]. Medicine(Baltimore), 2019, 98(11): e14898. DOI: 10.1097/MD.0000000000014898.
[48] 汪龙, 杨洁, 龚建明, 等. 骨质疏松治疗仪结合运动疗法治疗骨质疏松症的临床研究[J]. 东南国防医药, 2020, 22(1): 38-42. DOI: 10.3969/j.issn.1672-271X.2020.01.009.
[49] HUANG C C, WANG H H, CHEN K C, et al. Effects of a dynamic combined training on impulse response for middle-aged and elderly patients with osteoporosis and knee osteoarthritis: a randomized control trial[J]. Aging Clin Exp Res, 2021, 33(1): 115-123. DOI: 10.1007/s40520-020-01508-0.
[50] HARDING A T, WEEKS B K, LAMBERT C, et al. A comparison of bone-targeted exercise strategies to reduce fracture risk in middle-aged and older men with osteopenia and osteoporosis: LIFTMOR-M semi-randomized controlled trial[J]. J Bone Miner Res, 2020, 35(8): 1404-1414. DOI: 10.1002/jbmr.4008.
[51] ABOARRAGE JUNIOR A M, TEIXEIRA C V S, DOS SANTOS R N, et al. A high-intensity jump-based aquatic exercise program improves bone mineral density and functional fitness in postmenopausal women[J]. Rejuvenation Res, 2018, 21(6): 535-540. DOI: 10.1089/rej.2018.2069.
[52] GARCÍA-GOMÁRIZ C, BLASCO J M, MACIÁN-ROMERO C, et al. Effect of 2 years of endurance and high-impact training on preventing osteoporosis in postmenop ausal women: randomized clinical trial[J]. Menopause, 2018, 25(3): 301-306. DOI: 10.1097/GME.0000000000001005.
[53] MONTGOMERY G, ABT G, DOBSON C, et al. The mechanical loading and muscle activation of four common exercises used in osteoporosis prevention for early postmenopausal women[J]. J Electromyogr Kinesiol, 2019, 44: 124-131. DOI: 10.1016/j.jelekin.2018.12.004.
[54] CONRADSSON D, HALVARSSON A. The effects of dual-task balance training on gait in older women with osteoporosis: a randomized controlled trial[J]. Gait Posture, 2019, 68: 562-568. DOI: 10.1016/j.gaitpost.2019.01.005.
[55] 林丽勤, 吴美婷, 纪清治, 等. 核心稳定训练对预防老年骨质疏松症患者跌倒的影响[J]. 中国骨质疏松杂志, 2018, 24(7): 893-895, 909. DOI: 10.3969/j.issn.1006-7108.2018.07.010.
[56] KHAN A A, FARHAD A, SIDDIQUI P Q R, et al. Effects of osteoanabolic exercises on bone mineral density of osteoporotic females: a randomized controlled trial[J]. Int J Health Sci(Qassim), 2019, 13(1): 9-13.