化瘀接骨汤配合T形钢板内固定治疗桡骨远端骨折疗效及对患者骨代谢、微量元素和血清炎性因子影响

Effect of Huayu Jiegu Decoction Combined with T-Plate Fixation on Treatment of Distal Radius Fracture and Its Effect on Bone Metabolism,Microelements and Serum Inflammatory Factors

目的:探讨化瘀接骨汤配合T形钢板内固定治疗桡骨远端骨折疗效及对患者骨代谢、微量元素和血清炎性因子的影响,旨在为更好地治疗桡骨远端骨折患者提供有效的理论依据。方法:选取2014年8月—2018年8月期间医院收治的110例桡骨远端骨折患者作为研究对象,采用随机数字表达法将其分为对照组和研究组,每组55例,两组患者均行T形钢板内固定治疗,手术结束后,对照组患者采用云南白药和仙灵骨葆胶囊治疗,研究组患者采用化瘀接骨汤治疗,两组均治疗6周。比较不同治疗方法对两组患者的临床疗效、骨代谢、微量元素和血清炎性因子的影响。结果:(1)研究组临床治疗总有效率显著高于对照组(96.36%vs 72.73%)(χ~2=11.758,P<0.05);(2)两组治疗后钙(Ca)、镁(Mg)、铜(Cu)、铁(Fe)浓度与治疗前比较差异均无显著性(P>0.05),研究组与对照组治疗后Ca、Mg、Cu、Fe浓度比较差异均无显著性(P>0.05),两组治疗后锌(Zn)浓度较治疗前明显降低,但研究组治疗后Zn浓度降低程度小于对照组(P<0.05),两组治疗后铅(Pb)浓度较治疗前明显增高,但研究组治疗后Pb浓度增高程度小于对照组(P<0.05);(3)两组治疗后I型胶原交联羧基末端肽(CTX-I)、II型胶原交联羧基末端肽(CTXII)、核转录子-κB受体活化因子(RANK)、核转录子-κB受体活化因子配体(RANKL)、抗酒石酸酸性磷酸酶5b(TRACP5b)、骨保护素(OPG)、骨钙素(BGP)、I型前胶原羧基端肽(PICP)水平均较治疗前明显升高(P<0.05),研究组治疗后CTX-I、CTX-II、RANK、RANKL、TRACP5b水平较对照组明显降低(P<0.05),研究组治疗后ALP、OPG、BGP、PICP水平较对照组明显升高(P<0.05);(4)两组治疗后白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平均较治疗前明显降低(P<0.05),研究组治疗后IL-1、IL-6、TNF-α水平均较对照组明显降低(P<0.05)。结论:化瘀接骨汤配合T形钢板内固定治疗桡骨远端骨折的临床疗效确切,可明显改善患者骨代谢状态,调节患者血清Zn、Pb浓度,抑制患者IL-1、IL-6、TNF-α等炎性因子的释放,对骨折愈合具有明显的促进作用。

Objective:To investigate the effect of Huayu Jiegu decoction combined with T-plate fixation on treatment of distal radius fracture and its effect on bone metabolism,trace elements and serum inflammatory factors,and to provide an effective theoretical basis for better treatment of distal radius fractures.Methods:110 patients with distal radius fractures treated in our hospital between August 2014 and August 2018 were selected and randomly divided into control group and study group,each with 55 cases.All patients received the T-plate fixation,based on this,the control group received the Yunnan Baiyao capsules and Xianlinggubao capsule,while the observation group received the Huayu Jiegu decoction,both tid for 6 wk.Then the clinical efficacy,bone metabolism,trace elements,and serum inflammatory factors in the two groups were compared.Results:(1)The total effective rate of in the study group was significantly higher than that in the control group(96.36%vs 72.73%)(χ~2=11.758,P<0.05);The calcium(Ca),magnesium(Mg),copper(Cu),and iron(Fe)concentrations after treatment within the two groups showed no significant difference(P>0.05),and those concentrations between groups neither had no significant difference(P>0.05);The Zinc(Zn)concentration was decreased significantly after treatment in both groups,and the decreasing level was more obvious in the control group than in the study group(P<0.05);The concentration of Plumbum(Pb)in the two groups after treatment was significantly increased,but increasing level in the study group after treatment was less than that in the control group(P<0.05);(3)The type I collage cross-linked-telopeptide(CTX-I),type II collage cross-linkedtelopeptide(CTX-II),receptor activator of NF-κB(RANK),receptor activator of NF-κB ligand(RANKL),tartrate-resistant acid phosphatase 5 b(TRACP5 b),osteoprotegerin(OPG),Bone gla protein(BGP),procollagen I carboxy-terminal propeptide(PICP)and Alkaline phosphatase(ALP)levels were significantly increased(P<0.05);Compared with the control group,the levels of CTX-I,CTX-II,RANK,RANKL,and TRACP5 b in the study group were significantly decreased(P<0.05),the ALP,OPG,BGP,PEP levels in the study group were significantly increased(P<0.05);(4)The levels of interleukin-1(IL-1),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were significantly decreased after treatment in both groups(P<0.05),and the decreasing level was more significant in the study group than that in the control group(P<0.05).Conclusion:For patients with distal radius fractures,Huayu Jiegu decoction combined with T-plate fixation is an effective way to ameliorate the bone metabolism,regulate the serum Zn and Pb concentrations,inhibit the inflammatory factors such as IL-1,IL-6,TNF-α,etc.,which plays a significant role in promoting fracture healing.