补肾断续汤结合髓内钉固定治疗胫骨中下段骨折不愈合疗效及对C反应蛋白和炎症细胞因子的影响

Effect of BuShen Duanxu decoction and intramedullary nail fixation on fracture of tibial shaft nonunion and the influence on C-reactive protein and inflammatory cytokines

目的探讨补肾断续汤结合髓内钉固定治疗胫骨中下段骨折不愈合疗效以及对C反应蛋白(CRP)和炎症细胞因子的影响。方法将90例胫骨中下段骨折不愈合患者按照随机数字表法分为2组,观察组45例采用微创植骨后应用外固定架联合口服补肾断续汤治疗,对照组45例采用微创植骨后应用外固定架固定治疗。观察2组患者治疗后骨痂评分、骨折愈合时间、疼痛程度以及治疗前后血清C反应蛋白和炎症细胞因子水平变化情况,并采用Johner-Wruhs评分系统评估患者骨折愈合和下肢功能恢复情况。结果观察组术后3个月的骨痂评分明显高于对照组(P<0.05),且骨折愈合时间明显短于对照组(P<0.05);2组术后1个月和3个月疼痛评分均较入院时降低(P均<0.05),且观察组疼痛评分明显低于对照组(P<0.05);对照组术后1个月血清CRP、TNF-α及IL-6水平均无明显变化,观察组血清CRP、TNF-α及IL-6水平均较治疗前显著降低(P均<0.05);经过6个月康复,观察组骨折愈合和下肢功能恢复情况优于对照组(P<0.05)。结论补肾断续汤结合髓内钉固定治疗胫骨中下段骨折不愈合临床疗效肯定,可明显减轻术后炎症反应,促进患者肌肉及关节功能恢复,值得临床推广应用。

Objective It is to investigate the effect of Bushen Duanxu decochon combined with lntrameduttary nail Ilxatlon on fracture of tibial shaft nonunion and the effect on C-reactive protein and inflammatory cytokines in blood. Methods Ninety patients with middle and distal tihial fracture nonunion were randomly divided into 2 groups according to random number table grouping method, the observation group （ n = 45 ） was treated with minimally invasive bone grafting and external fixation com- bined with Bushen Duanxu decoction, the control group （ n = 45） was treated with minimally invasive bone grafting and exter- nal fixation. The bone scab scores, fracture healing time, degree of pain and the changes of blood C reactive protein （CRP） and cytokine before and after treatment were observed, and the Johner wruhs scoring system was used to assess fracture healing and lower limb function recovery. Results The bone scab scores after three months in the observation group were significantly higher and the fracture healing time was significantly lower than that of the control group（ P 〈 0.05 ）. The pain scores in 1,3 months after operation were decreased significantly compared with that on admission in both groups, and the the decrease in observation group was more significant than that in control group （P 〈 0.05 ）. The serum levels of CRP, TNF-α and IL-6 had no obvious change after treatment in control group, but the levels of these indexes in the observation group after treatment were decreased significantly compared with that before treatment（ P 〈 0. 05 ）. After six months of rehabilitation, the fracture healing and the limb function recovery was better in observation group than that of the control group. Conclusion Bushen Duanxu de- coction combined with intermittent intramedullary nail fixation had confirmed curative effect on nonunion of tibia fracture, which could reduce postoperative inflammatory reaction and promote the recovery of muscle and joint function of patients, it is worthy of clinical application.