补肾断续汤结合髓内钉固定治疗胫骨中下段骨折不愈合的效果

Clinical effect of nonunion of middle and lower tibial fractures treating with Bushenxuduan Decoction combined with intramedullary nail fixation

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的效果。方法选择2016年4月~2016年11月石家庄市中医院、易县医院骨科诊治的胫骨中下段骨折不愈合患者68例,按照随机数字表法分为两组,每组各34例。对照组予以髓内钉固定,试验组予以补肾断续汤结合髓内钉固定治疗,30 d为1个疗程,共服用2个疗程。比较临床疗效、骨痂评分、手术相关症状消失时间、膝关节及踝关节功能恢复情况、踝关节功能以及疼痛视觉模拟评分、手术并发症以及不良反应。结果与治疗前相比,两组患者治疗后Kofoed评分升高,VAS评分降低(P<0.05),与对照组相比,试验组治疗后Kofoed评分较高,VAS评分较低(P<0.05)。试验组治疗有效率高于对照组治疗有效率(P<0.05),试验组骨痂评分较高,骨折愈合时间、肿胀消退时间以及住院天数较对照组缩短(P<0.05),膝关节及踝关节功能恢复优良率较高(P<0.05)。试验组出现2例上腹不适以及恶心症状,未处理后自行恢复。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的效果显著。

Objective To study the clinical effect of Bushenxuduan Decoction combined with intramedullary nailing in treating nonunion of the middle and lower tibial fractures. Methods From Apirl 2016 to November 2016, in Shijiazhuang City Hospital, Yi County Hospital, 68 patients with nonunion of the middle and lower tibial fractures diagnosed and treated in were selected, according to random number table, they were divided into two groups, with 34 cases in each group. The control group were treated with intramedullary nail fixation, the experiment group were treated with Bushenxuduan Decoction combined with intramedullary nail, patients received Bushenxuduan Decoction 1 agent a day, 30 d for a course of treatment, and two groups were treated for 2 courses. The clinical efficacy, score of callus, disappearance time of symptoms related to surgery, recovery of knee joint and ankle joint function, ankle joint function, visual analogue scale of pain, complication of surgery and adverse reaction were compared. Results Compared with before treatment, Kofoed scores in two groups after treatment increased, and VAS score decreased （P 〈 0.05）, and compared with the control group , Kofoed scores in the experiment group were higher and the VAS scores were lower （P 〈 0.05）. The effective rate of the ex- periment group was higher than the control group （P 〈 0.05）. Compared with the control group, the scores of callus were higher in the experimental group, the time of fracture healing, swelling and the number of hospital stay were shorter than the control group （P 〈 0.05）. The excellent and good rate of knee joint and ankle function was higher （P 〈 0.05）. There were 2 cases with abdominal discomfort and nausea in the experimental group, and recovery untreated. Conclusion Bushen Decoction combined with intramedullary nail fixation for the treatment of nonunion of the middle and lower tibial fractures was effective.