“破、和、补”平乐正骨辨证理论在老年股骨粗隆间骨折围手术期的应用

Application of“Expelling,Harmonizing and Tonifying”in Theory of Pingle Orthopedics in Treating Elderly Patients with Femoral Intertrochanteric Fracture in the Perioperative Period

目的:探讨平乐正骨"破、和、补"辨证理论在老年股骨粗隆间骨折患者围手术期的应用。方法:采用随机、单盲平行对照临床研究方法。选取河南省洛阳正骨医院2014年10月至2015年10月期间收治的老年股骨粗隆间骨折患者44例,共44髋,分为观察组与对照组,每组22例。观察组中,男12例,女10例,平均年龄(68.1±3.1)岁,采用平乐正骨三期辨证药物治疗结合闭合复位髓内钉内固定术;对照组中,男11例,女11例,平均年龄(67.9±2.8)岁,采用安慰剂结合闭合复位髓内钉内固定术。从术中出血量、住院时间、围手术期并发症、骨折愈合率及术后3、6、12、24个月骨密度(Bone Mineral Density,BMD)改变、Harris评分方面对其临床应用疗效进行比较分析。结果:共43例患者获得完整随访,失访1例,随访时间18~36个月,平均时间26.6个月。2组患者术中出血量、住院时间比较,差异无统计学意义(P>0.05);骨折愈合率、围手术期下肢深静脉血栓形成比较,差异有统计学意义(P<0.05);术后12、24个月髋关节Harris评分比较,差异均有统计学意义(P<0.05);术后12个月骨密度值比较,差异有统计学意义(P<0.05)。结论:以平乐正骨"破、和、补"三期辨证药物为基础,结合髓内钉内固定治疗老年股骨粗隆间骨折,可降低围手术期中并发症的发生率,同时提高骨折愈合率、骨密度及髋关节功能的恢复,临床应用疗效满意。

Objective： To study the application of＂expelling,harmonizing and tonifying＂in theory of Pingle orthopedics in treating elderly patients with femoral intertrochanteric fracture in the perioperative period. Methods： a randomized,single-blind,controlled clinical research method was used and a retrospective analysis of from 44 cases with femoral intertrochanteric fracture who had treatment in the hospital from October 2014-October 2015. All patients were divided into treatment group with 22 cases（ 12 males and 10 females,aged 68. 1 ± 3. 1 years） and control group with 22 cases（ 11 males and 11 females,aged 67. 9 ± 2. 8years）. Patients in the treatment group received Pingle Orthopedics Ⅲ-stage medicinal treatment combined with closed reduction and internal fixation with intramedullary nail,while patients in the control groups took blank drugs and closed reduction and internal fixation with intramedullary nail. Blood loss,in-hospital duration,perioperative complications,the probability of fracture healing mineral density（ BMD） and Harris scores were observed to compare the clinical effect of the two groups. Results： A total of 43 patients were followed up for 18-36 months with an average of 26. 6 months and only one patient was not followed up. No difference and in-hospital duration for the patients in the two groups. There was difference in fracture healing rate,perioperative deep venous thrombosis and Harris score of 12 and 24 months after the surgery of the two groups（ P 0. 05）. There was difference in BMD of 12 months after the surgery of the two groups（ P 0. 05）. Conclusion： ＂Expelling,harmonizing and tonifying＂in theory of Pingle orthopedics combined with closed reduction and internal fixation intramedullary nail for the treatment of femoral intertrochanteric fracture,with a good clinical efficacy,may reduce the incidence of complications and increase fracture healing rate,BMD and joint function in the perioperative period.