骨牵引联合中药三期辨证治疗高龄股骨粗隆间骨折

Skeletal traction with three phases syndrome differentiation treatment of TCM treating intertrochanteric fracture of femur in elderly patients

目的探讨中药三期辨证结合骨牵引治疗老年股骨粗隆间骨折的临床疗效。方法以股骨粗隆间骨折63例,且均存在严重伴随疾病或早期并发症不适宜手术治疗或拒绝手术治疗的高龄患者作为本次研究对象,随机分为2组。对照组30例,采用体质量的1/10~1/7牵引重量进行单纯骨牵引和功能锻炼治疗,疗程6~8周;研究组33例,在对照组的基础上进行中药3期辨证治疗。初期(1~2周):活血化瘀、消肿止痛,以当归、桃仁、红花等加减;中期(3~6周):活血化瘀、和营生新、濡养筋骨,以当归、赤芍、续断、威灵仙等加减;后期(6周后):坚骨壮筋、益气血、补肝肾,联合补中益气汤。结果研究组的肿胀消退时间、疼痛明显减轻时间以及X线示骨痂出现的时间明显少于对照组,差异有统计学意义(P<0.05);研究组治愈效果明显较对照组好,差异有统计学意义(P<0.05)。结论中药3期辨证结合骨牵引在治疗老年股骨粗隆间骨折方面更加安全有效,能有效地缩短患者的肿胀消退时间、疼痛明显减轻时间以及X线示骨痂出现的时间,提高治愈率。

Objective To explore the clinical effect ofskeletal traction with three phase syndrome differentiation treatment of TCM on intertrochanteric fracture of femur in elderly patients.Methods 63 patients with femoral intertrochanteric fracture,who has serious illness or early complications that were not suitable for surgery,or refused to surgical treatment were divided into two groups randomly.In the control group,30 cases were treated with simple bone traction and functional exercise with the weight of 1/10 ~ 1/7 traction weight,the course of treatment was 6~8 weeks.On the basis of the control group,33 cases in the study group were treated with 3 stages of TCM syndrome differentiation.In the initial stage（1-2 weeks）： activating blood circulation to remove stasis,detumescence and pain relief,with angelica,peach kernel,safflower and so on.The mid stage（3-6 weeks）： activating blood and resolving stasis,harmonizing nutrient qi,nourishing bones and muscles with Chinese angelica,radix paeoniae rubra,Radix dipsaci,Chinese Clematis Root addition and subtraction.The later stage（6 weeks later）： Strengthening bones and tendons,replenishing qi and activating blood,tonifying kidney and liver with Middle-Tonifying Qi-Replenishing decoction.Results The swelling subsided time,pain relief time and X-ray appearance of bone callus in the study group were significantly less than those in the control group,the difference was statistically significant（P〈0.05）; The curative effect of the study group was significantly better than that of the control group,the difference was statistically significant（P〈 0.05）.Conclusion Skeletal traction with three phase syndrome differentiation treatment of TCM treating intertrochanteric fracture of femur in elderly patients is safer,it can shorten the time of swelling subsided,the time of pain relief obviously and the time of X-ray callus,and improve the cure rate of patients.