益骨汤对老年骨质疏松性股骨粗隆间骨折患者术后疗效的影响

Effect of Yigutang on postoperative efficacy of femoral intertrochanteric fracture in senile patients with osteoporosis

目的探讨益骨汤对老年骨质疏松性股骨粗隆间骨折患者术后疗效的影响。方法将2013年6月至2017年6月信阳市中医院收治的62例老年骨质疏松性股骨粗隆间骨折患者分为对照组和观察组,每组31例。2组患者均予以股骨近端防旋髓内钉内固定术进行治疗,术后第2天,对照组患者予以0.5μg阿法骨化醇软胶囊口服,连续10日,在第11天后改为隔日口服0.5μg阿法骨化醇软胶囊,连续治疗3个月;观察组患者予以益骨汤,每日1剂,水煎取汁口服,连续治疗3个月。比较2组患者手术时间、术中出血量、术后恢复时间及手术前、手术后3个月骨碱性磷酸酶(BALP)、骨钙素、核因子-κB受体活化因子配体(RANKL)、护骨素(OPG)、中医证候评分和手术前、手术后3、12个月的髋关节功能。随访12个月,观察2组患者临床疗效及不良反应发生率。结果 2组患者手术时间、术中出血量比较差异无统计学意义(P>0.05);观察组患者术后骨折愈合时间显著短于对照组(P<0.01)。术前2组患者血清BALP、骨钙素、RANKL、OPG水平比较差异无统计学意义(P>0.05);术后3个月2组患者血清BALP、骨钙素、OPG水平显著高于术前(P<0.05),RANKL水平显著低于术前(P<0.05);观察组患者血清BALP、骨钙素、OPG水平显著高于对照组(P<0.05),RANKL水平显著低于对照组(P<0.05)。术前2组患者中医证候评分比较差异无统计学意义(P>0.05)。2组患者术后3个月中医证候评分显著低于术前(P<0.05);观察组患者中医证候评分显著低于对照组(P<0.05)。2组患者术前髋关节功能评分比较差异无统计学意义(P>0.05)。2组患者术后3、12个月髋关节功能评分显著高于术前(P<0.01); 2组患者术后12个月髋关节功能评分显著高于术后3个月(P<0.01);观察组患者术后3、12个月髋关节功能评分均显著高于对照组(P<0.05)。对照组和观察组患者治疗总有效率分别为71.0%(22/31)和96.8%(30/31);观察组患者治疗总有效率显著高于对照组(χ~2=7.632,P<0.01)。对照组和观察组患者不良反应发生率分别为25.8%(8/31)和3.2%(1/31);观察组患者不良反应发生率显著低于对照组(χ~2=4.683,P<0.05)。结论老年骨质疏松性股骨粗隆间骨折术后应用益骨汤能够加速患者术后的恢复,获得较好的临床疗效,且无明显不良反应。

Objective To investigate the effect of Yigutang on postoperative efficacy of femoral intertrochanteric fracture in senile patients with osteoporosis. Methods Sixty-two elderly patients with osteoporosis who were performed with femoral intertrochanteric fracture from June2013 to June2017 in Xinyang Traditional Chinese Medical Hospital were divided into control group and observation group,with31 cases in each group.Patients in both groups were treated with femoral proximal anti-rotation intramedullary nail fixation.On the second day after surgery, patients in the control group were treated with 0.5 μg alfacalcidol soft capsule orally every day for10 consecutive days.On the11 th day for3 months,it was changed to oral 0.5 μg alfacalcidol soft capsule every other day for3 months.Patients in the observation group were given Yigutang which was decocted with water for oral administration,one dose per day.The operative time,intraoperative blood loss,postoperative recovery time,and the bone alkaline phosphatase (BALP),osteocalcin,nuclear factor-kappa B receptor activator ligand (RANKL),osteocalcin (OPG),traditional Chinese medicine(TCM) syndrome score before and at three months after operation and hip function score before and at3 and12 months after operation were compared between the two groups.The patients in the two groups were followed up for12 months to observe the clinical efficacy and the incidence of adverse reactions. Results There was no significant difference in the operative time and intraoperative blood loss between the two groups ( P >0.05).The postoperative fracture healing time of patients in the observation group was significantly shorter than that in the control group ( P <0.01).There was no significant difference in the serum BALP, osteocalcin,RANKL and OPG levels between the two groups before operation ( P >0.05).After three months of operation,the serum BALP,osteocalcin and OPG levels in the two groups were significantly higher than those before operation ( P <0.05),and RANKL level was significantly lower than that before operation ( P <0.05);the serum levels of BALP,osteocalcin and OPG in the observation group were significantly higher than those in the control group ( P <0.05),and the level of RANKL was significantly lower than that in the control group ( P < 0.05).There was no significant difference in the TCM syndrome score between the two groups before operation ( P >0.05).After three months of operation ,the TCM syndrome score of the two groups was significantly lower than that before operation ( P <0.05);the TCM syndrome score of patients in the observation group was significantly lower than that in the control group ( P <0.05).There was no significant difference in hip function scores between the two groups before operation ( P >0.05).At3,12 months after operation,the hip function scores of patients in the two groups were significantly higher than those before operation ( P <0.01).The hip function score of patients in the two groups at twelve months after operation was significantly higher than that at three months after operation ( P <0.01).At3,12 months after operation,the hip function score in the observation group was significantly higher than that in the control group ( P <0.05).The total effective rate of the control group and the observation group was 71.0%(22/31) and 96.8%(30/31),respectively.The total effective rate in the observation group was significantly higher than that in the control group (χ^2=7.632, P <0.01).The incidence of adverse reactions in the control group and the observation group was25.8%(8/31) and3.2%(1/31).The incidence of adverse reactions in the observation group was significantly lower than that in the control group (χ^2=4.683, P <0.05). Conclusion The application of Yigutang in the postoperative treatment of femoral intertrochanteric fracture in senile patients with osteoporosis can accelerate the postoperative recovery of the patients and obtain good clinical efficacy without obvious adverse reactions.