中药外敷和薰洗治疗第五跖骨基底部骨折

External applications of traditional Chinese drugs and Chinese herbal steaming washing therapy for treatment of the fifth metatarsal base fractures

目的:探讨中药外敷和薰洗治疗第五跖骨基底部骨折的临床疗效。方法:49例第五跖骨基底部骨折患者,随机分为中药外治组(25例)和石膏固定组(24例)。中药外治组分2期治疗,早中期(第1周至第5周)中药外敷后绷带“8”字包扎固定,每日1次;后期(第6周至第7周)中药薰洗,每日早晚各1次。石膏固定组采用石膏后托外固定5周。治疗开始后,前5周患者拄双拐,患足不负重;第6周改用单拐,患足足跟部着地;第7周去除拐杖双足行走。分别于治疗前和治疗3周、5周、7周后,采用疼痛数字评定量表(numerical rating scale,NRS)评分评价患足疼痛情况,测量患足肿胀度;治疗7周后,参照《中医病证诊断疗效标准》中跖骨骨折疗效评价标准对骨折愈合情况进行评分,并采用“起立–行走”计时测试从行走时间和步态两方面对患者步行能力进行评价。结果:①治疗和随访完成情况。治疗开始后第2周,中药外治组1例患者因出现皮肤发红、瘙痒而终止治疗退出试验,其余48例患者均完成治疗和随访。②患足疼痛NRS评分。时间因素和分组因素不存在交互效应(F=0.537,P=0.586);2组患者患足疼痛NRS评分总体比较,差异有统计学意义,即存在分组效应(F=23.858,P=0.000);治疗前后不同时间点之间患足疼痛NRS评分的差异有统计学意义,即存在时间效应(F=89.863,P=0.000);2组患者患足疼痛NRS评分随时间变化总体上均呈下降趋势,但两组的下降趋势不完全一致;治疗前,2组患者患足疼痛NRS评分比较,差异无统计学意义[(76.17±12.16)分,(75.13±12.86)分,t=0.287,P=0.775];治疗3周、5周和7周后,中药外治组患足疼痛NRS评分均低于石膏固定组[(19.33±11.43)分,(27.42±10.97)分,t=-2.500,P=0.016;(2.58±3.81)分,(8.25±5.48)分,t=-4.160,P=0.000;(3.83±4.30)分,(12.29±6.15)分,t=-5.448,P=0.000]。③患足肿胀度。时间因素和分组因素存在交互效应(F=43.818,P=0.000);2组患者患足肿胀度总体比较,差异有统计学意义,即存在分组效应(F=8.582,P=0.000);治疗前后不同时间点之间患足肿胀度的差异有统计学意义,即存在时间效应(F=156.319,P=0.000);2组患者患足肿胀度随时间变化总体上均呈下降趋势,但两组的下降趋势不完全一致;治疗前,2组患者患足肿胀度比较,差异无统计学意义[(1.21±0.27)cm,(1.22±0.26)cm,t=-0.047,P=0.963];治疗3周、5周和7周后,中药外治组患足肿胀度均低于石膏固定组[(0.59±0.21)cm,(0.75±0.26)cm,t=-2.501,P=0.016;(0.06±0.09)cm,(0.42±0.22)cm,t=-6.559,P=0.000;(0.08±0.09)cm,(0.42±0.16)cm,t=-8.877,P=0.000]。④骨折愈合评分和患者步行能力。治疗7周后,中药外治组骨折愈合评分和步态评分均低于石膏固定组,起立行走时间较石膏固定组短[(1.5±0.5)分,(2.2±0.5)分,t=-4.615,P=0.000;(1.6±0.8)分,(2.6±0.6)分,t=-4.679,P=0.000;(8.5±0.3)s,(9.1±0.4)s,t=-6.124,P=0.000]。结论:对于第五跖骨基底部骨折,采用中药外敷和薰洗治疗,在缓解患足疼痛、消除患足肿胀、促进骨折愈合、改善患者行走能力方面均优于石膏后托外固定。

Objective:To explore the clinical curative effects of external applications of traditional Chinese drugs(TCD)and Chinese herbal steaming washing therapy for treatment of the fifth metatarsal base fractures.Methods:Forty-nine patients with fifth metatarsal base fractures were randomly divided into TCD external treatment group(25)and plaster fixation group(24).The patients in TCD external treatment group received two-stage treatment.In the early-middle period(from the 1st week to the 5th week),the patients were treated with external application of TCD followed by fixation with figure-of-eight bandages,once a day.In the later period(from the 6th week to the 7th week),the patients were treated with Chinese herbal steaming washing therapy,twice a day in the morning and evening respectively.The patients in plaster fixation group were treated with plaster slab external fixation for 5 weeks.Assisted by double crutches,the patient can walk on the uninjured foot in the first 5 weeks after the begining of the treatment.Assisted by single crutch,the patient can walk and strike the ground with the heel of the injured foot in the 6th week.The patient can walk on double feet without the crutchs in the 7th week.The injured foot pain was evaluated by using numerical rating scale(NRS)scores and the injured foot swelling degree was measured before the treatment and after 3-,5-and 7-week treatment respectively.The fracture healing was scored after 7-week treatment according to the therapeutic effect evaluation standard of metatarsal fracture which was extracted from Standard for diagnosis and therapeutic effectiveness evaluation of traditional Chinese medicine syndromes,and the patient’s walking ability,including walking time and gait,was evaluated by using timed up and go test.Results:At the 2nd week after the begining of the treatment,one patient in TCD external treatment group dropped out of the trial for redness and itching in skin,and the treatment and follow-up were finished successfully in the other 48 patients.There was no interaction between time factor and group factor in injured foot pain NRS scores(F=0.537,P=0.586).There was statistical difference in injured foot pain NRS scores between the 2 groups in general,in other words,there was group effect(F=23.858,P=0.000).There was statistical difference in injured foot pain NRS scores between different timepoints before and after the treatment,in other words,there was time effect(F=89.863,P=0.000).The injured foot pain NRS scores presented a time-dependent decreasing trend in both of the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency.There was no statistical difference in injured foot pain NRS scores between the 2 groups before the treatment(76.17+/-12.16 vs 75.13+/-12.86 points,t=0.287,P=0.775).The injured foot pain NRS scores were lower in TCD external treatment group compared to plaster fixation group after 3-,5-and 7-week treatment(19.33+/-11.43 vs 27.42+/-10.97 points,t=-2.500,P=0.016;2.58+/-3.81 vs 8.25+/-5.48 points,t=-4.160,P=0.000;3.83+/-4.30 vs 12.29+/-6.15 points,t=-5.448,P=0.000).There was interaction between time factor and group factor in the injured foot swelling degree(F=43.818,P=0.000).There was statistical difference in injured foot swelling degree between the 2 groups in general,in other words,there was group effect(F=8.582,P=0.000).There was statistical difference in injured foot swelling degree between different timepoints before and after the treatment,in other words,there was time effect(F=156.319,P=0.000).The injured foot swelling degree presented a time-dependent decreasing trend in both of the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency.There was no statistical difference in injured foot swelling degree between the 2 groups before the treatment(1.21+/-0.27 vs 1.22+/-0.26 cm,t=-0.047,P=0.963).The injured foot swelling degree was lower in TCD external treatment group compared to plaster fixation group after 3-,5-and 7-week treatment(0.59+/-0.21 vs 0.75+/-0.26 cm,t=-2.501,P=0.016;0.06+/-0.09 vs 0.42+/-0.22 cm,t=-6.559,P=0.000;0.08+/-0.09 vs 0.42+/-0.16 cm,t=-8.877,P=0.000).The fracture healing scores and gait scores were lower and the up-and-go time was shorter in TCD external treatment group compared to plaster fixation group after 7-week treatment(1.5+/-0.5 vs 2.2+/-0.5 points,t=-4.615,P=0.000;1.6+/-0.8 vs 2.6+/-0.6 points,t=-4.679,P=0.000;8.5+/-0.3 vs 9.1+/-0.4 seconds,t=-6.124,P=0.000).Conclusion:For patients with the fifth metatarsal base fractures,the combination of external applications of TCD and Chinese herbal steaming washing therapy surpass plasterslab external fixation therapy in relieving foot pain,eliminating foot swelling,promoting fracture healing and improving walking ability.