凉血化瘀法结合血肿回植对踝部骨折术后关节功能恢复的临床观察

Clinical Observation on Joint Function Recovery in Postoperative Ankle Fracture Patients Treated by Therapy of Cooling Blood to Resolve Blood Stasis Combined with Hematoma Implantation

【目的】探讨凉血化瘀法结合血肿回植对踝部骨折术后踝关节肿胀及功能恢复的影响。【方法】将120例踝部骨折患者随机分成3组,分别为血肿回植组、中药组和中药+血肿回植组,每组各40例。3组患者均采用常规切开复位内固定术治疗,血肿回植组术中给予骨折线处血肿回植治疗,中药组于术后第1天开始给予凉血化瘀中药口服治疗14 d,中药+血肿回植组在血肿回植的基础上给予凉血化瘀中药口服治疗14 d。观察3组患者术后第2天、2周、4周时疼痛视觉模拟量表(VAS)评分、美国矫形足与踝关节协会(AOFAS)评分、踝部肿胀值及C反应蛋白(CRP)、血沉、白细胞介素6(IL-6)、白细胞介素1β(IL-1β)和肿瘤坏死因子α(TNF-α)等的变化情况,并比较3组患者的不良反应发生情况。【结果】(1)术后2周和4周时,3组患者的VAS疼痛评分和踝部肿胀值均较术后第2天明显降低,患肢踝部AOFAS评分均较术后第2天明显提高(P<0.05),且中药组和中药+血肿回植组患者对VAS疼痛评分和踝部肿胀值的降低作用及对患肢踝部AOFAS评分的升高作用均明显优于血肿回植组(P<0.01或P<0.05),而中药组与中药+血肿回植组比较,差异均无统计学意义(P>0.05)。(2)术后2周和4周时,3组患者的CRP、血沉、IL-6、IL-1β和TNF-α水平均较术后第2天明显降低(P<0.05),且中药组和中药+血肿回植组对CRP、血沉、IL-6、IL-1β和TNF-α水平的降低作用均明显优于血肿回植组(P<0.01),而中药组与中药+血肿回植组比较,差异均无统计学意义(P>0.05)。(3)3组患者不良反应发生率比较,差异均无统计学意义(P>0.05)。【结论】凉血化瘀中药可以通过降低踝部骨折部位血肿回植内固定术后的炎性反应,从而达到缓解术后疼痛、肿胀及促进踝部功能恢复的目的。

Objective To investigate the effect of therapy of cooling blood to resolve blood stasis combined with hematoma implantation on ankle swelling and functional recovery in postoperative patients with ankle fracture.Methods One hundred and twenty patients with ankle fracture were randomly divided into 3 groups,namely hematoma implantation group,Chinese medicine group and combined therapy group,and 40 cases were in each group.The 3 groups were all treated by conventional open reduction and internal fixation.Additionally,hematoma implantation group was given hematoma implantation at the fracture line during the operation,Chinese medicine group was given oral use of Chinese medicine for cooling blood to resolve blood stasis for 14 days from the first day after operation,and the combined therapy group was given hematoma implantation combined with oral use of Chinese medicine for 14 days.On the second day,second week and fourth week after operation,visual analogue scale(VAS)pain scores,American Orthopedic Foot and Ankle Society(AOFAS)scores,ankle swelling,and serum levels of C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),interleukin(IL)-6,IL-1βand tumor necrosis factor alpha(TNF-α)in the 3 groups were detected and recorded.Meanwhile,the incidence of adverse reactions in the groups was also recorded.Results(1)On the second week and fourth week after operation,the VAS pain scores and ankle swelling values were lower and AOFAS scores of the affected ankles were higher in the 3 groups than those on the second day after operation(P<0.05),and the effects of Chinese medicine group and the combined therapy group were stronger than those of the hematoma implantation group(P<0.05 or P<0.01),but the effects of Chinese medicine group were similar to those of the combined therapy group(P>0.05).(2)On the second week and fourth week after operation,the serum levels of CRP,ESR,IL-6,IL-1βand TNF-αin the 3 groups were significantly lowered(P<0.05 compared with those on the second day after operation),and the decrease in Chinese medicine group and the combined therapy group was superior to that in the hematoma implantation group(P<0.01),but the difference between Chinese medicine group and combined therapy group was insignificant(P>0.05).(3)There was no significant difference in the incidence of adverse reactions among the 3 groups(P>0.05).Conclusion Chinese medicine for cooling blood to resolve blood stasis can achieve the actions of relieving postoperative pain and swelling and promoting the recovery of ankle function of ankle fracture patients through reducing the inflammatory reaction in the fracture site of the ankle after internal fixation with hematoma implantation.