补肾断续汤结合髓内钉固定治疗预防胫骨中下段骨折不愈合临床研究

Clinical Study on Bushen Duanxu Tang Combined with Intramedullary Nail Fixation Treating and Preventing Nonunion in Middle and Distal Tibial Fractures

目的:观察胫骨中下段骨折应用补肾断续汤联合髓内钉固定治疗的临床疗效。方法:将择期行手术治疗的98例胫骨中下段骨折患者随机分为观察组与对照组,每组49例;对照组行髓内钉固定术治疗,术后予以常规处理;观察组在对照组的基础上于术后第2天开始口服补肾断续汤治疗,所有患者均治疗3个月;观察比较2组临床疗效及骨折愈合时间、骨折不愈合发生率,治疗前后疼痛视觉模拟评分法(VAS)评分、血液流变学指标[全血高切黏度(WBHV)、低切黏度(WBLV)、红细胞聚集指数(EAI)、血浆黏度(PV)]、骨代谢指标[碱性磷酸酶(ALP)、骨钙素(BGP)、钙(Ca)、磷(P)]水平变化。结果:骨折愈合总有效率观察组为95.9%,对照组为81.6%,差异有统计学意义(P <0.05)。治疗后,观察组骨折愈合时间短于对照组、骨折不愈合率低于对照组,差异均有统计学意义(P <0.05)。治疗后,2组疼痛VAS评分均较治疗前显著下降(P <0.05),且观察组VAS评分明显低于对照组(P <0.05)。治疗后,2组各项血流变学指标WBHV、WBLV、EAI、PV值均较治疗前显著降低(P <0.05);且观察组各项指标值均低于对照组(P <0.05)。治疗后,2组患者血清ALP、BGP、P水平均较治疗前显著升高(P <0.05),血清Ca水平显著降低(P <0.05);且观察组上述各项指标改善较对照组更显著(P <0.05)。结论:补肾断续汤联合髓内钉固定治疗胫骨中下段骨折,能明显缩短患者骨折愈合时间,减轻疼痛,有效预防骨折不愈合的发生,其机制可能与改善体内血流变学状态、调控骨代谢有关。

Objective:To observe the clinical effect of Bushen Duanxu tang combined with intramedullary nail fixation for nonunion in middle and distal tibial fractures. Methods:A total of 98 cases of patients undergoing elective surgery for middle and distal tibial fractures were randomly divided into the observation group and the control group,49 cases in each group. The control group was given intramedullary nail fixation,and routine treatment after surgery;from the second day after surgery,the observation group was additionally given oral administration of Bushen Duanxu tang based on the treatment of the control group. Both groups were treated for three months. The clinical effect,the fracture healing time and the incidence of fracture nonunion and side effect in the two groups were observed and compared. Before and after treatment,the changes of scores of Visual Analogue Scale(VAS), levels of hemorheology indexes including whole blood high viscosity(WBHV), whole blood low viscosity(WBLV),erythrocyte aggregation index(EAI) and plasma viscometry(PV),and levels of bone metabolic markers including alkaline phosphatase(ALP), bone Gla protein(BGP), calcium(Ca) and phosphorus(P) in the two groups were observed and compared. Results:The total effective rate of fracture healing was 95.9% in the observation group and 81.6%in the control group,the difference being significant(P < 0.05). After treatment,the fracture healing time in the observation group was shorter than that in the control group,and the incidence of fracture nonunion was lower than that in the control group, differences being significant(P < 0.05). After treatment, the VAS scores in the two groups were significantly decreased when compared with those before treatment(P < 0.05),and the score in the observation group was significantly lower than that in the control group(P < 0.05). After treatment, the values of hemorheology indexes including WBHV,WBLV,EAI and PV in the two groups were significantly decreased when compared with those before treatment(P < 0.05),and the above values in the observation group were significantly lower than those in the control group(P < 0.05). After treatment,the concentrations of ALP,BGP and P in serum in the two groups were significantly increased when compared with those before treatment(P < 0.05), and the levels of Ca in serum were significantly decreased(P < 0.05);the improvement of the above indexes in the observation group was more significant than that in the control group(P < 0.05).Conclusion:The therapy of Bushen Duanxu tang combined with intramedullary nail fixation in treating middle and distal tibial fractures can significantly shorten the fracture healing time, reduce pain and effectively prevent the incidence of fracture nonunion,whose mechanism may be related to the improvement of hemorheology and regulation of bone metabolism.