血府逐瘀汤对股骨颈骨折愈合时间、骨形成蛋白-2、血清胰岛素样生长因子-I的影响及临床疗效

Effects of Xuefu Zhuyu Decoction on the Healing Time of Femoral Neck Fracture,Serum BMP-2,IGF-1 and Efficacy Analysis

目的分析血府逐瘀汤应用在股骨颈骨折患者中对骨折预后影响以及血清骨形成蛋白(BMP-2)、胰岛素样生长因子(IGF-1)水平变化情况。方法回顾性选取2015年1月—2017年6月期间收治的股骨颈骨折患者180例,根据治疗方法不同分为对照组和治疗组。对照组患者采用常规手术治疗,治疗组在对照组治疗基础上联合中药血府逐瘀汤治疗。观察分析两组患者治疗前后血清IGF-1、血管内皮生长因子(VEGF)、BMP-2、IL-6、肿瘤坏死因子-α(TNF-α)和C反应蛋白(CRP)浓度变化;采用髋关节Harris评分对患者治疗效果进行评价;对患者疼痛、肿胀、便秘、口渴主要症状进行4级评分法;记录两组患者骨折愈合时间,术后发生尺神经麻痹、骨关节炎以及骨折延迟愈合等并发症发生情况。结果治疗后治疗组患者治疗优良率97.78%(88/90)显著高于对照组85.56%(77/90),两组比较差异有统计学意义(P<0.05)。治疗组治疗后血清胰岛素样生长因子-I(IGF-1)(282.54±21.58)μg/L,血管内皮生长因子(VEGF)(93.44±13.58)ng/L,骨形成蛋白-2(BMP-2)(12.87±1.69)ng/L;对照组治疗后IGF-1(2194.54±13.52)μg/L,VEGF(70.76±7.19)ng/L,BMP-2(7.58±0.89)ng/L;两组比较差异有统计学意义(P<0.05)。治疗组治疗后白介素-6(IL-6)(22.04±2.21)μg/L,肿瘤坏死因子-α(TNF-α)(30.05±3.21)μg/L,C反应蛋白(CRP)(1.15±0.65)mg/L;对照组治疗后IL-6(35.13±6.75)μg/L,TNF-α(45.65±9.15)μg/L,CRP(2.67±1.86)mg/L,两组比较差异有统计学意义(P<0.05)。治疗组治疗后疼痛(1.16±0.72)分,肿胀(1.02±0.71)分,便秘(1.12±0.89)分,口渴(0.86±0.73)分;对照组治疗后疼痛(1.98±0.35)分,肿胀(1.78±0.38)分,便秘(1.88±0.41)分,口渴(1.66±0.32)分,两组比较差异有统计学意义(P<0.05)。治疗组骨折愈合时间(8.21±1.35)周,发生尺神经麻痹1例,骨关节炎2例,骨折延迟愈合0例;对照组骨折愈合时间(11.54±3.52)周,发生尺神经麻痹7例,骨关节炎9例,骨折延迟愈合6例,两组比较差异有统计学意义(P<0.05)。结论血府逐瘀汤应用在股骨颈骨折患者中可以缩短骨折愈合时间,减轻体内炎症反应程度,减轻患者临床症状积分,促进骨折部位骨组织细胞增殖和分化,降低术后并发症发生率,值得在临床推广应用。

Objective To explore the effect of XuefuZhuyu Decoction on the prognosis of fracture of femoral neck fracture and the changes of serum BMP-2 and IGF-1 levels.Methods A retrospective study of 180 patients with femoral neck fractureadmitted from January 2015 to June 2017 was divided into a control group and a observation group according to different treatment method.Patients in the control group were treated with conventional surgery,and the observation group were treated withXuefuZhuyu Decoctionbased on the treatment of the control group,and the therapeutic effect of the two groups was analyzed.serum insulin-like growth factor-I(IGF-1),vascular endothelial growth factor(VEGF),bone morphogenetic protein-2(BMP-2),IL-6,tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)concentration changes was observed and analyzed.The Harris Harris score was used to evaluate the treatment effect of patients.A4-level scoring method on the main symptoms of pain,swelling,constipation,and thirst was performed.The fracture healing time of the two groups of patients was recorded.Postoperative complications such as ulnar nerve palsy,osteoarthritis,and delayed fracture healing.Results After treatment,the excellent and good rate of the treatment group(88/90)was 97.78%,which was significantly higher than that of the control group(77/90),85.56%.The difference between the two groups was statistically significant(P<0.05).Serum insulin-like growth factor-I(IGF-1)(282.54±21.58)μg/L,vascular endothelial growth factor(VEGF)(93.44±13.58)ng/L,bone morphogenetic protein-2(BMP-2)(12.87±1.69)ng/L;control group IGF-1(2194.54±13.52)μg/L,VEGF(70.76±7.19)ng/L,BMP-2(7.58±0.89)ng/L,the difference was statistically significant(P<0.05).After treatment,interleukin-6(IL-6)(22.04±2.21)μg/L,tumor necrosis factor-α(TNF-α)(30.05±3.21)μg/L,C-reactive protein(CRP)(1.15±0.65)Mg/L;IL-6(35.13±6.75)μg/L,TNF-α(45.65±9.15)μg/L,CRP(2.67±1.86)mg/L after treatment,the difference between the two groups is statistically significant Significance(P<0.05).Pain(1.16±0.72)points,swelling(1.02±0.71)points,constipation(1.12±0.89)points,thirst(0.86±0.73)points after treatment;control group pain(1.98±0.35)points,swelling after treatment(1.78±0.38)points,constipation(1.88±0.41)points,thirst(1.66±0.32)points,the difference between the two groups was statistically significant(P<0.05).The fracture healing time of the observation group was(8.21±1.35)week,there was 1 case of ulnar nerve paralysis,2 cases of osteoarthritis,and 0 case of delayed healing of fracture;In the control group,there were 7 cases of ulnar nerve palsy,9 cases of osteoarthritis,and 6 cases of delayed healing of the fracture,and the difference between groups was statistically significant(P<0.05).Conclusion The application of XuefuZhuyu Decoction in patients with femoral neck fracture can shorten fracture healing time,reduce the degree of inflammation in the body,reduce the patients′clinical symptoms integral,promote fracture bone cell proliferation and differentiation,reduce the incidence of postoperative complications,which was worth popularizing in clinical application.