壮筋养血汤加味联合切开复位内固定手术治疗晚期跟骨关节内骨折的疗效研究

Efficacy of Zhuangjin Yangxue Decoction Combined with Open Reduction and Internal Fixation Treating Advanced Stage of Intra-Articular Calcaneal Fractures

目的探讨壮筋养血汤加味联合切开复位内固定手术治疗晚期跟骨关节内骨折的疗效以及骨密度(BMD)和血钙水平的影响。方法筛选廊坊市人民医院和天津中医药大学第一附属医院2016年3月-2019年3月收治的跟骨关节内骨折患者92例作为研究对象,将纳入的病例按治疗方法不同分为对照组(46例)和观察组(46例)。两组患者接受跟骨关节内骨折切开复位内固定术;对照组术后常规感染预防等对症处理;观察组在对照组治疗基础上给予壮筋养血汤加味治疗,1剂/d,分早、晚内服,连续治疗3个月。比较两组足部功能疗效、放射学指标、距下关节活动度功能、骨折愈合时间以及BMD和血钙水平。结果观察组患者的优良率为93.48%,明显高于对照组为73.91%(P<0.05);与对照组比较,观察组患者治疗后跟骨Gissane角与B9hler角升高更明显,跟骨宽度下降更明显(P<0.01);观察组的轻度受限率(21.74%)明显高于对照组(43.48%),重度受限率(10.87%)显著低于对照组(30.43%)(P<0.05);观察组患者的骨折愈合时间(67.04±8.40) d显著少于对照组的骨折愈合时间(76.09±9.31) d(P<0.01);与对照组比较,观察组患者治疗后右跟骨BMD增加更明显,血钙下降更明显(P<0.01)。结论壮筋养血汤加味联合切开复位内固定手术治疗晚期跟骨关节内骨折的疗效显著,且可有效提高患者的BMD和降低血钙水平。

Objective To investigate the efficacy of Zhuangjin Yangxue Decoction combined with open reduction and internal fixation treating advanced stage of intra-articular calcaneal fractures and the effect on levels of bone mineral density(BMD)and serum calcium.Methods Ninety-two intra-articular calcaneal fractures patients admitted to the hospital from March 2016 to March 2019 were selected as the study subjects.The included patients were divided into control group(46 cases)and observation group(46 cases)according to different treatment methods.Both groups received open reduction and internal fixation for intra-articular calcaneal fractures.Control group was given with routine infection prevention and other symptomatic treatment post-operation.In the observation group,Zhuangjin Yangxue Decoction(1 dose/d and twice a day)was given on the basis of treatment in the control group.Both groups were treated for 3 months.Foot function efficacy,radiological indicators,subtalar range of motion function,fracture healing time,bone mineral density(BMD)and blood calcium levels were compared between the two groups.Results The excellent and good rate of the observation group was 93.48%,which was significantly higher than that of the control group(73.91%)(P<0.05).Compared with the control group,the Gissane Angle and Bohler Angle of the treated heel bone in the observation group were significantly increased,and the width of the heel bone was significantly decreased(P<0.01).The mild restriction rate(21.74%)in the observation group was significantly higher than that of the control group(43.48%),and the severe restriction rate(10.87%)was significantly lower than that of the control group(30.43%)(P<0.05).The fracture healing time[(67.04±8.40)d]in the observation group was significantly lower than that in the control group[(76.09±9.31)d](P<0.01).Compared with the control group,BMD of right calcaneal bone in the observation group was significantly increased,while serum calcium was significantly decreased after treatment(P<0.01).Conclusion The efficacy of Zhuangjin Yangxue Decoction combined with open reduction and internal fixation treating advanced stage of intra-articular calcaneal fractures is significant.The treatment can improve BMD and decrease serum calcium level.