五味消毒饮加味对跟骨关节内骨折切开复位内固定术后肢体肿胀及骨折愈合的影响

Effects of Wuwei-Xiaodu Decoction on limb swelling and fracture healing in intra-articular calcaneal fractures after open reduction and internal fixation

目的观察五味消毒饮加味对跟骨关节内骨折切开复位内固定术后患者的疗效及对血流动力学的影响。方法选择2016年4月-2019年2月廊坊市人民医院和天津中医药大学第一附属医院跟骨关节内骨折患者88例,采用随机数字表法分为2组,每组44例。2组均接受跟骨关节内骨折切开复位内固定术,对照组于术后给予常规治疗措施,观察组在对照组基础上服用五味消毒饮加味。2组均连续治疗12周。采用X线与CT测量跟骨Gissane角与Bohler角、跟骨高度,采用血流动力学检测仪测定ESR、纤维蛋白原(fibrinogen, Fb)、全血黏度;采用美国足踝骨科协会踝-后足评分系统评价足部功能的恢复情况,记录骨折愈合时间及并发症发生情况。结果治疗后,观察组跟骨Gissane角[(130.01±15.76)°比(121.33±14.33)°,t=2.793]、Bohler角[(33.04±5.03)°比(28.93±4.31)°,t=4.189]、跟骨高度[(44.13±6.13)mm比(40.06±5.87)mm,t=6.556]均高于对照组(P<0.01);血清ESR[(13.65±1.94)mm/h比(18.99±2.30)mm/h,t=11.772]、Fb[(301.83±32.04)g/L比(319.85±33.62)g/L,t=2.536]水平及全血黏度[(7.04±0.82)mPa?s比(8.34±0.92)mPa?s,t=6.997]均低于对照组(P<0.01)。观察组骨折愈合时间[(66.85±8.17)d比(78.04±9.44)d,t=5.945]早于对照组(P<0.01),足部功能恢复优良率[97.7%(43/44)比81.8%(36/44),χ^2=4.456]高于对照组(P=0.035),并发症发生率[4.6%(2/44)比20.5%(9/44),χ^2=5.091]低于对照组(P=0.024)。结论五味消毒饮加味可促进跟骨关节内骨折切开复位内固定术后患者骨骼形态的恢复及骨折愈合,改善患者的血流动力学,减少术后并发症。

Objective To investigate the effect of Wuwei-Xiaodu Decoction in treating intra-articular calcaneal fractures after open reduction and internal fixation and its effect on hemodynamics.Methods A total of 88 intra-articular calcaneal fractures patients admitted to Langfang People’s Hospital and the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from April of 2016 to February of 2019 were selected and randomly divided into the control group and the observation group(44 patients in each group)by the method of random number table.Both groups received open reduction and internal fixation for intra-articular calcaneal fractures.The control group received conventional treatment after surgery.The observation group were treated with Wuwei-Xiaodu Decoction on the basis of treatment in the control group.Both groups were treated for 12 weeks.The Gissane Angle,Bohler Angle and calcaneal height were detected by X-ray and CT.The hemodynamic analyzer was used to determine ESR,Fibrinogen(Fb),and whole blood viscosity.The recovery of foot function was evaluated by using the Ankle-posterior foot scoring system of the American Orthopaedic Association,and the fracture healing time and complications were recorded.Results After treatment,the Gissane Angle(130.01°±15.76°vs.121.33°±14.33°,t=2.793),Bohler Angle(33.04°±5.03°vs.28.93°±4.31°,t=4.189)and calcaneal height(44.13±6.13 mm vs.40.06±5.87 mm,t=6.556)in the observation group were significantly higher than those in the control group(P<0.01).The fracture healing time(66.85±8.17 d vs.78.04±9.44 d,t=5.945)in the observation group was significantly lower than that of the control group(P<0.01).After treatment,serum ESR(13.65±1.94 mm/h vs.18.99±2.30 mm/h,t=11.772),Fb(301.83±32.04 g/L vs.319.85±33.62 g/L,t=2.536)levels and whole blood viscosity(7.04±0.82 mPa?vs.8.34±0.92 mPa?,t=6.997)in the observation group were significantly lower than those in the control group(P<0.01).The effective rate of foot function recovery 6 months after operation in the observation group was 97.7%(43/44)and 81.8%(36/44)in the control group,and the difference between the two groups was statistically significant(χ^2=4.456,P=0.035).The complication rate was 4.6%(2/44)in the observation group and 20.5%(9/44)in the control group,and the difference between the two groups was statistically significant(χ^2=5.091,P=0.024).Conclusions The Wuwei-Xiaodu Decoction can promote the recovery of bone shape after open reduction and internal fixation of intra-articular calcaneal fractures,reduce the complications after operation,promote fracture healing,and improve the hemodynamics.