中药内服外敷联合内固定术治疗胫骨平台骨折的疗效观察

Therapeutic Effect of Oral and External Application of Chinese Medicine Combined with Internal Fixation on Tibial Plateau Fracture

【目的】探讨中药内服外敷联合内固定术治疗胫骨平台骨折的临床疗效。【方法】将112例胫骨平台骨折患者随机分为观察组和对照组,每组各56例。对照组给予内固定术和术后康复锻炼治疗,观察组在对照组的基础上加用身痛逐瘀汤加味方口服联合伤科黄水外敷治疗,疗程为8周。观察2组患者治疗前后美国纽约特种外科医院(HSS)膝关节功能评分、疼痛视觉模拟量表(VAS)评分、肿胀程度以及血清肿瘤坏死因子α(TNF-α)、超敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)、骨钙素(BGP)、碱性磷酸酶(BALP)、Ⅰ型胶原交联C端肽(β-CTX)水平的变化情况,比较2组患者的骨折愈合时间、完全负重时间、膝关节功能优良率和术后并发症发生情况。【结果】(1)术后6个月,观察组的膝关节功能优良率为96.4%(54/56),明显高于对照组的80.4%(45/56),差异有统计学意义(P<0.05)。(2)治疗后及术后6个月,2组患者的HSS评分均较治疗前明显升高(P<0.05),且观察组的HSS评分均明显高于对照组(P<0.05)。(3)治疗14 d、28 d后,2组患者的VAS评分及膝关节肿胀程度均较治疗前明显降低(P<0.05),且观察组的VAS评分及膝关节肿胀程度均明显低于对照组(P<0.05)。(4)观察组的影像学骨折愈合时间、临床功能愈合时间及完全负重时间均明显短于对照组(P<0.05)。(5)治疗后,2组患者血清TNF-α、hs-CRP、IL-6、β-CTX水平均较治疗前降低(P<0.05),血清BGP、BALP水平均较治疗前升高(P<0.05),且观察组治疗后血清TNF-α、hs-CRP、IL-6、β-CTX水平均明显低于对照组,血清BGP、BALP水平均明显高于对照组(P<0.05)。(6)经术后6个月随访,观察组的术后并发症发生率为5.4%(3/56),低于对照组的12.5%(7/56),差异有统计学意义(P<0.05)。【结论】中药内服外敷联合内固定术治疗胫骨平台骨折疗效确切,可以有效促进骨折愈合,改善膝关节功能,抑制炎症反应,促进骨代谢,减少术后并发症。

Objective To investigate the clinical effect of oral and external application of Chinese medicine combined with internal fixation on tibial plateau fractures.Methods A total of 112 patients with tibial plateau fractures were randomly divided into the observation group and the control group,with 56 cases in each group.The control group received internal fixation and postoperative rehabilitation exercises,and the observation group was given oral use of modified Shentong Zhuyu Decoction combined with external application of Shangke Huangshui medicated gauze on the basis of treatment for the control group.The treatment for the two groups lasted for 8 weeks.Before and after treatment,we observed the changes in the scores of the American Hospital for Special Surgery(HSS)knee joint function,visual analog scale(VAS)knee pain scores,knee joint swelling degree,and serum levels of tumor necrosis factor alpha(TNF-α),hypersensitive C-reactive protein(hs-CRP),interleukin 6(IL-6),osteocalcin(BGP),bone alkaline phosphatase(BALP),and type I collagen cross-linked C-terminal peptide(β-CTX).And after treatment,the fracture healing time,complete weight-bearing time,excellent rate of knee joint function,and the incidence of postoperative complications of the two groups were compared.Results(1)Six months after the surgery,the excellent rate of HSS knee joint function in the observation group was 96.4%(54/56),and that of the control group was 80.4%(45/56).The intergroup comparison showed that the excellent rate of the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05).(2)After treatment and 6 months after the surgery,the scores of HSS knee joint function in the two groups were increased in comparison with those before treatment(P<0.05),and the increase in the observation group was superior to that in the control group,the difference being statistically significant(P<0.05).(3)After treatment for 14 and 28 days,the VAS pain scores and knee joint swelling degree in the two groups were decreased in comparison with those before treatment(P<0.05),and the VAS pain scores and knee joint swelling degree in the observation group after treatment were lower than those in the control group,the difference being statistically significant(P<0.05).(4)The fracture healing time showed by medical imaging,fracture healing time showed by clinical function examination,and complete weight-bearing time in the observation group were markedly shorter than those in the control group,the difference being statistically significant(P<0.05).(5)After treatment,serum levels of TNF-α,hs-CRP,IL-6,andβ-CTX in the two groups were decreased,and serum levels of BGP and BALP were increased in comparison with those before treatment(P<0.05).And serum TNF-α,hs-CRP,IL-6,andβ-CTX levels in the observation group after treatment were lower and serum BGP and BALP levels were higher than those in the control group,the difference being statistically significant(P<0.05).(6)During the postoperative 6-month follow-up,the incidence of postoperative complications in the observation group was 5.4%(3/56),and was lower than that of the control group(12.5%,7/56),the difference being statistically significant(P<0.05).Conclusion Oral and external application of Chinese medicine combined with internal fixation exerts certain effect for the treatment of tibial plateau fractures by promoting fracture healing,improving knee joint function,inhibiting inflammation,promoting bone metabolism,and reducing postoperative complications.