补肾活血健脾法促进老年股骨粗隆间骨折术后康复临床观察

Clinical Observation of Bushen Gugu Decoction on Promoting Postoperative Rehabilitation of Elderly Patients with Intertrochanteric Fracture of Femur

目的:以"补肾活血健脾"理论为依据,组合而成的补肾固骨方加减,用以干预老年股骨粗隆间骨折患者的术后康复,评估其对老年股骨粗隆间骨折患者术后恢复的治疗作用,并观察补肾固骨方加减对老年股骨粗隆间骨折术后骨代谢指标及骨密度的影响。方法:收录2018年1月1日到2018年12月30日期间于中山市中医院确诊为老年股骨粗隆间骨折患者(年龄≥65岁)的病例资料,根据患者的治疗方案进行分组。采用补肾固骨方加减给予中药口服治疗患者分为研究组,对照组患者无中药干预,常规术后治疗方案;术后采用门诊复诊的方式对患者进行为期6个月的随访,记录两组患者空腹时静脉血各骨代谢指标值及术后骨密度值(bone mineral density,BMD),并在随访期间复查患者骨密度,对比分析两组患者骨代谢指标及骨密度变化;随访至第6个月时,评估老年患者术后生存质量,采用电话或门诊复诊的方式对患者进行问卷调查,对比分析两组患者各维度分数,分析患者生存质量状况。结果:共有确诊患者129例,根据入组标准剔除不符合要求的病例,本研究共入组98例患者的病例资料,研究组48例,对照组50例。两组患者性别分布,年龄均值,骨折Evans分型比较,差异无统计学意义(P>0.05);两组患者术前骨代谢指标钙(Ca)、磷(P)、骨碱性磷酸酶(BALP)、Ⅰ型胶原氨基末端延长肽(PINP)、甲状旁腺激素(PTH)、抗酒石酸酸性磷酸酶-5b(TRACP-5b)、1,25二羟维生素D3〔1,25(OH)2D3〕、及Ⅰ型胶原交联羧基末端肽(CTX-1)及骨密度值比较比较,差异无统计学意义(P>0.05);术后6个月,研究组Ca、P、1,25(OH)2D3、BALP及PINP值均高于对照组(P<0.05),PTH、TRACP-5b及CTX-1均低于对照组(P<0.05);两组患者术前骨密度比较,差异无统计学意义(P>0.05);术后6个月,两组患者骨密度均高于术前值(P<0.05),且研究组的股骨颈、大粗隆及转子间均显著高于对照组(P<0.05);两组患者术前SF-36评分差异无统计学意义(P>0.05),术后6个月,研究组在生理功能,生理职能,躯体得分,一般健康以及精力得分维度得分均显著高于对照组(P<0.05),社会功能,情感职能及精神健康高于对照组,但差异无统计学意义(P>0.05)。结论:采用补肾固骨方加减干预老年股骨粗隆间骨折患者术后恢复,可有效改善骨代谢,增加骨密度,促进老年患者术后恢复,提高患者生活质量。

Objective:Based on the theory of "tonifying the kidney,activating blood,and strengthening the spleen",a combination of Bushen Gugu prescriptions is used to intervene in the postoperative rehabilitation of elderly patients with femoral intertrochanteric fractures,and to evaluate its effects on elderly patients with femoral intertrochanteric fractures The therapeutic effect of postoperative recovery,and observe the effect of Bushen Gugu prescription on bone metabolism indexes and bone mineral density after senile intertrochanteric fractures.Methods:The case data of elderly patients with intertrochanteric fractures (age ≥ 65 years) diagnosed in Zhongshan Hospital of Traditional Chinese Medicine from January 1,2018 to December 30,2018 were collected and grouped according to the treatment plan of the patients.The patients who were treated with Bushen Gugu decoction and treated with traditional Chinese medicine were divided into study group.The control group had no traditional Chinese medicine intervention and had conventional postoperative treatment plan.After the operation,the patients were followed up for 6 months by outpatient follow-up,and the two groups were recorded.The values of bone metabolism indexes in venous blood and bone mineral density (BMD) (bone mineral density,BMD) after the patient’s fasting.The bone mineral density of the patients was rechecked during the follow-up period,and the changes in bone metabolism indexes and bone mineral density of the two groups were compared and analyzed;At the end of the month,the postoperative quality of life of elderly patients was assessed,and questionnaire surveys were conducted on the patients by telephone or outpatient follow-up.The scores of various dimensions of the two groups of patients were compared and the quality of life of the patients was analyzed.Results:There were a total of 129 confirmed patients.According to the enrollment criteria,cases that did not meet the requirements were excluded.The study included 98 patients’ case data,48 in the study group and 50 in the control group.There was no statistically significant difference in the gender distribution,age average,and fracture Evans classification of the two groups of patients (P>0.05);the two groups of patients were preoperative bone metabolism indexes calcium (Ca),phosphorus (P),bone alkaline phosphatase (BALP),type I collagen amino terminal extension peptide (PINP),parathyroid hormone (PTH),tartrate-resistant acid phosphatase-5b (TRACP-5b),1,25 dihydroxyvitamin D3[1,25(OH)2D3],and type I collagen cross-linked carboxyl terminal peptide (CTX-1) and bone mineral density value comparison,the difference was not statistically significant (P>0.05);6 months after surgery,the study group Ca,P,1,25 (OH) 2D3,BALP and PINP values were all higher than those of the control group (P<0.05),and PTH,TRACP-5b and CTX-1 were all lower than those of the control group (P<0.05);there was no difference in preoperative bone mineral density between the two groups Statistical significance (P>0.05);6 months after surgery,the bone mineral density of the two groups was higher than the preoperative value (P<0.05),and the femoral neck,greater trochanter and intertrochanter of the study group were significantly higher than those of the control Group (P<0.05);there was no significant difference in SF-36 scores between the two groups before surgery (P>0.05).At 6 months after surgery,the study group had scores of physiological function,physiological function,body score,general health and energy score The dimensional scores were significantly higher than those of the control group (P<0.05),and social function,emotional function and mental health were higher than those of the control group,but the difference was not statistically significant (P>0.05).Conclusion:The use of Bushen Gugu decoction to intervene in the postoperative recovery of elderly patients with intertrochanteric fractures can effectively improve bone metabolism,increase bone density,promote postoperative recovery of elderly patients,and improve the quality of life of patients.