“秦氏疼痛方”联合单次小剂量地塞米松治疗踝关节骨折后急性软组织损伤的疗效研究

Efficacy study of“Qin⁃shi tengtong formula”combined with single low⁃dose dexamethasone in the treatment of acute soft tissue injury after ankle fracture

目的探讨“秦氏疼痛方”联合单次小剂量地塞米松治疗踝关节骨折后急性软组织损伤的临床疗效。方法选取2019年8月至2021年3月在我院住院治疗的符合标准的踝关节骨折患者200例,通过简单随机分组将患者分为生理盐水对照组(盐水组)、地塞米松对照组(地米组)、“秦氏疼痛方”对照组(疼痛方组)及“秦氏疼痛方”联合地塞米松治疗组(联合治疗组)。所有患者入院后,均给予抬高患肢、制动固定作为基础治疗,并在规定时间内对各组患者实施干预措施。比较4组患者在分组治疗前、伤后24 h、伤后48 h患肢的肢体周径差、血清炎症及创伤指标(包括IL⁃6、TNF⁃α、CK)水平、患肢张力性水疱及术后切口感染发生率。结果伤后24 h及48 h时,地米组、疼痛方组和联合治疗组的肢体周径差均明显小于盐水组(P<0.05);伤后48 h时,联合治疗组明显小于地米组和疼痛方组(P<0.05)。伤后24 h及48 h时,地米组、疼痛方组和联合治疗组的血清炎症和创伤指标(IL⁃6、TNF⁃α、CK)均明显小于盐水组(P<0.05);伤后48 h时,联合治疗组明显小于地米组和疼痛方组(P<0.05)。伤后48 h时,地米组、疼痛方组和联合治疗组的张力性水疱发生率均明显小于盐水组(P<0.05),联合治疗组明显小于地米组和疼痛方组(P<0.05);在整个随访期间,各组间切口感染率差异无统计学意义(P>0.05)。结论相比单用地塞米松或单用疼痛方治疗踝关节骨折后的急性软组织损伤,疼痛方联合单次小剂量地塞米松在减轻患者的肢体肿胀程度、降低张力性水疱发生率及改善血清创伤和炎症指标方面效果更佳,且切口感染发生率并无明显增加;该中西医结合用药方案效果优于单用中药或单用西药。

Objective To investigate the clinical efficacy of“Qin⁃shi tengtong Formula”combined with single low⁃dose dexamethasone in the treatment of acute soft tissue injury after ankle fracture.Methods From August 2019 to March 2021,200 patients with ankle fracture were selected and randomly divided into saline group,dexamethasone group,“Qin⁃shitengtong Formula”group and“Qin⁃shitengtong Formula”combined with dexamethasone treatment group(combined treatment group).After admission,all patients were given the basic treatment including lifting affected limbs and immobilization,and the intervention measures were implemented in each group within the specified time.The limb circumference difference,serum inflammatory and traumatic indicator(including IL⁃6,TNF⁃α,CK)level,the incidence of tension blisters and postoperative incision infection were compared before treatment,24 hours and 48 hours after injury.Results At 24 hours and 48 hours after injury,the limb circumference difference in the dexamethasone group,“Qin⁃shitengtong Formula”group and combined treatment group was significantly less than that in the saline group(P<0.05);At 48 hours after injury,the limb circumference difference in the combined treatment group was significantly less than that in the dexamethasone group and“Qin⁃shitengtong Formula”group(P<0.05).At 24 hours and 48 hours after injury,the serum inflammatory and trauma indicators(IL⁃6,TNF⁃α,CK)in the dexamethasone group,“Qin⁃shitengtong Formula”group and combined treatment group were significantly lower than those in the saline group(P<0.05);At 48 hours after injury,the serum inflammatory and trauma indicators in the combined treatment group were significantly lower than those in the dexamethasone group and“Qin⁃shitengtong Formula”group(P<0.05).At 48 hours hours after injury,the incidence of tension blisters in the dexamethasone group,“Qin⁃shitengtong Formula”group and combined treatment group was significantly lower than that in the saline group(P<0.05),and the combined treatment group was significantly lower than that in the dexamethasone group and“Qin⁃shitengtong Formula”group(P<0.05).During follow⁃up,there was no significant difference in the wound infection rate among four groups(P>0.05).Conclusion Compared with dexamethasone or“Qin⁃shitengtong Formula”in the treatment of acute soft tissue injury after ankle fracture,“Qin⁃shitengtong Formula”combined with single low⁃dose of dexamethasone is more effective in reliving limb swelling,reducing the incidence of tension blisters and improving the serum trauma and inflammatory indicators,while the incidence of incision infection has no significant increase.The combination of traditional Chinese medicine and Western medicine shows better therapeutic effects than that of Western medicine or traditional Chinese medicine alone.