养血固肾汤联合骨化三醇对绝经后骨质疏松性股骨颈骨折空心螺钉内固定术后患者骨代谢指标及骨折愈合的影响

Effects of Yangxue Gushen Decoction Combined with Calcitriol on Bone Metabolism Indexes and Fracture Healing in Patients with Postmenopausal Osteoporotic Femoral Neck Fracture After Cannulated Screw Internal Fixation

【目的】探讨养血固肾汤联合骨化三醇治疗对绝经后骨质疏松性股骨颈骨折空心螺钉内固定术后患者骨代谢指标及骨折愈合的影响。【方法】将98例绝经后骨质疏松性股骨颈骨折患者随机分为试验组和对照组,每组各49例。2组患者均行空心螺钉内固定术治疗,术后均给予镇痛、抗生素预防感染、低分子肝素钠预防静脉血栓等常规治疗,在此基础上,对照组患者给予骨化三醇软胶囊口服治疗,试验组患者给予养血固肾汤联合骨化三醇软胶囊口服治疗,疗程为3个月并随访12个月以上。观察2组患者术前、术后疼痛视觉模拟量表(VAS)评分、健侧股骨颈骨密度和骨代谢相关指标的变化情况,比较2组患者的骨折愈合时间。【结果】(1)98例患者中,有5例患者失访,最终试验组46例、对照组47例患者能按要求接受12个月以上的随访,平均随访时间为(25.7±7.9)个月。(2)术后7 d和1个月,2组患者的疼痛VAS评分均较术前明显降低(P<0.01),且试验组的降低作用均明显优于对照组(P<0.01)。(3)试验组的骨折愈合时间为(11.3±0.71)周,明显短于对照组的(12.4±1.36)周,差异有统计学意义(P<0.01)。(4)术后半年,2组患者的骨密度值均较术前明显提高(P<0.05),且试验组的提高作用明显优于对照组(P<0.01)。(5)术后3个月,2组患者血清总Ⅰ型前胶原氨基端延长肽(tPINP)、骨钙素(BGP)、碱性磷酸酶(ALP)、胰岛素样生长因子Ⅰ(IGF-Ⅰ)水平均较术前明显升高(P<0.05),血清全段甲状旁腺素(iPTH)、Ⅰ型胶原羧基末端肽(sCTx)水平均较术前明显降低(P<0.05),且试验组对血清BGP、ALP、tPINP、IGF-I水平的升高作用和对血清iPTH、sCTx水平的降低作用均明显优于对照组(P<0.05或P<0.01)。【结论】养血固肾汤联合骨化三醇能显著加快绝经后骨质疏松性股骨颈骨折患者空心螺钉内固定术后的骨折愈合过程,减轻短期术后疼痛,改善术后血清骨代谢相关指标。

Objective To investigate the effects of Yangxue Gushen Decoction combined with calcitriol on bone metabolism indexes and fracture healing in patients with postmenopausal osteoporotic femoral neck fracture after cannulated screw internal fixation. Methods Ninety-eight patients with postmenopausal osteoporotic femoral neck fractures were randomly divided into the trial group and the control group,49 cases in each group. Both groups were given cannulated screw internal fixation, and then were treated with conventional treatment such as postoperative analgesia, antibiotics to prevent infection, and low molecular heparin sodium to prevent vein thrombosis. And additionally,the control group was given oral use of calcitriol soft capsules,while the treatment group was given oral use of calcitriol soft capsules together with Yangxue Gushen Decoction,a prescription with the actions of nourishing blood and strengthening kidney. The course of treatment lasted for 3 months and the follow-up lasted for over 12 months. The changes of visual analogue scale(VAS)pain scores,bone mineral density(BMD)of the healthy femoral neck and bone metabolism in the two groups were observed before and after surgery,and the fracture healing time of the two groups was compared. Results(1)Among the 98 patients,5 patients were lost to follow-up. Finally,46 patients in the trial group and 47 patients in the control group were followed up for more than 12 months as required,with averaged follow-up time of(25.7 ± 7.9)months.(2)Seven days and one month after surgery,the VAS pain scores in the two groups were significantly lower than those before surgery(P<0.01),and the lowering effect in the trial group was significantly superior to that in the control group(P<0.01).(3)The fracture healing time of the trail group was(11.3 ± 0.71)weeks,which was significantly shorter than(12.4 ± 1.36)weeks in the control group, and the difference was statistically significant(P<0.01).(4)Half a year after surgery,BMD of the two groups was significantly increased compared with that before surgery(P<0.05),and the effect on increasing BMD in the trial group was significantly superior to that in the control group(P<0.01).(5)Three months after surgery,the levels of serum total procollagen type I N-peptide(tPINP),bone gla-protein(BGP), alkaline phosphatase(ALP)and insulin-like growth factor Ⅰ(IGF-Ⅰ) in the two groups were significantly increased compared with those before surgery(P<0.05). The levels of serum intact parathyroid hormone(iPTH) and serum type Ⅰ collagen cross-linked N-telopeptide(sCTx) in the two groups were significantly lower than those before operation(P<0.05). The effect on increasing serum BGP,ALP,tPINP and IGF-I levels and the effect on lowering serum iPTH and sCTx levels in the trial group were significantly superior to those in the control group(P<0.05 or P<0.01). Conclusion Yangxue Gushen Decoction combined with calcitriol can significantly accelerate the fracture healing process in the patients with postmenopausal osteoporotic femoral neck fracture after cannulated screw internal fixation. It can relieve postoperative short-term pain and improve the indexes related to postoperative serum bone metabolism.