续骨活血汤辅助手术治疗老年闭合性股骨转子间骨折临床研究

Clinical Study on Xugu Huoxue Tang Assisting Operation for Closed Intertrochanteric Femur Fractures in the Elderly

目的:观察续骨活血汤辅助手术治疗老年闭合性股骨转子间骨折的临床疗效。方法:选取80例老年闭合性股骨转子间骨折患者为研究对象,按照随机数字表法分为对照组与研究组各40例。对照组采用人工半髋关节置换术治疗,研究组在对照组基础上加服续骨活血汤。采用Harris评分表评定患者髋关节功能,采用自制生活质量综合调查问卷评估患者生活质量,采用酶联免疫吸附法测定患者Ⅰ型前胶原羧基端肽(PICP)、骨碱性磷酸酶(BALP)、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)、骨钙素(BGP)水平;测量2组股骨头平均骨密度、局部骨密度;记录2组下地负重时间、骨性愈合时间、患侧肿胀消退时间;记录2组治疗前后足背动脉血流速度峰值、血流量、管径及治疗过程中并发症发生情况。结果:与同组术前比较,2组术后4、8、14周Harris评分均逐渐升高(P<0.05);与对照组术后4、8、14周比较,研究组同期Harris评分均较高(P<0.05)。与同组治疗前比较,治疗后2组BALP、BGP、PICP水平均升高(P<0.05),股骨头局部骨密度、平均骨密度及足背动脉管径、血流量、血流速度峰值均增大(P<0.05),β-CTX水平均降低(P<0.05);与对照组治疗后比较,研究组治疗后BALP、BGP、PICP水平均较高(P<0.05),股骨头局部骨密度、平均骨密度及足背动脉管径、血流量、血流速度峰值均较大(P<0.05),β-CTX水平较低(P<0.05)。与对照组治疗后比较,研究组治疗后社会功能、躯体功能、心理功能、疼痛度评分均较高(P<0.05),患侧肿胀消退、下地负重、骨性愈合时间均较短(P<0.05)。对照组并发症发生率40.00%,高于研究组12.50%(P<0.05)。结论:续骨活血汤辅助手术治疗能够明显提高老年闭合性股骨转子间骨折患者关节功能,提高生活质量,改善骨代谢及足背动脉血流状况,增大骨密度,减少并发症。

Objective:To observe the clinical effect of Xugu Huoxue tang assisting operation for closed intertrochanteric femur fractures in the elderly. Methods:A total of 80 cases of elderly patients with closed intertrochanteric femur fractures were selected as the study subjects,and divided into the control group and the study group according to the random number table method,with 40 cases in each group. The control group was treated with artificial hemiarthroplasty,and the study group was additionally treated with Xugu Huoxue tang based on the treatment of the control group. The hip joint function was evaluated by Harris scores,the quality of life by self-made comprehensive questionnaire on quality of life,and the levels of carboxyterminal propeptide of type I procollagen(PICP), bone alkaline phosphatase(BALP), β-isomerized C-terminal telopeptides(β-CTX) and osteocalcin(BGP) by enzyme-linked immunosorbent assay. The average bone mineral density and local bone mineral density of femoral head in the two groups were measured. The weight-bearing time,bone healing time and swelling regression time of the affected limbs in the two groups were recorded. The peak value of artery velocity,blood flow and pipe diameter in dorsum pedis before and after treatment,and the incidence of complications during treatment were recorded in the two groups. Results: At 4, 8 and 14 weeks after operation, the Harris scores in the two groups were gradually increased when compared with those before operation(P<0.05);the Harris scores in the study group were higher than those in the control group at the same time period(P<0.05). After treatment,the levels of BALP,BGP and PICP in the two groups were increased when compared with those before treatment(P<0.05),and the average bone mineral density and local bone mineral density of femoral head as well as the peak value of artery velocity, blood flow and pipe diameter in dorsum pedis were increased(P<0.05),and β-CTX levels were decreased(P<0.05);the levels of BALP,BGP and PICP in the study group were higher than those in the control group(P<0.05),and the average bone mineral density and local bone mineral density of femoral head as well as the peak value of artery velocity,blood flow and pipe diameter in dorsum pedis were larger(P<0.05), and β-CTX level was lower(P<0.05). After treatment, the scores of social function, physical function,mental function and pain in the study group were higher than those in the control group(P<0.05),and the swelling regression time of the affected limbs,weight-bearing time and bone healing time were shorter(P<0.05). The incidence of complications was 40.00% in the control group,higher than that of 12.50% in the study group(P<0.05). Conclusion:Xugu Huoxue tang assisting operation can significantly improve the joint function of elderly patients with closed intertrochanteric femur fractures, improve quality of life, bone metabolism and artery blood flow in dorsum pedis, increase bone mineral density and reduce complications.