补肾活血汤治疗胫骨骨折非感染性骨不连临床研究

Clinical Study on Kidney-Nourishing and Blood-Activating Decoction in the Treatment of Non-Infectious Nonunion of Tibial Fracture

目的:观察补肾活血汤治疗胫骨骨折非感染性骨不连的临床疗效。方法:将80例胫骨骨折非感染性骨不连患者按照随机数字表法分为对照组和观察组,每组各40例。对照组患者给予常规治疗,观察组在对照组治疗的基础上加用补肾活血汤。比较两组患者的临床疗效、术后并发症发生率,检测两组患者手术前后骨代谢指标[骨钙素(osteocalcin,OC)、骨碱性磷酸酶(bone alkaline phosphatase,BALP)、抗酒石酸酸性磷酸酶-5b(Tartaric acid Acid phosphatase-5b,TRACP-5b)、Ⅰ型胶原羧基端交联肽(typeⅠcollagen carboxyl terminal cross-linked peptide,CTX-Ⅰ)]、外周血Runx2、Osterix基因表达水平。结果:观察组有效率为97.5%,对照组有效率为85.0%,两组患者有效率比较,差异有统计学意义(P<0.05)。两组患者手术后血清OC、BALP高于本组手术前,TRACP-5b、CTX-Ⅰ低于本组手术前;手术后观察组OC、BALP高于对照组,TRACP-5b、CTX-Ⅰ低于对照组,差异均有统计学意义(P<0.05)。两组患者手术后Runx2、Os-terix mRNA表达水平高于本组手术前,且手术后观察组高于对照组,差异均有统计学意义(P<0.05)。观察组术后并发症发生率低于对照组,但差异无统计学意义(P>0.05)。结论:补肾活血汤可能通过上调Runx2/Osterix通路活性,促进胫骨骨折非感染性骨不连患者的骨折愈合,并可改善骨代谢指标。

Objective:To observe the clinical efficacy of Kidney-Nourishing and Blood-Activating Decoction on non-infectious non-union of tibial fracture.Methods:A total of 80 patients with non infective nonunion of tibial fracture were randomly divided into the control group and the observation group,with 40 cases in each group.The patients in the control group were given routine treat-ment,while the ones in the observation group were given Kidney-Nourishing and Blood-Activating Decoction on the basis of the treatment in the control group.The clinical efficacy and the incidence of postoperative complications were compared between the two groups.The levels of bone metabolism indexes[including osteocalcin(OC),bone alkaline phosphatase(BALP),tartaric acid phosphatase-5b(tracp-5b),type I collagen terminal cross linked peptide(CTX-I)],the expression level of Runx2/osterix path-way related molecules in peripheral blood.before and after operation were measured.Results:The effective rate was 97.5%in the observation group and 85.0%in the control group.There was significant difference between the two groups(P<0.05).The levels of serum OC and BALP in the two groups after operation were higher than those before operation,and the levels of TRACP-5b and CTX-I were lower than those before operation;After operation,the levels of OC and BALP in the observation group were higher than those in the control group,while the levels of TRACP-5b and CTX-I in the observation group were lower than those in the con-trol group,and all the differences were statistically significant(P<0.05).The expression levels of Runx2 and Osterix mRNA in the two groups after operation were higher than those before operation,and the above indexes in the observation group after operation was higher than those in the control group,and all the differences were statistically significant(P<0.05).The incidence of postop-erative complications in the observation group was lower than that in the control group,but the difference was not statistically signifi-cant(P>0.05).Conclusion:Kidney-Nourishing and Blood-Activating Decoction may promote fracture healing in patients with non-infectious nonunion of tibial fracture and enhance bone metabolism by up-regulating the activity of Runx2/Osterix pathway.