基于“虚、瘀”理论探讨补肾活血法治疗Ⅱ型骨质疏松性髋部骨折的临床研究

Based on the theory of“deficiency and stasis”to explore the clinical study of tonifying kidney and activating blood circulation in the treatment of typeⅡosteoporotic hip fracture

[目的]探讨“虚、瘀”理论指导下补肾活血法治疗Ⅱ型骨质疏松性髋部骨折的临床疗效。[方法]2020年6月—2021年3月,纳入单侧股骨颈或股骨粗隆间新鲜闭合骨折行内固定治疗的老年患者80例。按随机数字表法随机分为治疗组和对照组,每组40例,术后第1天开始,在常规治疗的基础上,治疗组予强骨活血汤口服,对照组按3期辨证口服中药,疗程均为6个月。观察并记录两组患者术前、术后1~6个月拍摄髋部X线片评估骨折愈合情况,术后3个月、6个月检查L1-4和健侧股骨颈骨密度,骨代谢指标总Ⅰ型前胶原氨基端延长肽(T-PINP)、β-胶原特殊序列(β-CTX)、骨钙素(N-MID)。术后6个月评估髋关节功能、生活质量。[结果]治疗组骨折临床愈合时间较对照组缩短,差异有统计学意义(P<0.05)。两组患者L1-4骨密度比较,术后3个月和6个月,治疗组均明显优于对照组(P<0.05);两组患者健侧股骨颈骨密度比较,术后3个月,差异无统计学意义(P>0.05);术后6个月,治疗组明显优于对照组(P<0.05)。术后3个月和6个月,治疗组T-PINP均高于对照组,差异有统计学意义(P<0.05),β-CTX均低于对照组,差异有统计学意义(P<0.05),N-MID差异无统计学意义(P>0.05)。术后3个月,对照组Harris评分优于对照组,差异有统计学意义(P<0.05);术后6个月,两组患者Harris评分比较差异无统计学意义(P>0.05)。术后6个月生活质量评分比较,治疗组生活质量水平健康描述系统(EQ-5D)指数和健康刻度尺(EQ-VAS)评分均优于对照组,差异均有统计学意义(P<0.05)。[结论]补肾活血法可促进Ⅱ型骨质疏松性髋部骨折愈合,改善骨密度,调控骨代谢,提高临床疗效和生活质量水平。

[Objective]To explore the clinical effect of tonifying kidney and activating blood under the guidance of“deficiency and stasis”theory in the treatment of typeⅡosteoporotic hip fracture.[Methods]From June 2020 to March 2021,80 elderly patients with unilateral femoral neck or intertrochanteric fresh closed fractures treated with internal fixation were enrolled.Randomly divided into treatment group and control group according to random number table method,40 cases in each group.On the basis of conventional treatment,the treatment group was given Qianggu Huoxue Decoction orally,and the control group was given traditional Chinese medicine orally in three stages,the course of treatment was 6 months.Observe and record hip radiographs were taken before surgery and 1 to 6 months after surgery to evaluate fracture healing in both groups.Bone mineral density of L1-4 and healthy femoral neck and bone metabolism indexes(T-PINP,β-CTX,N-MID)were examined 3 and 6 months after operation.Hip function and quality of life were evaluated 6 months after surgery.[Results]The clinical healing time of the treatment group was shorter than that of the control group,and the difference was statistically significant(P<0.05).The comparison of L1-4 bone mineral density between 2 groups showed that 3 and 6 months after surgery,and the treatment group was significantly better than the control group(P<0.05).Comparison of bone mineral density of healthy femoral neck between the two groups showed that 3 months after surgery,and the difference was not statistically significant(P>0.05),and 6 months after surgery,and the treatment group was significantly better than the control group(P<0.05).At 3 and 6 months after surgery,T-PINP in the treatment group was higher than that in the control group,and the difference was statistically significant(P<0.05);β-CTX was lower than that in the control group,and the difference was statistically significant(P<0.05);N-MID change was not significant(P>0.05).The 3 months after surgery,Harris score of the control group was better than that of the control group,and the difference was statistically significant(P<0.05),and there was no significant difference in Harris score of the two groups 6 months after surgery(P>0.05).The EQ-5D index and EQ-VAS score of the treatment group were better than those of the control group at 6 months after surgery,and the differences were statistically significant(P<0.05).[Conclusion]Tonifying kidney and promoting blood circulation can promote hip fracture healing,improve bone density,regulate bone metabolism,improve clinical efficacy and quality of life.