活血通络方对桡骨远端骨折患者锁定加压接骨板内固定术后早期炎症状态及腕关节功能恢复的干预作用

Intervention Effect of Huoxue Tongluo Prescription on Early Inflammation and Wrist Function Recovery after Locking Compression Plate Internal Fixation in Patients with Distal Radius Fractures

目的观察应用活血通络方对桡骨远端骨折患者锁定加压接骨板(Locking compression plate,LCP)内固定术后早期炎症状态及腕关节功能恢复的干预作用。方法选取2019年7月—2020年7月期间于唐山市第二医院行LCP内固定术的110例桡骨远端骨折患者为研究对象,按随机信封法分为对照组(55例,给予扶他林乳剂涂搽治疗)和治疗组(55例,在对照组治疗基础上给予活血通络方治疗)。两组患者均治疗1个月。观察两组患者中医证候积分、腕关节肿胀程度、疼痛程度、Cooney腕关节功能、氧化应激[超氧化物歧化酶(Superoxide dismutase,SOD)、总抗氧化能力(Total antioxidant capacity,TAC)、丙二醛(Malondialdehyde,MDA)]及血清炎症因子[白介素-6(Interleukin-6,IL-6)、白介素-1β(Interleukin-1β,IL-1β)、C-反应蛋白(C-reaction protein,CRP)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)],统计治疗后临床疗效。结果治疗后,两组患者关节持续刺痛、痛处固定、疼痛剧烈、局部僵硬、腰膝酸软、活动时加重、四肢疲乏评分均较治疗前降低,差异有统计学意义(P<0.05);且治疗组关节持续刺痛、痛处固定、疼痛剧烈、局部僵硬、腰膝酸软、活动时加重、四肢疲乏评分均较对照组降低,差异有统计学意义(P<0.05)。治疗后,治疗组临床疗效98.18%(54/55)高于对照组83.64%(46/55),差异有统计学意义(P<0.05)。治疗后,两组患者腕关节肿胀程度、疼痛程度均较治疗前降低,Cooney腕关节评分较治疗前升高,差异有统计学意义(P<0.05);且治疗组腕关节肿胀程度、疼痛程度均较对照组降低,Cooney腕关节评分较对照组升高,差异有统计学意义(P<0.05)。治疗后,两组患者MDA水平均较治疗前降低,SOD、TAC较治疗前升高,差异有统计学意义(P<0.05);且治疗组MDA水平较对照组降低,SOD、TAC较对照组升高,差异有统计学意义(P<0.05)。治疗后,两组患者IL-6、IL-1β、CRP、TNF-α水平均较治疗前降低,差异有统计学意义(P<0.05);且治疗组IL-6、IL-1β、CRP、TNF-α水平均较对照组降低,差异有统计学意义(P<0.05)。结论活血通络方能够有效改善桡骨远端骨折患者LCP内固定术后临床症状,降低早期炎症反应,促使腕关节功能恢复,值得临床推广使用。

Objective To observe the intervention effect of Huoxue Tongluo Prescription on the early inflammation and wrist function recovery after locking compression plate(LCP)internal fixation in patients with distal radius fractures.Methods A total of 110 patients with distal radius fractures who underwent LCP internal fixation in Tangshan Second Hospital from July 2019 to July 2020 were enrolled and divided into a control group(n=55,treated with votalin emulsion)and an observation group(n=55,treated with additional Huoxue Tongluo Prescription on the basis of the therapeutic protocol of the control group)by a random envelope method.All patients were treated for one month.The traditional Chinese medicine(TCM)syndrome scores,wrist swelling degree,pain degree,Cooney wrist function scores,oxidative stress[superoxide dismutase(SOD),total antioxidant capacity(TAC),and malondialdehyde(MDA)],and serum inflammatory factors[interleukin 6(IL-6),interleukin 1β(IL-1β),C-reactive protein(CRP),and tumor necrosis factorα(TNF-α)]of the two groups were observed.The clinical efficacy after treatment was analyzed.Results After treatment,the scores of continuous tingling of joints,fixed pain,severe pain,local stiffness,soreness of waist and knees,aggravation during activities,and fatigue of limbs in the two groups were all lower than those before treatment(P<0.05),and the above scores in the observation group were lower than those in the control group(P<0.05).After treatment,the clinical effective rate of the observation group was 98.18%(54/55),higher than 83.64%(46/55)of the control group(P<0.05).After treatment,the degree of wrist swelling and pain in both groups were reduced,and the Cooney wrist function scores were increased as compared with those before treatment(P<0.05).The degree of wrist swelling and pain in the observation group was lower and the Cooney wrist function score was higher than those in the control group(P<0.05).After treatment,the levels of MDA in the two groups were lower and SOD and TAC were higher than those before treatment(P<0.05).The level of MDA in the observation group was lower and SOD and TAC were higher than those in the control group(P<0.05).After treatment,the levels of IL-6,IL-1β,CRP,and TNF-αin both groups were lower than those before treatment(P<0.05),and the above levels in the observation group were lower than those in the control group(P<0.05).Conclusion Huoxue Tongluo Prescription can effectively improve the clinical symptoms of patients with distal radius fractures after LCP internal fixation,reduce the early inflammatory response,and promote the recovery of wrist function,which is worthy of clinical promotion.