复方续断接骨丸内服联合手法复位小夹板外固定治疗老年骨质疏松性桡骨远端骨折的临床观察

Clinical observation of compound Dipsacus Jiegu pill combined with manual reduction and small splint external fixation on osteoporotic distal radius fractures in the elderly

目的观察复方续断接骨丸内服联合手法复位小夹板外固定治疗老年骨质疏松性桡骨远端骨折的临床疗效。方法将78例老年骨质疏松性桡骨远端骨折患者按照随机数字表法分为2组,对照组39例采用手法复位小夹板外固定治疗,研究组39例在对照组治疗基础上联合复方续断接骨丸治疗。治疗2个月后,比较2组治疗前后中医证候评分、骨痂生长状况评分、血清骨形态发生蛋白2(BMP-2)、胰岛素样生长因子-1(IGF-1)、IGF-2、血管内皮生长因子(VEGF)水平,记录2组的骨折愈合时间及疼痛、肿胀、淤斑消失时间,观察治疗期间药物不良反应及并发症,统计2组临床疗效。结果研究组总有效率92.31%(36/39),对照组总有效率79.49%(31/39),研究组临床疗效优于对照组(P<0.05)。2组治疗后中医证候主症评分、次症评分均较本组治疗前降低(P<0.05),且研究组治疗后均低于对照组(P<0.05)。研究组骨折愈合时间及疼痛、肿胀、淤斑消失时间均短于对照组(P<0.05)。2组治疗后1、2个月骨痂生长状况评分均高于本组治疗前(P<0.05),2组治疗后2个月均高于本组治疗后1个月(P<0.05),且研究组治疗后1、2个月均高于对照组同期(P<0.05)。2组治疗后血清BMP-2、IGF-1、IGF-2、VEGF水平均较本组治疗前升高(P<0.05),且研究组均高于对照组(P<0.05)。结论复方续断接骨丸内服联合手法复位小夹板外固定治疗老年骨质疏松性桡骨远端骨折有助于缩短骨折愈合及疼痛、肿胀、淤斑等症状消失时间,提升临床疗效,可能与激活生长因子及骨形成蛋白等因子表达,加速骨折部位组织生长及血运重建有关。

Objective To explore the clinical efficacy of compound Dipsacus Jiegu pills combined with manual reduction and small splint external fixation in the treatment of senile osteoporotic distal radius fractures.Methods A total of 78 elderly patients with osteoporotic distal radius fracture were selected as the research objects.They were randomly 1∶1 to receive manual reduction and small splint external fixation(control group)or Dipsacus Jiegu pills+manual reduction and small splint external fixation(study group)for two months.The clinical efficacy,traditional Chinese medicine(TCM)syndrome score,callus growth status,serum bone morphogenetic protein-2(BMP-2),insulin-like growth factor-1(IGF-1),IGF-2,vascular endothelial growth factor(VEGF)levels of patients in the two groups were evaluated,and the fracture healing time,pain,swelling,ecchymosis and other symptoms disappearance time of patients in the two groups were recorded,and the adverse drug reactions and complications were observed during treatment.Results The total effective rate in the study group was significantly higher than that in the control group(92.31%[36/39]vs 79.49%[31/39],P<0.05).After treatment,the main syndrome score and secondary syndrome score of TCM syndrome in the both group were Significantly lower than before treatment(P<0.05),and the study group was more prevalent(P<0.05).The disappearance time of fracture healing,pain,swelling,ecchymosis and other symptoms in the study group was significantly shorter than that in the control group(P<0.05).The score of callus growth in the two groups was significantly higher than that before treatment(P<0.05),and which in the study group was significantly higher than in the control group(P<0.05).The levels of serum BMP-2,IGF-1,IGF-2 and VEGF in the two groups after treatment were significantly higher than those before treatment(P<0.05),and which in the study group were significantly higher than in the control group(P<0.05).There were no adverse reactions and complications in both groups during treatment.Conclusion The application of compound Dipsacus Jiegu pill combined with manual reduction and small splint external fixation in the treatment of elderly patients with osteoporotic distal radius fracture helps to shorten the time for the disappearance of symptoms such as fracture healing,pain,swelling and ecchymosis,and improve the clinical efficacy.Research and analysis may be related to the expression of factors such as activating growth factor and bone morphogenetic protein,and accelerating the growth of tissue at the fracture site and revascularization.