基于平乐正骨“气血共调平衡理论”中药内服外敷治疗老年股骨转子间骨折的有效性及安全性

Efficacy and safety of internal and external application of traditional Chinese medicine for the treatment of intertrochanteric fracture in the elderly based on Pingle bone-setting“qi-blood co-regulation and balance theory”

目的探讨以平乐正骨“气血共调平衡理论”为指导,中医骨折分期辨证中药内服外敷治疗老年股骨转子间骨折的有效性及安全性。方法选取2020年1月—2022年1月河南省洛阳正骨医院收治的老年股骨转子间骨折患者80例,按随机数字表法分为对照组和观察组,每组40例。对照组行股骨近端防旋髓内钉内固定术治疗,围术期予常规预防血栓、预防感染、抗骨质疏松、补液治疗,并指导康复锻炼。观察组在对照组治疗基础上以平乐正骨“气血共调平衡理论”为指导,中医骨折分期辨证中药内服(活血疏肝汤、补阳还五汤、养血止痛丸、特制接骨丸)外敷(骨炎膏)治疗。比较2组术中情况、手术治疗前后各时间点疼痛视觉模拟量表(VAS)评分、治疗前后髋关节功能(Harris)评分和日常生活自理能力(ADL)评分、住院时间、术后首次下地行走时间、消肿时间、骨折愈合时间、完全负重时间及安全性(术后并发症发生率、出血事件发生率、血常规、肝肾功能等)。结果2组术中情况(手术时间、术中出血量、透视次数)比较差异均无统计学意义(P均>0.05)。2组术后VAS评分均较术前明显降低(P均<0.05),观察组术后7 d、14 d VAS评分均明显低于对照组(P均<0.05)。观察组术后14 d髋关节Harris评分明显高于对照组(P<0.05),术后3,6个月髋关节Harris评分仍高于对照组,但差异无统计学意义(P均>0.05)。观察组术后14 d、3个月、6个月ADL评分均明显高于对照组(P均<0.05)。观察组住院时间、术后首次下地行走时间、消肿时间、骨折愈合时间、完全负重时间均明显短于对照组(P均<0.05)。观察组术后并发症发生率为10.0%(4/40),低于对照组的27.5%(10/40),差异有统计学意义(P<0.05)。2组出血事件总发生率比较差异无统计学意义(P>0.05)。2组治疗期间血常规、肝肾功能均未出现明显异常,中药外敷处未出现皮肤过敏、感染、伤口延迟愈合等不良反应。结论在平乐正骨“气血共调平衡理论”指导下,对老年股骨转子间骨折患者进行中医骨折分期辨证中药内服外敷治疗可有效降低围手术期并发症发生率,减轻疼痛,缩短消肿时间及骨折愈合时间,提高生活自理能力,且不会影响肝肾功能或增加出血倾向。

Objective It is to investigate the effectiveness and safety of the treatment of intertrochanteric fractures in the elderly with internal and external application of traditional Chinese medicine according to fracture staging and differentiation under the guidance of Pingle bone-setting“qi-blood co-regulation and balance theory”.Methods Eighty elderly patients with intertrochanteric fracture admitted to Henan Provincial Orthopedic Hospital from January 2020 to January 2022 were selected and divided into control group and observation group according to the random number table method,40 cases in each group.The control group was treated with proximal femoral nail anti-rotation,and was given routine thromboprophylaxis,infection prevention,anti-osteoporosis,fluid replacement therapy and guided rehabilitation exercises during the perioperative period.The observation group was treated with internal application of traditional Chinese medicine(Huoxue Shugan decotion,Buyang Huanwu decoction,Yangxue Zhitong pill,Jiegu pill)and external application of Guyan plaster according to fracture staging and differentiation under the guidance of Pingle bone-setting“qi-blood co-regulation and balance theory”.The intraoperative conditions,visual analogue scale(VAS)scores of pain at each time point before and after surgical treatment,hip function(Harris)scores and activities of daily living(ADL)scores before and after treatment,length of hospital stay,time to first walk on the floor after surgery,time to swelling reduction,time to fracture healing,time to full weight bearing,and safety(postoperative complication rate,bleeding event rate,blood count,liver and kidney function,etc.)were compared between the two groups.Results There was no statistically significant difference in intraoperative conditions(operating time,intraoperative bleeding,and number of fluoroscopic views)between the two groups(all P>0.05).The postoperative VAS scores of both groups were significantly lower than those before surgery(both P<0.05),and the postoperative VAS scores of the observation group were significantly lower than those of the control group at 7 days and 14 days after operation(all P<0.05).The 14 day postoperative hip Harris score of the observation group was significantly higher than that of the control group(P<0.05),and the 3-and 6-month postoperative hip Harris scores were still higher than those of the control group,but the differences were not statistically significant(all P>0.05).The ADL scores at 14 days,3 months and 6 months after surgery were significantly higher in the observation group than those in the control group(all P<0.05).The length of hospital stay,time to first walk on the ground after surgery,time to swelling reduction,time to fracture healing,and time to full weight bearing were significantly shorter in the observation group than those in the control group(all P<0.05).The incidence of postoperative complications was 10.0%(4/40)in the observation group,which was lower than that of 27.5%(10/40)in the control group,and the difference was statistically significant(P<0.05).The difference in the total incidence of bleeding events was not statistically significant between the two groups(P>0.05).There were no significant abnormalities in blood routine and liver and kidney functions during the treatment period in the two groups,and no adverse reactions such as skin allergy,infection and delayed wound healing were observed at the topical application of Chinese medicine.Conclusion Internal and external application of traditional Chinese medicine according to fracture staging and differentiation under the guidance of Pingle bone-setting“qi-blood co-regulation and balance theory”can effectively reduce the incidence of perioperative complications,reduce pain,shorten the time of swelling and fracture healing,and improve activities of daily living without affecting liver and kidney function or increase bleeding tendency in the treatment of intertrochanteric fractures in the elderly.