三七接骨丸联合胫骨搬运术治疗胫骨骨缺损临床疗效观察

Clinical efficacy of Sanqi Jiegu Pill combined with tibia transport surgery in the treatment of tibial bone defects

目的观察三七接骨丸联合胫骨搬运术治疗胫骨骨缺损(BD)患者的临床效果。方法选取2019年2月至2021年9月河南省洛阳正骨医院收治的94例胫骨BD患者作为研究对象,以电脑随机数表法按1∶1比例分为A组和B组各47例。B组患者接受胫骨搬运术治疗,A组患者接受三七接骨丸联合胫骨搬运术治疗。比较两组术后6个月的治疗效果和影像学总有效率;比较两组患者术前和术后7 d、14 d、30 d的视觉模拟评分法(VAS)评分,术前、术后3个月的实验室指标[骨钙素(BGP)、血管内皮生长因子(VEGF)、骨形态发生蛋白-2(BMP-2)、胰岛素样生长因子-1(IGF-1)]、炎性因子[核因子-κB(NF-κB)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)]和术后6个月内的并发症发生情况。结果A组患者的优良率和影像学总有效率分别为97.87%、100.00%,明显高于B组的82.98%、87.23%,差异均具有统计学意义(P<0.05);术后7 d、14 d、30 d,A组患者的VAS评分分别为(3.24±0.57)分、(2.35±0.33)分、(1.49±0.24)分,明显低于B组的(4.18±0.83)分、(3.06±0.52)分、(2.28±0.47)分,差异均具有统计学意义(P<0.05);术后3个月,A组患者的血清BGP、VEGF、BMP-2、IGF-1水平分别为(9.16±1.76)μg/L、(330.81±22.67)ng/L、(263.50±20.20)ng/L、(348.06±28.77)μg/L,明显高于B组的(7.42±1.54)μg/L、(287.51±19.49)ng/L、(213.46±17.92)ng/L、(305.87±25.64)μg/L,差异均具有统计学意义(P<0.05);术后3个月,A组患者的血清NF-κB、TNF-α、CRP、IL-6水平分别为(28.30±4.62)pg/L、(1.56±0.64)mg/L、(52.44±7.62)mg/L、(3.47±0.61)pg/mL,明显低于B组的(47.29±6.88)pg/L、(3.15±0.86)mg/L、(81.42±12.57)mg/L、(5.72±0.79)pg/mL,差异均有统计学意义(P<0.05);A组患者的术后并发症总发生率为6.38%,明显低于B组的23.40%,差异有统计学意义(P<0.05)。结论三七接骨丸联合胫骨搬运术治疗胫骨BD患者可进一步提升治疗效果及影像学总有效率、减轻疼痛感、缓解炎性反应、减少并发症,同时对促进骨愈合具有积极意义。

Objective To observe the clinical effect of Sanqi Jiegu Pill combined with tibia transport surgery in the treatment of tibial bone defects(BD).Methods Ninety-four patients with tibial BD admitted to Luoyang Orthopedic Traumatological Hospital of Henan Province from February 2019 to September 2021 were selected.According to the random number table method,they were divided into group A and group B according to the ratio of 1:1,with 47 patients in each group.The patients in the group B were treated with tibia transport,and the patients in the group A were treated with Sanqi Jiegu Pill combined with tibia transport surgery.The treatment efficacy and imaging total response rate were compared between the two groups at 6 months after surgery.The Visual Analogue Scale(VAS)scores of two groups of patients before surgery,on the 7 d,14 d,and 30 d after surgery,and the laboratory indicators[bone gla protein(BGP),vascular endothelial growth factor(VEGF),bone morphogenetic protein-2(BMP-2),insulin-like growth factor-1(IGF-1)]and inflammatory factors[nuclear factor-κB(NF-κB),tumor necrosis factorα(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6)]were compared between the two groups before and 3 months after surgery,as well as the incidence of complications within 6 months after surgery.Results The excellent and good rate and total effective rate of imaging in group A were 97.87% and 100.00%,respectively,which were significantly higher than 82.98% and 87.23% in the group B(P<0.05).At 7 d,14 d and 30 d after operation,the VAS scores in the group A were(3.24±0.57)points,(2.35±0.33)points,and(1.49±0.24)points,respectively,which were significantly lower than(4.18±0.83)points,(3.06±0.52)points,and(2.28±0.47)points in the group B(P<0.05).Three months after operation,the serum BGP,VEGF,BMP-2,and IGF-1 levels in the group A were(9.16±1.76)μg/L,(330.81±22.67)ng/L,(263.50±20.20)ng/L,(348.06±28.77)μg/L,respectively,which were significantly higher than(7.42±1.54)μg/L,(287.51±19.49)ng/L,(213.46±17.92)ng/L,(305.87±25.64)μg/L in the group B(P<0.05).Three months after operation,the serum NF-κB,TNF-α,CRP,and IL-6 levels in the group A were(28.30±4.62)pg/L,(1.56±0.64)mg/L,(52.44±7.62)mg/L,and(3.47±0.61)pg/mL,respectively,which were significantly lower than(47.29±6.88)pg/L,(3.15±0.86)mg/L,(81.42±12.57)mg/L,and(5.72±0.79)pg/mL in the group B(P<0.05).The total incidence of postoperative complications in the group A was 6.38%,which was significantly lower than 23.40% in the group B(P<0.05).Conclusion Sanqi Jiegu Pill combined with tibia transport surgery in the treatment of tibia BD patients can further improve the therapeutic effect and the total effective rate of imaging,relieve pain,alleviate inflammatory reactions,reduce complications,and have a positive significance in promoting bone healing.