双龙接骨丸联合正骨紫金丹治疗脑卒中偏瘫侧桡骨远端闭合性骨折的临床效果

Clinical effect of Shuanglong Jiegu pill combined with Zhenggu Zijindan on closed fracture of distal radius in hemiplegic side of stroke

目的探讨双龙接骨丸联合正骨紫金丹对脑卒中偏瘫侧桡骨远端闭合性骨折患者神经和腕关节功能的影响。方法入选脑卒中偏瘫侧桡骨远端闭合性骨折患者以随机数表法分为试验组和对照组。对照组采用正骨紫金丹治疗,每晨餐后30 min服用1次,每次15 g,连服8周。试验组在对照组的基础上联合双龙接骨丸治疗,温水送服,每天1次,每次15 g,早餐后30 min服用,连续用药8周。对比2组美国国立卫生研究院卒中量表(NIHSS)和临床疗效;用Gartland Werley评分评估治疗后1和2个月腕关节功能;用酶联免疫吸附试验法检测血清基质金属蛋白酶组织抑制因子1(TIMP-1)与基质金属蛋白酶9(MMP-9)表达量;观察并统计2组药物不良反应发生率。结果试验组和对照组分别纳入44例受试者。试验组和对照组的总有效率分别为93.18%(41例/44例)和86.37%(38例/44例),差异有统计学意义(P<0.05);对照组残余畸形、客观评价、主观评价和并发症评分分别是2.00±0.78、4.00±0.56、4.00±0.12和4.00±0.46;试验组残余畸形、客观评价、主观评价和并发症评分分别是1.00±0.67、2.00±0.12、1.00±0.98和2.00±0.23;组间比较,差异均有统计学意义(均P<0.05)。治疗后,试验组和对照组的NIHSS评分分别为1.42±0.47和3.65±0.74,试验组和对照组的腕关节功能Gartland Werle评分分别为2.92±0.48和4.76±0.89,试验组和对照组血清TIMP-1表达量分别为(425.61±15.57)和(362.94±13.25)μg·L^(-1),血清MMP-9表达量分别为(46.25±3.34)和(57.82±4.18)μg·L^(-1),试验组上述指标与对照组比较,差异均有统计学意义(均P<0.05);治疗后,试验组和对照组的总药物不良反应发生率分别为6.82%和27.27%,差异有统计学意义(P<0.05)。结论双龙接骨丸联合正骨紫金丹治疗脑卒中偏瘫侧桡骨远端闭合性骨折患者疗效显著,可改善患者的神经功能和腕关节功能,下调MMP-9水平和上调TIMP-1水平,减轻脑屏障受损情况与炎症反应的发生,降低药物不良反应发生率。

Objective To explore the effect of Shuanglong Jiegu pill combined with Zhenggu Zijindan on nerve and wrist function of patients with closed fracture of distal radius on hemiplegic side of stroke.Methods Patients with closed fracture of distal radius on hemiplegic side of stroke were selected and divided into control group and treatment group by random number table.The control group was treated with Zhenggu Zijindan,once a day,every 30 min after breakfast,15 g each time for 8 weeks.On the basis of the control group,the treatment group was treated with Shuanglong Jiegu pills,taken with warm water,once a day,15 g each time,30 min after breakfast,for 8 weeks.The National Institutes of Health Stroke Scale(NIHSS)was compared between two groups;the clinical effects of the two groups were compared;the wrist function was assessed by Gartland werley score at 1 and 2 months after treatment;serum tissue inhibitor of matrix metalloproteinase-1(TIMP-1)and matrix metalloproteinase-9(MMP-9)levels;And the incidence of adverse drug reactions.Results The treatment group and the control group included 44 subjects respectively.After treatment,the overall efficacy rates of the treament and control groups were 93.18%(41 cases/44 cases)and 86.37%(38 cases/44 cases),respectively,with statistically significant differences(P<0.05).The residual deformity,objective evaluation,subjective evaluation,and complication scores of the control group were 2.00±0.78,4.00±0.56,4.00±0.12,and 4.00±0.46,respectively;the residual deformity,objective evaluation,subjective evaluation,and complication scores of the treament group were 1.00±0.67,2.00±0.12,1.00±0.98,and 2.00±0.23,respectively,with statistically significant difference(all P<0.05).After treatment,the NIHSS scores of the treament group and the control group were 1.42±0.47 and 3.65±0.74,respectively;the Gartland Werle scores of wrist joint function of the treament group and the control group were 3.65±0.74 and 1.42±0.47,respectively.After treatment,the expression levels of serum TIMP-1 in the treatment group and the control group were(425.61±15.57)and(362.94±13.25)μg·L^(-1),respectively,and the expression levels of serum MMP-9 were(46.25±3.34)and(57.82±4.18)μg·L^(-1),respectively.The above indexes in the treatment group were significantly different from those in the control group(all P<0.05).After treatment,the total incidence of adverse drug reactions in the treament and control groups was 6.82%and 27.27%,respectively,with statistically significant difference(P<0.05).Conclusion Shuanglong Jiegu pill combined with Zhenggu Zijindan has significant curative effect in the treatment of stroke patients with hemiplegic distal radius closed fracture,and it can improve the neurological function and wrist function of the patients,down-regulate the level of MMP-9 and up-regulate the level of TIMP-1,and reduce brain barrier damage.