补肾活血法治疗老年半髋关节置换术后肾虚血瘀证的临床观察

Clinical Observation of Tonifying Kidney and Activating Blood Circulation Treatment of Kidney Deficiency and Blood Stasis Syndrome after Elderly Hemihip Arthroplasty

目的探讨补肾活血法治疗老年半髋关节置换术后肾虚血瘀证的效果。方法选取2021年4—12月于广州中医药大学第三附属医院行半髋关节置换术且术后诊断为肾虚血瘀证的88例老年股骨颈骨折患者,依据治疗方法不同分为对照组(45例)和试验组(43例),对照组接受常规骨科治疗和基础疾病治疗,试验组在对照组的基础上进行补肾活血法综合治疗,方药予补肾活血汤加减(骨脂10 g、熟地10 g、菟丝子10 g,杜仲3 g、枸杞子3 g、当归尾3 g、山茱萸3 g、肉苁蓉3 g、没药3 g、独活3 g,红花2 g)。比较两组患者炎症指标[C反应蛋白(CRP)、红细胞沉降率(ESR)]、疼痛程度[视觉模拟评分法(VAS)评分]、髋关节功能恢复情况、中医证候评分以及临床疗效。结果两组术前CRP、ESR水平比较差异无统计学意义(P>0.05);术后第7天,试验组CRP、ESR明显低于对照组[69.6(51.9,87.2)mg/L比87.7(66.0,125.0)mg/L、(84±38)mm/1 h比(116±31)mm/1 h](P<0.01)。两组患者术前VAS评分比较差异无统计学意义(P>0.05);术后第7天,试验组VAS评分低于对照组[(5.02±0.99)分比(6.40±0.72)分](P<0.01)。两组患者术后第1天Harris评分比较差异无统计学意义(P>0.05);术后2周,试验组Harris评分高于对照组[(84.1±4.8)分比(72.4±9.7)分](P<0.01)。试验组自行下地行走时间短于对照组[7(7,8)d比8(8,9)d](P<0.01)。两组患者术前中医证候评分比较差异无统计学意义(P>0.05);术后2周,试验组低于对照组[(24.65±3.84)分比(31.07±5.34)分](P<0.01)。试验组治疗均有效,总有效率为100.0%(43/43),对照组总有效率为93.3%(42/45),两组比较差异无统计学意义(P>0.05)。结论基于补肾活血法对老年股骨颈骨折术后肾虚血瘀证的患者行中医综合治疗,可有效减轻患者术后疼痛,缓解术后炎症,促进髋关节功能恢复。

Objective To explore the effect of tonifying kidney and activating blood circulation in the treatment of kidney deficiency and blood stasis syndrome after hemihip arthroplasty in the elderly.Methods A total of 88 elderly patients with femoral neck fracture who underwent hemiarthroplasty in the Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from Apr.to Dec.2021 were included and divided into a control group(45 cases)and a test group(43 cases)according to the treatment method.The control group received routine orthopedic treatment and basic disease treatment,and the test group received comprehensive treatment of kidney activating blood circulation on the basis of the control group′s regimen.The prescription was treated with Bushen Huoxue decoction added/subtracted(psoralea 10 g corylifolia,prepared rhizome of rehmannia 10 g,dodder 10 g,eucommia ulmoides 3 g,fruit of Chinese wolfberry 3 g,angelica tail 3 g,dogwood 3 g,cistanche deserticola 3 g,myrrh 3 g,radix angelicae tuhuo 3 g,safflower 2 g).The inflammatory indexes[C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)],pain degree[visual analogue scale(VAS)score],hip joint function recovery,traditional Chinese medicine(TCM)syndrome score,and clinical efficacy were compared between the two groups.Results There was no significant difference in preoperative CRP and ESR levels between the two groups(P>0.05).On postoperative day 7,CRP and ESR in the test group were significantly lower than those in the control group[69.6(51.9,87.2)mg/L vs 87.7(66.0,125.0)mg/L,(84±38)mm/1 h vs(116±31)mm/1 h](P<0.01).There was no significant difference in preoperative VAS score between the two groups(P>0.05).On postoperative day 7,the VAS score of the test group was lower than that of the control group(5.02±0.99 vs 6.40±0.72)(P<0.01).There was no significant difference in Harris score between the two groups on the first day after operation(P>0.05).At 2 weeks after operation,the Harris score of the test group was significantly higher than that of the control group(84.1±4.8 vs 72.4±9.7)(P<0.01).The time for self-propelled walking of the test group was shorter than that of the control group[7(7,8)d vs 8(8,9)d](P<0.01).There was no significant difference in preoperative TCM syndrome scores between the two groups(P>0.05).Two weeks after operation,the TCM syndrome score of the test group was lower than that of the control group(24.65±3.84 vs 31.07±5.34)(P<0.01).The treatment in the test group was effective for all cases,and the total effective rate was 100.0%(43/43),while the total effective rate of the control group was 93.3%(42/45),but there was no significant difference between the two groups(P>0.05).Conclusion Based on the method of tonifying kidney and promoting blood circulation,the comprehensive TCM treatment for elderly patients with kidney deficiency and blood stasis syndrome after operation of femoral neck fracture can effectively reduce the postoperative pain,relieve the postoperative inflamemation,and contribute to the recovery of postoperative hip joint function.