中医手法复位、中药熏洗联合固定对胫骨骨折患者骨转换生化标志物的影响

Effect of Traditional Chinese Medicine Manual Reduction and Traditional Chinese Medicine Fumigation and Washing Combined Fixation on Biochemical Markers of Bone Transformation in Patients with Tibial Fracture

目的研究中医手法复位、中药熏洗联合内固定对胫骨骨折患者骨转换生化标志物的影响。方法纳入2019年1月—2020年12月台州市博爱医院收治的200例胫骨骨折患者作为研究对象,应用随机数字表法将其分为A组、B组、C组和D组,每组50例。A组给予髌上入路髓内钉内固定术治疗,B组在A组基础上给予中医手法复位,C组在A组基础上给予中药熏洗,D组在A组基础上给予中医手法复位和中药熏洗,对4组患者术后疼痛情况、功能恢复情况、炎症因子水平及骨转换生化标志物进行分析。结果观察4组患者的术后疼痛情况和功能恢复情况发现,A组和B组的术后疼痛评分相近(P>0.05),C组的术后疼痛评分低于A组和B组(P<0.05),D组的术后疼痛感评分低于A组、B组和C组(P<0.05);A组和C组的膝关节美国纽约特种外科医院(HSS)评分相近(P>0.05)。观察4组患者术后炎症因子水平发现,A组和B组的白细胞介素-5(IL-5)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)和血清超敏C反应蛋白(hs-CRP)指标水平相近(P>0.05),C组和D组的IL-5、IL-6、IL-10和hs-CRP指标水平相近(P>0.05),C组和D组的IL-5、IL-6、IL-10和hs-CRP指标水平低于A组和B组(P<0.05)。观察4组患者术后骨转换生化标志物发现,B组和C组的骨钙素(BGP)、骨碱性磷酸酶(BALP)、Ⅰ型前胶原羧基端肽(PICP)、碱性成纤维细胞因子(bFGF)、骨形态发生蛋白-7(BMP-7)、转化生长因子-β1(TGF-β1)、Ⅰ型胶原羧基端肽β特殊序(β-CTX)指标水平相近(P>0.05),且BGP、BALP、PICP、bFGF、BMP-7、TGF-β1均高于A组(P<0.05),β-CTX低于A组(P<0.05)。结论通过研究中医手法复位、中药熏洗联合内固定对胫骨骨折患者骨转换生化标志物的影响发现,中医手法复位联合内固定利于患者膝关节功能恢复,中药熏洗联合内固定可有效减轻患者术后疼痛和炎症反应,中医手法复位、中药熏洗联合内固定的效果更佳,不仅可促进患者膝关节功能恢复,缓解患者术后疼痛和减轻炎症反应,还可更好地促进患者骨折愈合。

Objective To study the effect of traditional Chinese medicine(TCM)manual reduction,traditional Chinese medicine fumigation and washing combined with internal fixation on biochemical markers of bone conversion in patients with tibial fracture.Methods A total of 200 patients with tibial fracture admitted to the hospital from January 2019 to December 2020 were included as the research subjects.They were divided into group A,group B,group C and group D by random number table method,with 50 patients in each group.A group was given the patellar approach intramedullary nail fixation treatment.B group was given TCM manual reduction on the basis of group A.Group C given TCM fumigation on the basis of group A.Group D was given TCM manual reduction and herbal fumigation on the basis of group A.The postoperative pain in patients,function recovery and inflammatory factor levels and bone turnover biochemical markers of four groups were analyzed.Results The postoperative pain and functional recovery of the four groups were observed.The postoperative pain score of group A and group B was similar(P>0.05),the postoperative pain score of group C was lower than that of group A and group B(P<0.05),and the postoperative pain score of group D was lower than that of group A,group B and group C(P<0.05).The Hospital for Special Surgery(HSS)score of knee in group A and group C was similar(P>0.05),the HSS score of knee in group B was higher than that of group A and C(P<0.05),and th score of group D was higher than that of group A,B and C(P<0.05).After the observation of postoperative inflammatory cytokines in the four groups,the levels of interleukin-5(IL-5),interleukin-6(IL-6),interleukin-10I(L-10)and serum hypersensitive C-reactive protein(hs-CRP)in group A and group B were similar(P>0.05).The levels of IL-5,IL-6,IL-10 and hs-CRP in group C and D were similar(P>0.05),while the levels of IL-5,IL-6,IL-10 and hs-CRP in group C and D were lower than those in group A and B(P<0.05).Biochemical markers of postoperative bone turnover were observed in the four groups.The indexes of osteocalcin(BGP),bone alkaline phosphatase(BALP),Ⅰtype procollagen carboxy-terminal peptide(PICP),basic fibroblast factor(bFGF),bone morphogenetic protein-7(BMP-7),transforming growth factor-β1(TGF-β1)and special sequence of collagen carboxy-terminal peptide β(β-CTX)were similar between group B and group C(P>0.05).The levels of BGP,BALP,PICP,BFGF,BMP-7 and TGF-β1 were higher than those in group A(P<0.05),andβ-CTX was lower than that in group A(P<0.05).The levels of BGP,BALP,PICP,BFGF,BMP-7 and TGF-β1 in group D were higher than those in group A,B and C(P<0.05),andβ-CTX in group D was lower than that in group A,B and C(P<0.05).Conclusion Through the study of TCM manual reduction and fumigation combined internal fixation of bone turnover biochemical markers in patients with tibial fractures,it is found that the influence of TCM manual reduction combined internal fixation for patients with knee joint function recovery,TCM fumigation combined fixation can effectively relieve patients postoperative pain and inflammation,and the effect is better.It can not only promote patients'knee function recovery,relieve postoperative pain and inflammation,but also better promote patients'fracture healing.