理气补血汤对失神经胫骨骨折愈合的影响

Effect of Liqi Buxue Decoction on the Healing of Denervation Tibial Fracture

目的:探讨理气补血汤对坐骨神经损伤后胫骨骨折愈合的影响及机制。方法:2022年8月—2023年8月将27只SD雄性大鼠按随机数字表法分为A、B、C三组,每组9只。A组,单纯胫骨骨折内固定+生理盐水;B组,坐骨神经切断+骨折内固定+生理盐水;C组,坐骨神经切断+骨折内固定+理气补血汤。干预28 d后,X线观察骨折愈合情况并予以Lane-Sandhu评分;苏木素伊红(HE)及马松染色观察骨痂形态;酶联免疫吸附试验(ELISA)测定血清骨碱性磷酸酶(BALP)、Ⅰ型前胶原N端前肽(PⅠNP)、Ⅰ型胶原C端肽(CTX-Ⅰ)、抗酒石酸酸性磷酸酶(TRACP-5b)含量。结果:X线显示,A组骨痂基本已吸收;B组骨折线部分模糊,骨痂呈梭形膨大;C组骨折线模糊,有少量骨痂存留。A组、C组Lane-Sandhu评分均高于B组(P<0.05),但A组与C组组间比较,差异无统计学意义(P>0.05)。HE及马松染色显示,A组骨痂成熟明显高于B组、C组,C组较B组成熟度好;A组的血清BALP、PⅠNP表达均高于B组、C组,C组明显高于B组;CTX-Ⅰ、TRACP-5b的表达B组、C组均高于A组,C组均低于B组(P<0.05)。结论:理气补血汤可明显改善坐骨神经损伤后胫骨骨折愈合的质量,可能与促进成骨、抑制破骨、调节骨痂重塑有关。

Objective:To explore the effects of Liqi Buxue Decoction on tibia fracture healing after sciatic nerve injury and its mechanism.Method:From August 2022 to August 2023,27 SD male rats were divided into A,B,C three groups according to random number table method,with 9 rats in each group.Group A,simple tibial fracture internal fixation+normal saline;group B,sciatic nerve transection+fracture internal fixation+normal saline;group C,sciatic nerve transection+fracture internal fixation+Liqi Buxue Decoction.After 28 d of intervention,fracture healing was evaluated by X-ray and the Lane-Sandhu score was given;the bone scab morphology was observed by hematoxylin(HE)and Masson staining;the serum bone alkaline phosphatase(BALP),N-terminal propeptide of typeⅠprocollagen(PⅠNP),C-terminal telopeptide of typeⅠcollagen(CTX-Ⅰ)and tartrate resistant acid phosphatase(TRACP-5b)were measured by enzyme-linked immunosorbent assay(ELISA).Result:The X-ray showed the bone scab had basically been absorbed in group A;the partial blurring of the fracture line and spindle shaped expansion of the bone scab in group B;the blurred fracture line with a small amount of bone scab remained in group C.Lane-Sandhu scores in group A and group C were higher than that in group B(P<0.05),but compared between group A and group C,there was no statistically significant difference(P>0.05).HE and Masson staining showed that the maturation of bone scab in group A was significantly higher than those in group B and group C,group C had better maturation than group B.The serum BALP and PⅠNP expression in group A were higher than those in group B and group C;the expression of CTX-Ⅰand TRACP-5b in group B and group C were higher than that of group A,group C was lower than group B(P<0.05).Conclusion:Liqi Buxue Decoction can significantly improve the quality of tibial fracture healing after sciatic nerve injury,which may be related to promoting osteogenesis,inhibiting osteoclasis,and regulating bone scab remodeling.