杜仲续断汤辅助治疗创伤性胫骨平台骨折患者的疗效分析

Analysis of Efficacy of Adjuvant Treatment with Duzhong Xuduan Decoction for Patients with Traumatic Tibial Plateau Factures

【目的】观察杜仲续断汤(由杜仲、续断、秦艽、木瓜、川芎、乳香、炙川乌、苏木、甘草等中药组成)辅助治疗对创伤性胫骨平台骨折患者术后临床症状改善和对血清人骨形态发生蛋白2(BMP-2)、碱性磷酸酶(ALP)、胰岛素样生长因子1(IGF-1)水平的影响。【方法】将80例创伤性胫骨平台骨折患者随机分为对照组和治疗组,每组各40例。2组患者均给予钢板内固定手术治疗,在此基础上,治疗组给予杜仲续断汤治疗,疗程为30 d,并对2组患者进行约24周随访调查。观察2组患者的骨痂生长情况以及治疗前后美国特种外科医院膝关节功能评分(HSS)及血清BMP-2、ALP、IGF-1等骨形成相关指标的变化情况,比较2组患者的临床疗效和不良事件发生情况。【结果】(1)疗效方面,经术后24周后的随访,治疗组和对照组的临床优良率分别为95.00%(38/40)和77.50%(31/40),组间比较,治疗组的疗效明显优于对照组(P<0.05)。(2)骨痂生长方面,治疗后,治疗组的不同骨痂生长量(包括少量、中量、大量)生成时间以及骨折愈合时间均较对照组明显缩短(P<0.05)。(3)骨形成相关指标方面,治疗后,2组患者血清BMP-2、ALP、IGF-1水平均较治疗前明显升高(P<0.05),且治疗组的升高幅度均明显优于对照组(P<0.01)。(4)膝关节功能方面,治疗后,2组患者的关节疼痛程度、行走能力判定、活动度判定、肌力判定、稳定性判定、屈曲畸形程度等各项HSS评分及其总分均较治疗前明显升高(P<0.05),且治疗组的升高幅度均明显优于对照组(P<0.01)。(5)不良事件方面,治疗组的不良事件发生率为5.00%(2/40),对照组为12.50%(5/40),组间比较,差异无统计学意义(P>0.05)。【结论】杜仲续断汤辅助治疗创伤性胫骨平台骨折患者,能有效改善患者术后临床症状,显著升高血清BMP-2、ALP、IGF-1等骨形成相关指标水平,缩短骨痂生成时间,促进膝关节功能恢复。

Objective To study the effects of adjuvant treatment with Duzhong Xuduan Decoction(composed of Eucommiae Cortex,Dipsaci Radix,Gentianae Macrophyllae Radix,Chaenomelis Fructus,Chuanxiong Rhizoma,Olibanum,Aconiti Radix Cocta,Sappan Lignum,Glycyrrhizae Radix et Rhizoma,etc.)on the improvement of clinical symptoms and to observe the effects on the serum levels of human bone morphogenetic protein 2(BMP-2),alkaline phosphatase(ALP),and insulin-like growth factor 1(IGF-1)in the traumatic tibial plateau fracture patients at postoperative period.Methods Eighty patients with traumatic tibial plateau fracture were randomly divided into control group and treatment group,40 cases in each group.The patients in the two groups were given surgical treatment by internal fixation with steel plate,and additionally,the treatment group was given Duzhong Xuduan Decoction orally.Both groups were treated for 30 days as a course of treatment,and then were followed-up for about 24 weeks.The formation of callus and the changes in the Hospital for Special Surgery(HSS)knee function scores as well as the serum levels of osteogenic indicators such as BMP-2,ALP and IGF-1 in the two groups before and after treatment were observed.Moreover,the clinical efficacy and the incidence of adverse events in the two groups were compared.Results(1)The 24-week follow-up after the operation showed that the clinical excellence rate of the treatment group was 95.00%(38/40)and that of the control group was 77.50%(31/40).The intergroup comparison showed that the therapeutic efficacy of the treatment group was significantly superior to that of the control group(P<0.05).(2)After treatment,the time for the formation of small-,middle-and large-amount callus and the fracture healing time in the treatment group were significantly shorter than those in the control group(P<0.05).(3)After treatment,the serum levels of osteogenic indicators of BMP-2,ALP,and IGF-1 in the two groups were significantly higher than those before treatment(P<0.05),and the increase in the treatment group was significantly superior to that in the control group(P<0.01).(4)After treatment,the overall HSS knee function scores and the scores of HSS items of joint pain,walking ability,mobility,muscle strength,stability,and flexion deformity in the two groups were significantly higher than those before treatment(P<0.05),and the increase in the treatment group was significantly superior to that in the control group(P<0.01).(5)The incidence of adverse events in the treatment group was 5.00%(2/40),and that in the control group was 12.50%(5/40),and the intergroup comparison showed that the difference was not statistically significant(P>0.05).Conclusion The adjuvant treatment with Duzhong Xuduan Decoction can effectively improve the postoperative clinical symptoms of the patients with traumatic tibial plateau fractures,significantly increase the serum levels of osteogenic indicators of BMP-2,ALP,and IGF-1,shorten the time for the callus formation,and promote the recovery of knee joint function.