新伤续断汤对股骨转子间骨折患者股骨近端防旋髓内钉术后愈合的影响

Effect of Xinshang Xuduan decoction on postoperative healing of PFNA in patients with intertrochanteric fracture

目的:探讨新伤续断汤对股骨转子间骨折股骨近端防旋髓内钉(PFNA)术后骨折愈合的影响。方法:选取符合纳入标准的PFNA术后患者64例,随机分为对照组、观察组,每组32例。术后常规治疗为对照组,术后常规治疗基础上口服新伤续断汤为观察组。记录两组患者在治疗6周及术后3个月时髋关节Harris评分、影像学变化。记录两组患者首次下床锻炼时间,及术前、术后第1天、治疗2周、治疗6周血红蛋白(Hb)值。检测两组患者术前、术后3个月的骨代谢标志物。结果:收集64例患者因术后并发症等原因脱落5例,对照组29例、观察组30例,完成率92%。治疗6周及术后3个月时,观察组Harris评分优于对照组,差异有统计学意义(P<0.05)。在首次下床锻炼时间方面,观察组优于对照组,差异有统计学意义(P<0.05)。观察组治疗2、6周时Hb水平低于对照组,差异有统计学意义(P<0.05)。骨代谢方面,在术后3个月时观察组人N中段骨钙素、总Ⅰ型胶原氨基端延长肽、25-羟基维生素D水平较对照组升高,而β-胶原特殊序列较对照组下降,差异有统计学意义(均P<0.05)。影像学方面,治疗6周、术后3个月时观察组骨痂生长情况优于对照组,术后3个月观察组的骨折愈合优于对照组,差异有统计学意义(均P<0.05)。结论:新伤续断汤能有效改善髋关节功能,减少卧床时间,改善贫血症状,调节骨代谢,促进成骨细胞,抑制破骨细胞,刺激骨痂生长,促进骨折愈合,提升患者生活质量。

Objective:To investigate effect of Xinshang Xuduan decoction on fracture healing of intertrochanteric fracture after proximal femoral nail antirotation(PFNA).Methods:64 patients PFNA postoperative were selected and divided into control group and observation group randomly,with 32 cases in each group.The postoperative routine treatment were used as the control group,and Xinshang Xuduan decoction on the basis of postoperative routine treatment were used as the observation group.The Harris score and imaging changes of the two groups were recorded 6 weeks after treatment and 3 months after operation.The first out-of-bed exercise time of patients in the two groups were recorded.The hemoglobin values of the two groups were recorded before operation,on the first day after operation,2 weeks after treatment,and 6 weeks after treatment.Bone metabolic markers were detected before and 3 months after surgery in the two groups.Results:64 patients were collected in the study.Due to postoperative complications,5 cases dropped,29 cases in the control group and 30 cases in the observation group completed.The completion rate is 92%.The observation group’s Harris scores at 6 weeks and 3 months after operation were better than the control group,difference statistically significant(P<0.05).The time of first out-of-bed exercise in the observation group was better than that in the control group,difference was statistically significant(P<0.05).The hemoglobin levels of the observation group were significantly better than those in the control group after 2 weeks and 6 weeks of treatment,differences statistically significant(P<0.05).In terms of markers of bone metabolism,the observation group’slevels of N-MID,PINP and 25-(OH)D3 were higher than those in the control group,while the observation group’s level ofβ-CTX was significantly lower than that in the control group 3 months after surgery,differences statistically significant(all P<0.05).In terms of imaging,callus growth of the treatment group was better than the control group after 6 weeks’treatment and 3 months after surgery,and fracture healing of the treatment group was better than the control group 3 months after surgery,differences statistically significant(all P<0.05).Conclusion:Xinshang Xuduan decoction can effectively improve hip joint function,reduce bed time,improve anemia symptoms,regulate bone metabolism,promote osteoblasts,inhibit osteoclasts,stimulate callus growth,promote fracture healing,and inhance patients’quality of life.