补肾活血方结合骨搬移治疗胫骨中下段骨折不愈合机制及疗效观察

Clinical Observation and Mechanism of Bushen Huoxue Decoction Combined with Bone Mobilization in the Treatment of Middle and Distal Tibial Fracture Nonunion

目的:探讨补肾活血方结合骨搬移治疗胫骨中下段骨折不愈合的机制及临床效果。方法:研究对象选自我院2015年2月—2017年10月收治的112例胫骨中下段骨折不愈合患者,采用随机数字表将其分成两组,每组56例。两组均给予骨搬移手术治疗,观察组在此基础上联合给予中医补肾活血方治疗,连续治疗12周。对比两组临床疗效及骨折愈合时间、骨痂评分,治疗前后相关量表[Lysholm膝关节功能评分量表(LKSS)、Kofoed评分标准]评分、血清标志物[骨形态发生蛋白(BMP)-2、胰岛素样生长因子1(IGF-1)、血管内皮生长因子(VEGF)]水平变化。结果:经12周治疗后,观察组总有效率达92.86%(52/56),与对照组[78.57%(44/56)]比较显著上升(P<0.05)。观察组骨折愈合时间显著短于对照组、骨痂评分显著高于对照组(P<0.05)。两组治疗后LKSS、Kofoed评分均较治疗前显著上升(P<0.05),治疗后观察组LKSS、Kofoed评分均明显高于对照组(P<0.05)。两组治疗后血清BMP-2、IGF-1、VEGF水平均较治疗前显著升高(P<0.05),且治疗后观察组血清BMP-2、IGF-1、VEGF水平均明显高于对照组(P<0.05)。结论:对胫骨中下段骨折不愈合患者给予补肾活血方结合骨搬移治疗能有效促进骨折愈合,提高膝关节和踝关节功能,其机制可能与上调患者血清中BMP-2、IGF-1、VEGF表达水平有关。

Objective:To explore clinical effect and mechanism effect of Bushen Huoxue Decoction combined with bone mobilization in the treatment of middle and distal tibial fracture nonunion.Methods:Selected 112 cases with middle and distal tibial fracture nonunion in our hospital from February 2015 to October 2017 as research objectives and divided them into two groups randomly with 56 cases in each group.Provided bone mobilization surgery to two groups,and provided Bushen Huoxue Decoction to observation group additionally for 12 consecutive weeks.Compared two groups’clinical effect,fracture healing time,osteotylus score,scores of relevant scales[Lysholm Knee Function Rating Scale(LKSS),Kofoed Score],serum markers[bone morphogenetic protein(BMP)-2,insulin-like growth factor 1(IGF-1),vascular endothelial growth factor(VEGF)]before and after treatments.Results:After 12 weeks treatment,observation group’s overall effective rate was 92.68%(52/56)which was significant higher than control group’s(78.57%(44/56),P<0.05)Observation group’s fracture healing time was significant shorter than control group’s,and osteotylus score was significant higher than control group’s(P<0.05).Two groups’LKSS,Kofoed score after treatment were significant higher than those before treatment(P<0.05),observation group’s LKSS,Kofoed score after treatment were significant higher than control group’s(P<0.05).Two groups’levels of serum BMP-2,IGF-1,VEGF after treatment were significant higher than those before treatment(P<0.05),and observation group’s level of serum BMP-2,IGF-1,VEGF after treatment were significant higher than control group’s(P<0.05).Conclusion:Bushen Huoxue Decoction combined with bone mobilization helps patients with middle and distal tibial fracture nonunion to promote fracture healing and improve knee and ankle function,its mechanism may be related to the up-regulation of BMP-2,IGF-1 and VEGF expression levels in serum.