骨九方配合PFNA内固定微创治疗骨质疏松性股骨粗隆间骨折的临床研究  

Clinical Research of Gujiu Recipe Plus Minimally Invasive Treatment with PFNA Internal Fixation for Treatment of Osteoporotic Intertrochanteric Fractures

作　　者：许小志[1] 谢学文[2] 曾文磊[1] 张兆华[2] 罗学辉[1] 冯兴伦[1] 余虹[1] 林洁[1] 翁天才[1] 

机构地区：[1]广东省佛山市中医院三水医院,广东佛山528100 [2]广东省佛山市中医院,广东佛山528000

出　　处：《广州中医药大学学报》2016年第6期799-804,共6页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：广东省佛山市医学类科技攻关项目(编号:2015AB001425)

摘　　要：【目的】探讨中药骨九方配合PFNA内固定微创治疗骨质疏松性股骨粗隆间骨折的临床疗效。【方法】将60例（60髋）老年骨质疏松性股骨粗隆间骨折患者随机分为治疗组和对照组各30例（30髋）,在PFNA内固定微创治疗基础上,治疗组给予中药骨九方汤剂＋安慰剂软胶囊治疗,对照组给予骨化三醇软胶囊＋安慰剂汤剂治疗,疗程均为3个月。观察2组患者术前术后血清骨碱性磷酸酶（BALP）、抗酒石酸酸性磷酸酶（TRACP5b）水平和健侧桡骨远端骨密度值,同时观察2组患者股骨粗隆间骨折愈合情况,记录患髋Harris评分和患髋疼痛视觉模拟评分（VAS）。【结果】（1）全部病例均获得4～13个月不等的随访,平均随访（8.127±1.40）个月。（2）术后6周时,2组骨折临床愈合率比较,差异无统计学意义（P〉0.05）;术后3个月,治疗组骨折临床愈合率明显优于对照组（P〈0.05）。（3）术后3个月,治疗组BALP水平较术前明显升高,TRACP5b水平较术前明显降低（P〈0.05）;对照组BALP和TRACP5b水平均较术前变化不明显（P〉0.05）;治疗组在改善BALP和TRACP5b水平方面均优于对照组（P〈0.05）。（4）术后3个月,治疗组健侧桡骨远端骨密度值较术前升高（P〈0.05）,而对照组较术前略有升高,但差异无统计学意义（P〉0.05）;治疗组在改善骨密度值方面优于对照组（P〈0.05）。（5）术后12个月,2组患者Harris患髋功能评分比较,差异无统计学意义（P〉0.05）。（6）术后1～5周,治疗组患髋疼痛VAS评分均低于对照组,差异均有统计学意义（P〈0.05）。【结论】骨九方能改善骨质疏松性股骨粗隆间骨折患者骨代谢生化指标,提高骨密度,促进骨愈合,同时应用骨九方治疗,可取得更加满意的疗效。Objective To explore the clinical effect of Gujiu Recipe plus minimally invasive treatment with proximal femoral nail antirotation （PFNA） internal fixation for the treatment of osteoporotic intertroehanteric fractures （OIF）. Methods Sixty senile OIF patients（involving 60 hips） were randomized into treatment group and control group, 30 cases （30 hips） in each group. Based on the minimally invasive treatment with PFNA internal fixation, the treatment group was orally given the decoction of Gujiu Recipe plus placebo soft capsules, and the control group was orally given calcitriol soft capsules plus placebo decoction. The treatment course of the two groups lasted for 3 months. Preoperative and postoperative serum bone alkaline phosphatase（BALP） and tartrate- resistant acid phosphatase （TRACPSb） levels as well as bone mineral density（BMD） of the healthy distal radius of the two groups were detected. Meanwhile, the healing of the fractures was observed, and hip Harris scores and visual analogue scale （VAS） scores for hip pain were also recorded. Results （1） All cases had the follow-up for 4 to 13 months, averaging 8.127 ± 1.40 months. （2） On the 6th week after the surgery, the difference of clinical cure rate for the fractures between the two groups was insignificant （P 〉 0.05） , and on the 3rd month after the surgery, the treatment group had higher clinical cure rate than the control group （P 〈 0.05）. （3） On the 3rd month after the surgery, BALP was increased and TRACP5b was reduced in the treatment group as compared with that before treatment（P 〈 0.05） , while the two indicators showed no obvious changes in the control group（P 〉 0.05）. And the treatment group had better effect on improving the levels of BALP and TRACP5 than the control group （P 〈 0.05）.（4） On the 3rd month after the surgery, BMD of the healthy distal radius of the treatment group was enhanced as compared with that before treatment（P 〈 0.05）, and the BMD only showed a

关 键 词：PFNA内固定 骨质疏松症 股骨粗隆间骨折 骨九方 骨密度 

分 类 号：R274.12[医药卫生—中医骨伤科学]