自拟骨九汤配合Ilizarov技术骨搬移治疗胫骨感染性骨折不愈合的疗效及对骨代谢和血液流变学的影响  

Efficacy of self-made Gujiu Decoction combined with Ilizarov technique for bone transport on nonunion of tibial infectious fracture and its effect on bone metabolism and hemorheology

作　　者：李卓伟[1] 王朝辉[1] 何斌[1] 杨松[1] LI Zhuowei;WANG Zhaohui;HE Bin;YANG Song(Foshan Hospital of Traditional Chinese Medicine,Foshan 528000,Guangdong,China)

机构地区：[1]广东省佛山市中医院

出　　处：《现代中西医结合杂志》2020年第1期39-43,共5页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的观察自拟骨九汤配合Ilizarov技术骨搬移治疗胫骨感染性骨折不愈合的疗效及对骨代谢和血液流变学的影响。方法将2015年1月-2018年11月佛山市中医院收治的80例胫骨感染性骨折不愈合患者随机分为对照组和观察组,每组40例。对照组在局部感染控制后行Ilizarov技术骨搬移,观察组在术后给予自拟骨九汤内服2个月。采用疼痛视觉模拟评分(VAS)评定2组患者术前及术后1周、2周、1个月的疼痛程度,统计2组患者拆除外固定架后骨延长区域的矿化时间、带架时间和骨搬移时间,根据Ilizarov方法研究与应用协会评分标准评价2组患者拆除外固定架后的骨愈合及肢体功能情况,检测2组患者术前及术后1个月、2个月血清骨形态发生蛋白-2(BMP-2)、胰岛素样生长因子-1(IGF-1)、特异性碱性磷酸酶(ALP)、抗酒石酸酸性磷酸酶5b (TRACP5b)水平及高切全血黏度、低切全血黏度、血浆黏度、红细胞聚集指数。结果观察组术后1周、2周和1个月的VAS评分均明显低于对照组(P均<0.05),拆除外固定架后骨延长区域的矿化时间、带架时间和骨搬移时间均明显短于对照组(P均<0.05),骨愈合和肢体功能的优良率明显高于对照组(P均<0.05)。术后1个月、2个月时2组血清ALP、BMP-2、IGF-1水平均明显高于术前(P均<0.05),TRACP5b水平及高切全血黏度、低切全血黏度、血浆黏度和红细胞聚集指数均明显低于术前(P均<0.05),且观察组各指标改善程度明显大于对照组(P均<0.05)。结论自拟骨九汤可以提高患者血清中的骨合成因子含量,降低骨分解因子含量以及改善血液流变学,从而提高Ilizarov技术骨搬移治疗胫骨感染性骨折不愈合的临床效果。Objective It is to observe the curative effect of self-made Gujiu Decoction combined with Ilizarov technique for bone transport on nonunion of tibial infectious fracture and its effect on bone metabolism and hemorheology. Methods Eighty patients with nonunion of tibia infectious fracture treated in Foshan Hospital of TCM from January 2015 to November 2018 were randomly divided into control group and observation group, with 40 cases in each group. The control group underwent Ilizarov technique bone transfer after local infection control, and the observation group was treated with self-made Gujiu Decoction for 2 months after operation. Pain visual analogue score(VAS) was used to assess the pain level of the patients in the two groups before and 1 week, 2 weeks, and 1 month after operation. The mineralization time of the bone extension area, fixation support carrying time and bone removal time after removal of the external fixation were calculated in the two groups. The bone healing and limb function of the two groups were evaluated according to the scoring criteria of Ilizarov method research and application association in the two groups after removal of the external fixator, and the levels of serum bone morphology morphogenetic protein-2(BMP-2), insulin-like growth factor-1(IGF-1), specific alkaline phosphatase(ALP), tartrate-resistant acid phosphatase 5 b(TRACP5 b), high-cut whole blood viscosity, low cut whole blood viscosity, plasma viscosity, and red blood cell aggregation index were determined before and in 1 and 2 months after surgery in the two groups. Results The VAS scores in the observation group at 1 week, 2 weeks, and 1 month after operation were significantly lower(P<0.05),the mineralization time of the bone extension area, fixation support carrying time and bone removal time after removal of the external fixation were all significantly shorter(P<0.05), and the excellent rate of bone healing and limb function was significantly higher than that of the control group(P<0.05). At 1 and 2 months after surg

关 键 词：骨九汤 ILIZAROV技术 骨搬移 骨折 骨代谢 血液流变学 

分 类 号：R683.42[医药卫生—骨科学]