自然铜合方在股骨干骨折术后骨不连脾肾两虚夹瘀证治疗中的应用  

Application of pyritum integrated decoction in treatment of spleen-kidney-deficiency-blood-stasis-type postoperative nonunion of femoral shaft fractures

作　　者：盛红枫 张培祥[1] 张魁[1] 陆建伟[1] SHENG Hongfeng;ZHANG Peixiang;ZHANG Kui;LU Jianwei(Tongde Hospital of Zhejiang Province,Hangzhou 310012,Zhejiang,China)

机构地区：[1]浙江省立同德医院

出　　处：《中医正骨》2019年第12期1-9,共9页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：浙江省中医药科技计划项目(2017ZA017)

摘　　要：目的:探讨自然铜合方在股骨干骨折术后骨不连脾肾两虚夹瘀证治疗中的应用价值。方法:回顾性分析2010年1月至2017年6月40例股骨干骨折交锁髓内钉内固定术后骨不连脾肾两虚夹瘀证患者的病例资料,自然铜合方组和碳酸钙D3组各20例。2组患者采用原内固定方式重新固定骨折并在骨折端植骨后,均予以碳酸钙D3片口服,每次2片,每日1次;自然铜合方组患者在此基础上予以自然铜合方水煎服,每日1剂,早晚各1次。治疗9个月后,检测2组患者骨密度,并参照《骨科学》中骨折临床愈合评价标准评价疗效。分别于治疗前和治疗3个月后、6个月后、9个月后,检测血清骨钙素(bone glaprotein,BGP)、骨保护素(osteoprotegerin,OPG)、Ⅰ型胶原N末端肽(collagen typeⅠN-telepeptide,NTX)、抗酒石酸酸性磷酸酶5b(tartrate resistant acid phosphatase-5b,TRACP-5b)水平观察骨代谢情况,检测血清谷草转氨酶(aspartate aminotransferase,AST)、谷丙转氨酶(alanine aminotransferase,ALT)、肌酐(creatinine,Cr)水平评价肝肾功能。结果:①骨密度和临床疗效。治疗前2组患者骨密度比较,差异无统计学意义[(0.91±0.06)g·cm^-2,(0.93±0.05)g·cm^-2,t=4.109,P=0.197];治疗9个月后,2组患者骨密度均比治疗前提高[(0.91±0.06)g·cm^-2,(1.38±0.04)g·cm^-2,t=25.900,P=0.000;(0.93±0.05)g·cm^-2,(1.07±0.03)g·cm^-2,t=8.994,P=0.000],且自然铜合方组骨密度高于碳酸钙D3组(t=26.684,P=0.000)。自然铜合方组骨折临床愈合13例、好转6例、无效1例,碳酸钙D3组骨折临床愈合6例、好转8例、无效6例,自然铜合方组临床疗效优于碳酸钙D3组(Z=-2.472,P=0.013)。②血清BGP水平。时间因素和分组因素存在交互效应(F=3.343,P=0.022);2组患者血清BGP水平总体比较,差异有统计学意义,即存在分组效应(F=8.398,P=0.006);治疗前后不同时间点之间患者血清BGP水平的差异有统计学意义,即存在时间效应(F=64.142,P=0.000);2组患者血清BGP�Objective:To explore the applied values of pyritum integrated decoction in treatment of spleen-kidney-deficiency-blood-stasis-type postoperative nonunion of femoral shat fractures.Metliods:The medical records of 40 patients with spleen-kidney-deficiency-blood-stasis-type fracture nonunion ater internal fixation with interlocking intramedullary nail for treatment of femoral shat fractures from January 2010 to June 2017 were analyzed retrospectively.Twenty patients were treated with pyritum integrated decoction(pyritum integrated decoction group),while the others were treated with calcium carbonate D3(calcium carbonate D3 group).All patients in the 2 groups were treated with oral applications of calcium carbonate D3 tablets ater the fractures were refixed with initial internal fixation method and bone grafting were conducted at the broken ends of fractured femoral shaft,once a day,2 tablets at a time.Moreover,the patients in pyritum integrated decoction group were treated with pyritum integrated decoction,one dose a day in the morning and evening respectively.After 9-month treatment,the bone mineral density(BMD)was measured in the 2 groups,and the curative effects were evaluated according to clinical fracture healing evaluation standard which was extracted from ORTHOPAEDICS.The serum levels of bone glaprotein(BGP),osteoprotegerin(OPG),collagen type Ⅰ N-telepeptide(NTX)and tartrate resistant acid phosphatase-5b(TRACP-5b)were detected for evaluating bone metabolism and the serum levels of aspartate aminotransferase(AST),alanine aminotransferase(ALT)and creatinine(Cr)were detected for evaluating functions of liver and kidney before the treatment and after 3-,-and 9-month treatment respectively.Results:There was no statistical difference in the BMDbetween the 2 groups before the treatment(0.91+/-0.06 vs 0.93+/-0.05 gcm(2),=4.109,P=0.197).The BMD increased in the 2 groups ater 9-month treatment compared to pre-treatment(0.91+/-0.06 vs 1.38+/-0.04 gcm(2),=25.900,P=0.000;0.93+/-0.05 vs 1.07+/-0.03 gcm(2),=8.994,P=0

关 键 词：股骨骨折 手术后并发症 骨折 不愈合 脾虚 肾虚 血瘀 自然铜 骨密度 骨钙素 骨保护素 Ⅰ型胶原N末端肽 抗酒石酸酸性磷 

分 类 号：R28[医药卫生—中药学]