温针灸联合股骨近端防旋髓内钉内固定治疗骨质疏松性股骨转子间骨折临床观察  

Clinical Observations on Warm Needling Moxibustion plus Proximal Femoral Nail Antirotation Internal Fixation for Osteoporotic Intertrochanteric Fracture

作　　者：刘体军[1] 胡容[1] 许雪梅 LIU Ti-jun;HU Rong;XU Xue-mei(Xiantao First People’s Hospital,Xiantao 433000,China)

机构地区：[1]仙桃市第一人民医院,仙桃433000

出　　处：《上海针灸杂志》2020年第10期1309-1313,共5页Shanghai Journal of Acupuncture and Moxibustion

摘　　要：目的观察温针灸联合股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定治疗骨质疏松性股骨转子间骨折的疗效及相关机制。方法将76例骨质疏松性股骨转子间骨折患者随机分为对照组和观察组,每组38例。对照组予PFNA内固定术,治疗组予温针灸联合PFNA内固定术。记录患者骨折愈合时间;治疗前后进行Harris评分及视觉模拟量表(visual analogue scale,VAS)评分,测定患者健侧股骨颈的骨密度值;比较两组患者术后1年内的骨折再发生率;治疗前后测定血清核因子-κB受体活化因子配体(receptor activator of nuclear factor-κB ligand,RANKL)、网膜素-1水平。结果观察组患者的骨折愈合时间明显短于对照组(P<0.05);治疗后两组患者Harris及VAS评分均明显改善(P<0.05),观察组Harris及VAS评分均优于对照组(P<0.05);治疗后观察组健侧股骨颈骨密度明显升高(P<0.05),且高于对照组(P<0.05);术后1年,观察组骨折再发生率明显低于对照组(P<0.05);观察组患者血清RANKL水平降低(P<0.05),血清网膜素-1水平升高(P<0.05),且观察组血清RANKL、网膜素-1水平与对照组比较差异有统计学意义(P<0.05)。结论温针灸联合PFNA内固定治疗骨质疏松性股骨转子间骨折可加快骨折愈合,改善髋关节功能,缓解疼痛症状,提高健侧股骨颈骨密度,降低骨折再发生率,这可能与其调节患者血清RANKL、网膜素-1水平有关。Objective To investigate the efficacy of warm needling moxibustion plus proximal femoral nail antirotation(PFNA)internal fixation for osteoporotic intertrochanteric fracture and the related mechanism.Method Seventy-six patients were randomized to control and observation groups,38 cases in each group.The control group received PFNA internal fixation and the observation group,warm needling moxibustion in addition.Fracture healing time was recorded in the patients.The Harris score and the Visual Analogue Scale(VAS)score were recorded before and after treatment.The bone mineral density of femoral neck on the healthy side was measured in the patients.The recurrence rates of fracture were compared between the two groups of patients in one year after surgery.Serum receptor activator of nuclear factor-κB ligand(RANKL)and omentin-1 levels were measured before and after treatment.Result Fracture healing time was significantly shorter in the observation group than in the control group(P<0.05).After treatment,the Harris score and the VAS score improved significantly in both groups of patients(P<0.05)and were better in the observation group than in the control group(P<0.05).After treatment,the bone mineral density of femoral neck on the healthy side increased significantly in the observation group(P<0.05)and were higher than in the control group(P<0.05).The recurrence rate of fracture was significantly lower in the observation group than in the control group at one year after surgery(P<0.05).Serum RANKL levels decreased and omentin-1 levels increased in the observation group of patients(both P<0.05)and they had statistically significant differences between the observation and control groups(P<0.05).Conclusion Warm needling moxibustion plus PFNA internal fixation for osteoporotic intertrochanteric fracture can quicken fracture healing,improve hip function,relieve pain symptoms,increase the bone mineral density of femoral neck on the healthy side and decrease the recurrence rate of fracture.Those may be related to its regulati

关 键 词：温针疗法 骨质疏松 股骨骨折 骨折固定术 HARRIS评分 视觉模拟量表 骨密度 

分 类 号：R246.2[医药卫生—针灸推拿学]