关节镜下锁定加压接骨板内固定联合逐瘀通络法治疗桡骨远端骨折的临床效果分析  

Clinical effect analysis of locking compressing plates internal fixation under arthroscopy combined with Zhuyu Tongluo method in the treatment of distal radius fractures

作　　者：李志刚[1] 曾祥悦[2] 曹哲铭 Li Zhigang;Zeng Xiangyue;Cao Zheming(Department of Hand Surgery,the Second Hospital of Tangshan City,Hebei Tangshan 063600,China;Department of Otolaryngology,Tangshan Vocational and Technical College,Hebei Tangshan 063600,China;Department of Surgery,Tangshan Harbor Economic Development Zone Hospital,Hebei Tangshan 063611,China)

机构地区：[1]唐山市第二医院手四科,063600 [2]唐山职业技术学院临床医学系耳鼻喉教研室,063600 [3]唐山市海港经济开发区医院外科,063611

出　　处：《中国医师进修杂志》2021年第6期547-552,共6页Chinese Journal of Postgraduates of Medicine

基　　金：河北省中医药管理局科研计划项目(2021414)。

摘　　要：目的探讨关节镜下锁定加压接骨板(LCP)内固定联合逐瘀通络法治疗桡骨远端骨折(DRF)的疗效及对关节功能、血液流变学、血清碱性成纤维细胞生长因子(bFGF)、骨形态发生蛋白2(BMP-2)的影响。方法选取河北省唐山市第二医院2017年6月至2020年1月收治的DRF患者78例,按照随机数字表法分为对照组和研究组各39例。对照组给予关节镜下LCP内固定治疗,研究组在对照组基础上联合逐瘀通络法治疗。比较两组恢复情况、手术前后血液流变学指标(血浆黏度、全血黏度高切、全血黏度低切、红细胞压积)、血清bFGF、BMP-2水平,并随访6个月,比较两组手术后腕关节活动度、腕关节功能优良率。结果研究组肿胀消退时间、疼痛消失时间、瘀斑消失时间、骨折影像学愈合时间短于对照组[(10.37±3.13)d比(14.62±3.38)d、(12.39±2.97)d比(17.14±4.02)d、(19.15±2.35)d比(24.36±3.27)d、(68.21±7.12)d比(80.07±8.24)d],差异有统计学意义(P<0.05)。研究组术后1、2周血浆黏度、全血黏度高切、全血黏度低切、红细胞压积均低于对照组,差异有统计学意义(P<0.05)。研究组术后1、2周血清bFGF、BMP-2高于对照组[术后1周:(356.27±46.29)μg/L比(236.51±37.42)μg/L、(614.28±61.47)μg/L比(487.39±48.24)μg/L;术后2周:(502.07±113.21)μg/L比(381.59±82.75)μg/L、(910.77±97.20)μg/L比(731.35±92.13)μg/L],差异有统计学意义(P<0.05)。术后6个月研究组掌屈、背伸、桡偏、尺偏优于对照组,差异有统计学意义(P<0.05)。术后6个月研究组腕关节功能优良率高于对照组[89.5%(34/38)比70.3%(26/37)],差异有统计学意义(P<0.05)。结论关节镜下LCP内固定联合逐瘀通络法治疗DRF患者,可提高血清bFGF、BMP-2水平,减轻炎性反应,改善血液流变学,促进骨折愈合,改善腕关节活动度及腕关节功能。Objective To explore the effect of locking compressing plates(LCP)internal fixation under arthroscopy combined with Zhuyu Tongluo method in the treatment of distal radius fractures(DRF)and its effects on joint function,hemorheology,serum basic fibroblast growth factor(bFGF)and bone morphogenetic protein 2(BMP-2).Methods A total of 78 patients with DRF admitted to the Second Hospital of Tangshan City from June 2017 to January 2020 were selected and grouped according to the random number table method,with 39 cases in each group.The control group was treated with LCP internal fixation under arthroscopy,and the study group was treated with Zhuyu Tongluo method on the basis of the control group.The recovery,hemorheology(plasma viscosity,whole blood viscosity high cut,whole blood low cut,hematocrit),serum bFGF,BMP-2 levels,before and after the operation were compared between the two groups.They were followed up for 6 months and the range of motion of the wrist joints before and after the operation and the excellent and good rate of wrist joint function between the two groups were compared.Results The swelling subsidence time,pain disappearance time,ecchymosis disappearance time,and fracture imaging healing time in the study group were shorter than those in the control group:(10.37±3.13)d vs.(14.62±3.38)d,(12.39±2.97)d vs.(17.14±4.02)d,(19.15±2.35)d vs.(24.36±3.27)d,(68.21±7.12)d vs.(80.07±8.24)d,and the differences were statistically significant(P<0.05).The plasma viscosity,whole blood viscosity high-cut,whole blood low-cut,and hematocrit in the study group were lower than those in the control group at 1 and 2 weeks after operation(P<0.05).The levels of serum bFGF and BMP-2 in the study group were higher than those in the control group at 1 and 2 weeks after operation:at 1 week after operation:(356.27±46.29)μg/L vs.(236.51±37.42)μg/L,(614.28±61.47)μg/L vs.(487.39±48.24)μg/L;at 2 weeks after operation:(502.07±113.21)μg/L vs.(381.59±82.75)μg/L,(910.77±97.20)μg/L vs.(731.35±92.13)μg/L,and the diffe

关 键 词：桡骨骨折 关节镜 锁定加压接骨板 逐瘀通络法 血液流变学 成纤维细胞生长因子2 

分 类 号：R687.3[医药卫生—骨科学]