双切口金属植入物内固定联合伤骨再生汤治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折临床观察  

Clinical observation of double - incision metal implant internal fixation combined with Shanggu Zaisheng Decoction for treatment of schatzker Ⅴ and Ⅵ tibial plateau fractures

作　　者：白煜 刘春辉 吕恩君 BAI Yu;LIU Chunhui;LV Enjun(Department of Orthopedics,First Hospital of Dandong,Dandong,Liaoning 118000;不详)

机构地区：[1]辽宁省丹东市第一医院骨科,辽宁丹东118000 [2]辽宁省丹东市中医院内一科,辽宁丹东118000

出　　处：《河北中医》2021年第8期1327-1331,共5页Hebei Journal of Traditional Chinese Medicine

摘　　要：目的观察双切口金属植入物内固定联合伤骨再生汤治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折的临床疗效。方法将114例SchatzkerⅤ、Ⅵ型胫骨平台骨折患者按照随机数字表法分为2组。2组均予双切口金属植入物内固定治疗,对照组57例术后予骨康胶囊治疗,治疗组57例术后予伤骨再生汤治疗。2组均治疗2个月。比较2组治疗前后Rasmussen膝关节功能评分、骨转换生化标志物[骨形成指标:血清骨碱性磷酸酶(BALP)、Ⅰ型前胶原N端前肽(PINP)、骨钙素(OC);骨吸收指标:血清脱氧吡啶酚(D-pyr)、Ⅰ型胶原交联羧基末端肽(CTX-Ⅰ)、抗酒石酸酸性磷酸酶(TRAP)、尿吡啶啉(PYD)]、血清炎症因子[促炎因子:白细胞介素1β(IL-1β)、IL-6、IL-22;抗炎因子:IL-4、IL-13、可溶性肿瘤坏死因子Ⅰ型受体(sTNF-RⅠ)]变化情况,并统计2组临床疗效及并发症发生情况。结果治疗组总有效率92.98%(53/57),对照组总有效率78.95%(45/57),治疗组疗效优于对照组(P<0.05)。治疗后2组Rasmussen膝关节功能评分均较本组治疗前升高(P<0.05),且治疗后治疗组高于对照组(P<0.05)。治疗后2组BALP、PINP、OC水平均较本组治疗前升高(P<0.05),D-pyr、CTX-Ⅰ、TRAP、PYD水平均降低(P<0.05),且治疗后治疗组BALP、PINP、OC水平均高于对照组(P<0.05),D-pyr、CTX-Ⅰ、TRAP、PYD水平均低于对照组(P<0.05)。治疗后2组血清IL-1β、IL-6、IL-22水平均较本组治疗前降低(P<0.05),血清IL-4、IL-13、sTNF-RⅠ水平均升高(P<0.05),且治疗后治疗组血清IL-1β、IL-6、IL-22水平均低于对照组(P<0.05),血清IL-4、IL-13、sTNF-RⅠ水平均高于对照组(P<0.05)。结论双切口金属植入物内固定联合伤骨再生汤治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折疗效确切,可有效改善骨代谢,促进骨折端愈合,且不会引起强烈的全身炎性反应,具有临床推广价值。Objective To observe the clinical efficacy of double-incision metal implant internal fixation combined with Shanggu Zaisheng Decoction in the treatment of SchatzkerⅤandⅥtibial plateau fractures.Methods Totally 114 patients with SchatzkerⅤandⅥtibial plateau fractures(TPFs)were randomly divided into two groups.In addition double-incision metal implant internal fixation,57 cases in control group were treated with Gukang capsule,and 57 cases in treatment group with Shanggu Zaisheng Decoction.The treatment continued 2 months,the aim was to compare Rasmussen's functional score for the knee joints,bone turnover markers,bone formation indexes including bone alkaline phosphatase(BALP),procollagen typeⅠN-terminal propeptide(PINP),osteocalcin(OC);bone resorption indexes including deoxypyridioline(D-pyr),carboxyl-terminal cross-linked telopeptide of type 1 collagen(CTX-Ⅰ),tartrate resistant acid phosphatase(TRAP),pyridinoline(PYD);inflammatory factor including pro-inflammatory factor[interleukin-1β(IL-1β),IL-6,IL-22],anti-inflammatory factor[IL-4,IL-13,soluble tumor necrosis factor receptorⅠ(sTNF-RⅠ)before and after treatment;the curative effect and complications were counted.Results The total response rates in treatment group and control group were 92.98%(53/57)and 78.95%(45/57),respectively,the curative effect being better in treatment group than control group(P<0.05).After treatment,Rasmussen's functional score for the knee joints in groups was increased(P<0.05),treatment group was increased in comparison with control group;BALP,PINP,OC in groups were increased(P<0.05),which increased in treatment group when compared with cortrol group(P<0.05);D-pyr,CTX-Ⅰ,TRAP,PYD in groups were downregulated(P<0.05),which downregulated in treatment group when compared with cortrol group(P<0.05);IL-1β,IL-6,IL-22 in groups decreased(P<0.05),improvement of which in treatment group were significantly better(P<0.05);IL-4,IL-13,sTNF-RⅠin groups were increased(P<0.05),treatment group was higher than control group(P<0.05).

关 键 词：胫骨骨折 外科手术 中西医结合疗法 

分 类 号：R683.423.058[医药卫生—骨科学]