黄连解毒汤加减治疗跟骨骨折术前肿胀的临床研究  

A clinical study of modified Huanglian Jiedu Tang(黄连解毒汤)for treatment of preoperative swelling of calcaneal fractures

作　　者：陈强 何智南 李强[1] 袁海涛 胡和军[1] 邓雄伟[1] CHEN Qiang;HE Zhinan;LI Qiang;YUAN Haitao;HU Hejun;DENG Xiongwei(Nanchang Hongdu Hospital of TCM,Nanchang 330038,Jiangxi,China)

机构地区：[1]南昌市洪都中医院,江西南昌330038

出　　处：《中医正骨》2024年第4期5-10,20,共7页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：江西省中医药中青年骨干人才(第一批)培养计划项目(赣中医药科教字[2020]2号);南昌市科学技术局医疗卫生引导性科技计划项目(洪科字[2023]336号);南昌市市级重点专科建设项目(洪卫体改字[2023]10号)。

摘　　要：目的:观察黄连解毒汤加减治疗跟骨骨折术前肿胀的临床疗效和安全性,并探讨其可能的作用机制。方法:将符合要求的70例SandersⅡ~Ⅳ型跟骨骨折患者随机分为2组,每组35例。2组患者入院后均给予石膏托外固定制动、抬高患肢、静脉滴注甘露醇注射液、皮下注射那屈肝素钙等常规治疗。常规治疗组在此基础上口服地奥司明片,每次0.9 g,每日1次,晚餐后服用,共服用7 d;黄连解毒汤组在常规治疗基础上口服黄连解毒汤加减,早晚各1次,共服用7 d。比较2组患者的患肢肿胀率、疼痛视觉模拟量表(visual analogue scale,VAS)评分、血清C反应蛋白(C-reactive protein,CRP)水平、血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平、血清白细胞介素-6(interleukin 6,IL-6)水平、中医证候积分及并发症发生情况。结果:①患肢肿胀率。2组患者的患肢肿胀率随时间变化均呈先升高后降低的趋势(F=246.771,P=0.000;F=282.982,P=0.000);治疗前2组患者患肢肿胀率的差异无统计学意义(t=0.596,P=0.553);治疗第3天和治疗第7天,黄连解毒汤组患者的患肢肿胀率均低于常规治疗组(t=2.147,P=0.035;t=2.799,P=0.007)。②疼痛VAS评分。2组患者的疼痛VAS评分随时间变化均呈逐渐降低的趋势(F=262.877,P=0.000;F=462.471,P=0.000);治疗前2组患者疼痛VAS评分的差异无统计学意义(t=0.432,P=0.667);治疗第3天和治疗第7天,黄连解毒汤组患者的疼痛VAS评分均低于常规治疗组(t=3.200,P=0.002;t=8.735,P=0.000)。③血清CRP水平。2组患者的血清CRP水平随时间变化均呈先升高后降低的趋势(F=1355.001,P=0.000;F=2271.167,P=0.000);治疗前2组患者血清CRP水平的差异无统计学意义(t=-0.470,P=0.570);治疗第3天和治疗第7天,黄连解毒汤组患者的血清CRP水平均低于常规治疗组(t=4.575,P=0.000;t=25.065,P=0.000)。④血清TNF-α水平。2组患者的血清TNF-α水平随时间变化均呈先升高后降低的趋势(F=366.536,PObjective:To observe the clinical outcome and safety of modified Huanglian Jiedu Tang(黄连解毒汤,HLJDT)in treatment of preoperative swelling in patients with calcaneal fractures,and to explore its underlying mechanism.Methods:Seventy patients with Sanders typeⅡ-Ⅳcalcaneal fractures were enrolled in the study and were randomized into conventional treatment group and HLJDT treatment group,35 ones in each group.All patients in the 2 groups were treated with conventional treatment including plaster fixing,braking,raising the injured limbs,intravenous drip infusion of mannitol injection and subcutaneous injection of nadroparin calcium after the hospital admission.In addition,the patients in conventional treatment group were treated with oral application of diosmin tablets,once a day(after supper),0.9 g at a time for consecutive 7 days;and the patients in HLJDT treatment group were treated with oral application of modified HLJDT,twice a day in the morning and evening respectively for consecutive 7 days.The swelling rate of the affected limb,pain visual analogue scale(VAS)score,serum levels of C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)and interleukin 6(IL-6),TCM syndrome score and complications were compared between the 2 groups.Results:①The swelling rate of the affected limbs presented a upward firstly and downward subsequently trend over time in the 2 groups(F=246.771,P=0.000;F=282.982,P=0.000).The comparison of swelling rate of the affected limbs between the 2 groups revealed no significant differences before the treatment(t=0.596,P=0.553);while,after 3-and 7-day treatment,the swelling rate of the affected limbs was lower in HLJDT treatment group compared to conventional treatment group(t=2.147,P=0.035;t=2.799,P=0.007).②The pain VAS score presented a gradual downward trend over time in the 2 groups(F=262.877,P=0.000;F=462.471,P=0.000).There was no statistical difference in the pain VAS score between the 2 groups before the treatment(t=0.432,P=0.667);while,after 3-and 7-day treatment,the pai

关 键 词：黄连解毒汤 骨折 跟骨 肿胀 炎症因子 骨折并发症 

分 类 号：R274.1[医药卫生—中医骨伤科学]