全杜仲胶囊联合空心钉内固定治疗GardenⅢ~Ⅳ型股骨颈骨折的临床研究  

Clinical study on the combined treatment of Whole Eucommia Capsules and cannulated screw fixation for Garden Ⅲ~Ⅳfemoral neck fractures

作　　者：杜贵强 刘立云 DU Gui-qiang;LIU Li-yun(Ward 1,Department of Hip Surgery,Luoyang Orthopedic-Traumatological Hospital of Henan Province(Henan Provincial Orthopedic Hospital),Zhengzhou 450000,Henan,China;不详)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)髋关节外一科,河南郑州450000 [2]河南省洛阳正骨医院(河南省骨科医院)髋部损伤科,河南郑州450000

出　　处：《广东医学》2024年第8期1028-1032,共5页Guangdong Medical Journal

基　　金：河南省中医药科学研究专项课题(20-21ZY2082)。

摘　　要：目的探讨全杜仲胶囊在空心钉内固定治疗GardenⅢ~Ⅳ型股骨颈骨折术后的应用价值。方法前瞻性选择2020年6月至2022年6月期间110例接受空心钉内固定治疗的GardenⅢ~Ⅳ型股骨颈骨折患者,随机分为两组,每组55例,分别于术后给予全杜仲胶囊治疗(观察组)和常规治疗(对照组),连续治疗6个月。术后评价复位等级,观察内固定失败、骨折不愈合、股骨头坏死的发生率;分别于治疗前和治疗结束后,评价Harris评分,检测血清血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)以及含半胱氨酸的天冬氨酸蛋白水解酶-3(Caspase-3)的水平。结果受试者退出情况:观察组共4例退出,其中2例因未按时按剂量服药退出、2例因失访退出;对照组共4例退出,其中1例因未按时按剂量服药退出、3例因失访退出。治疗后两组间复位等级、内固定失败发生率、骨折不愈合发生率的比较差异无统计学意义(P>0.05),Harris评分、股骨头坏死发生率的比较差异有统计学意义(P<0.05),观察组的Harris评分高于对照组、股骨头坏死发生率低于对照组。治疗结束后,观察组血清VEGF、bFGF水平高于治疗前,Caspase-3水平低于治疗前(P<0.05),对照组血清指标与治疗前比较差异无统计学意义(P>0.05)。观察组治疗结束后血清VEGF、bFGF水平高于对照组,Caspase-3水平低于对照组,组间治疗后比较差异有统计学意义(P<0.05)。结论空心钉内固定治疗GardenⅢ~Ⅳ型股骨颈骨折术后全杜仲胶囊治疗有利于改善关节功能、预防股骨头坏死,其机制可能于上调VEGF、bFGF以及下调Caspase-3有关。Objective To explore the clinical value of whole Eucommia capsules in the postoperative application of cannulated screw fixation for Garden Ⅲ~Ⅳ femoral neck fractures.Methods A prospective study was conducted on 110 patients with Garden Ⅲ~Ⅳ femoral neck fractures who received cannulated screw fixation from June 2020 to June 2022.The patients were randomly divided into two groups,each with 55 patients:the observation group received whole Eucommia capsules postoperatively,while the control group received conventional treatment for 6 months.Postoperative evaluations included reduction grade,incidences of internal fixation failure,fracture nonunion,and femoral head necrosis.Harris scores were assessed before and after treatment,and serum levels of vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF),and cysteine-aspartic acid protease-3(Caspase-3)were measured.Results Four patients(2 due to non-compliance with medication,2 lost to follow-up)withdrew from the observation group,and four patients(1 due to non-compliance with medication,3 lost to follow-up)withdrew from the control group.There were no statistically significant differences between the two groups in reduction grade,internal fixation failure rate,or fracture nonunion rate(P>0.05).Significant differences were observed in Harris scores and femoral head necrosis rates(P<0.05),with the observation group showing higher Harris scores and lower femoral head necrosis rates than the control group.After treatment,the observation group showed increased levels of VEGF and bFGF and decreased levels of Caspase-3 compared to pre-treatment(P<0.05),while the control group showed no significant changes in serum indicators(P>0.05).Conclusio1n Postoperative treatment with whole Eucommia capsules after cannulated screw fixation for Garden II-IV femoral neck fractures is beneficial for improving joint function and preventing femoral head necrosis.The mechanism may be related to the upregulation of VEGF and bFCF and the downregulation of Caspase-3

关 键 词：股骨颈骨折 股骨头坏死 全杜仲胶囊 血管内皮生长因子 碱性成纤维细胞生长因子 含半胱氨酸的天冬氨酸蛋白水解酶-3 

分 类 号：R683.4[医药卫生—骨科学] R274.1[医药卫生—外科学]