补肾活血汤联合桡动脉茎突返...手舟骨骨折患者临床影响研究_李培豪.pdf

镇痛方内服外敷可通过内服外敷两种途径使中药有效成分到达病灶,抑制病灶炎症反应,促进炎性产物吸收,减轻水肿,降低疼痛。结果显示,3 组患者不良发生较轻,B 组和 C 组均出现了局部皮肤瘙痒症状,可能与镇痛方治疗后软组织修复有关,但 3组各不良反应发生率对比无差异,说明中药镇痛方内服外敷治疗四肢闭合性骨折不仅疗效确切,且安全性高。综上所述,中药镇痛方内服外敷治疗四肢闭合性骨折疗效确切,可显著改善中医症状,降低疼痛,提升睡眠质量,其机制可能与抑制炎症反应有关,值得临床进一步研究。参考文献1 中华医学会骨科学分会创伤骨科学组,中华医学会骨科学分会外固定与肢体重建学组,中国医师协会创伤外科医师分会创伤感染专业委员会,等.中国开放性骨折诊断与治疗指南(2019版)J.中华创伤骨科杂志,2019,21(11):921-928.2 唐俊琳,潘芳,王保平,等.渐进性肌肉放松训练对四肢骨折患者术后心理弹性、自我效能感及睡眠质量的影响 J.国际护理学杂志,2021,40(1):79-82.3 刘玉林,徐翀,王秋生,等.手术联合中药外洗治疗三踝骨折临床疗效观察 J.中华中医药学刊,2018,36(1):242-244.4 徐禄基,唐晶,梁启楼,等.中药辅助髋关节置换术治疗老年股骨颈骨折的临床疗效 J.世界中医药,2019,14(9):2375-2378.5 胥少汀,葛宝丰,徐印坎.实用骨科学 M.北京:人民军医出版社,2012.6 刘钟华,赵长伟,闻辉.中医骨伤科学 M.北京:科学出版社,2016.7 郑筱萸.中药新药临床研究指导原则(试行)M.北京:中国医药科技出版社,2002:342.8Melzack R.The McGill Pain Questionnaire:major properties andscoring methods J.Pain,1975,1(3):277-299.9 李建明.睡眠状况自评量表(SRSS)简介 J.中国健康心理学杂志,2012,20(12):1851.10 张黎,李阳,陈长香.创伤性骨折患者心理弹性现状及其影响因素 J.职业与健康,2017,33(5):649-651.11 刘宇,李新宇,姜葳,等.曲马多的临床应用进展 J.中国实验诊断学,2018,22(2):377-379.12 王佳域,于丹丹,李明,等.药物滥用人群曲马多复方制剂滥用/使用现状 J.中国药物警戒,2020,17(2):98-105.13Pinho-Ribeiro FA,Verri WA Jr,Chiu IM.Nociceptor SensoryNeuron-Immune Interactions in Pain and Inflammation J.TrendsImmunol,2017,38(1):5-19.14 余能,方略,黄晓涛,等.中西医联合治疗对闭合性骨折围手术期炎症的影响 J.温州医科大学学报,2018,48(10):764-768.15 吴晖,方真华,潘娜,等.开放性与闭合性下肢骨折术后切口感染及血清炎症因子变化 J.中华医院感染学杂志,2020,30(5):721-724.(收稿日期 2021-03-22)基金项目:防城港市科学研究与技术开发计划课题(编号:16006011)。作者简介:李培豪,在职硕士研究生,副主任医师,主要从事创伤骨科研究,E-mail:15907702090 。补肾活血汤联合桡动脉茎突返支骨瓣转位对陈旧性手舟骨骨折患者临床影响研究李培豪,陈环月,黄永光,杨其锋(防城港市中医医院骨伤科,广西 防城港 538000)摘要:目的:分析补肾活血汤联合桡动脉茎突返支骨瓣转位对陈旧性手舟骨骨折患者疗效影响。方法:选取 2016年 9 月2020 年 9 月防城港市中医医院收治的陈旧性手舟骨骨折患者 96 例,随机数字表法分成两组,对照组(48 例)行桡动脉茎突返支骨瓣转位术,观察组(48 例)术后加服补肾活血汤,观察患者术后腕关节功能恢复情况及血清炎性因子、骨代谢指标改变状况。结果:观察组患者优良率为 95.83%,高于对照组的 85.42%,差异有统计学意义(P0.05);两组患者腕关节评分较治疗前均显著上升,且观察组高于对照组,观察组骨折愈合时间低于对照组,差异均有统计学意义(P0.05);术后1 月观察组患者血清肿瘤坏死因子-(TNF-)、高迁移率族蛋白 B1(HMGB1)及白细胞介素-6(IL-6)含量较术后 1 天、对照组显著降低,差异均有统计学意义(P0.05);术后 1 月观察组患者血清总骨型前胶原氨基端延长肽(Total-PINP)、型胶原羧基端肽 特殊序列(-CTX)含量较术后 1 天、对照组显著下降,骨钙素(BGP)、型胶原羧基端肽(PICP)含量较术后 1 天、对照组显著上升,差异均有统计学意义(P0.05)。结论:补肾活血汤联合桡动脉茎突返支骨瓣转位可明显改善陈旧性手舟骨骨折患者腕关节活动功能,促进患肢更快愈合。关键词:手舟骨骨折;桡动脉茎突返支骨瓣转位;中西医结合;骨代谢指标 中图分类号:R 274.11,R 683.41 文献标志码:A 文章编号:1000-3649(2023)02-0158-04851四 川 中 医Journal of Sichuan of Traditional Chinese Medicine2023 年第 41 卷第 2 期Vol.41,No.2,2023 Clinical Study on the Effect of Bushen Huoxue Decoction Combined with Transposition of Radial Sacral Sacral Re-current Bone Flap for Old Hand Scaphoid Fracture/LI Peihao,CHEN Huanyue,HUANG Yongguang,et al./Department ofOrthopedics and Traumatology,Fangchenggang Municipal Hospital of Traditional Chinese Medicine(Fangchenggang Guangxi538000,China)Abstract:Objective:To analyze the effect of Bushen Huoxue Decoction combined with transposition of the radial branch ofthe radial artery for the treatment of old hand scaphoid fractures.Methods:Ninety-six patients with old hand scaphoid fractureswho were treated in our hospital from September 2016 to September 2020 were enrolled.The patients were randomly divided intotwo groups.The controlled group(48 patients)underwent radial branching of the sacral process.In the observation group(48 ca-ses),the Bushen Huoxue Decoction was added after operation,and the recovery of wrist function and the changes of serum in-flammatory factors and bone metabolic indexes were observed.Results:The excellent and good rate of the observation group was95.83%,which was higher than 85.42%of the controlled group(P0.05).The wrist joint scores of the two groups were signif-icantly higher than those before treatment,and the observation group was higher than the controlled group.The fracture healingtime of the observation group was lower than that of the controlled group(P0.05).The serum tumor necrosis factor-(TNF-)and high mobility group protein B1(HMGB1)were observed in the observation group at 1 month after operation.The contentof interleukin-6(IL-6)was significantly lower than that of the controlled group at 1 day after operation(P0.05).The serumtotal bone type I procollagen was observed in the observation group 1 month after operation.The content of amino-terminal prolon-gation peptide(Total-PINP)and type I collagen carboxy-terminal peptide-CTX was significantly lower than that of the con-trolled group 1 day after surgery,and osteocalcin(BGP)and type I collagen carboxy terminal peptide.The content of PICP wassignificantly higher than that of the controlled group 1 day after operation(P0.05),具有可比性。本研究经防城港市中医医院医学伦理委员会批准,患者或家属知情并签署同意书。1.3方法两组患者均进行桡动脉茎突返支骨瓣转位术,患肢使用止血带止血,作纵行切口于腕背部咽窝,切开皮肤与皮下组织,头静脉与桡神经浅支拉向一侧。将桡动脉返支向近端游离直到和桡动脉汇合,桡骨茎突长入区将骨膜锐性切开,骨刀凿取骨瓣,大小为 10.5cm 备用。Lister 结节位置将腕背支持带切开,沿着桡侧腕短伸肌与长伸肌间进入,桡背侧关节囊切开使舟骨暴露,断端机化组织清除,硬化骨去除,复位舟骨骨块,舟骨“高一长度比”及“舟骨内角”调整,进针点为结节部位将直径3.5mm 且长度适当的松质骨拧入加压螺钉固定,骨块断端休整为槽状。骨瓣转位并嵌入骨槽,将骨瓣筋膜在周边关节囊上缝合并固定,切口关闭,手术后两周功能位使用石膏托固定。观察组患者术后加服补肾活血汤,处方如下:炙甘草 6g,熟地 20g,骨9512023 年第 41 卷第 2 期Vol.41,No.2,2023四 川 中 医Journal of Sichuan of Traditional Chinese Medicine碎补 25g,黄芪 25g,泽泻 10g,淫羊霍 20g,五加皮10g,肉苁蓉 20g,青皮 10g,续断 20g,赤芍 15g,杜仲 15g,川牛膝 15g,菟丝子 15g,川芎 15g,山茱萸 15g,当归 15g。诸药加入清水煎至 200