手术切开复位内固定联合桃红四物汤治疗肱骨髁间骨折及对炎性因子的影响
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摘要
目的:探讨手术切开复位内固定联合桃红四物汤治疗肱骨髁间骨折的效果及对炎性因子的影响。方法:选择2013年2月—2018年5月医院进行治疗的肱骨髁间骨折患者92例,按照随机数字的方法将患者分为两组,对照组和观察组,每组46例,对照组给予尺骨鹰嘴截骨入路的手术切开复位联合内固定治疗,观察组在对照组治疗方法的基础上使用桃红四物汤治疗,对治疗效果进行对比。结果:经过治疗后,对照组的血管内皮生长因子从[(175.83±19.86)ng/L升高到(230.47±21.55)ng/L],骨形态发生蛋白-2从[(42.67±5.91)ng/L升高到(78.61±5.55)ng/L],血清胰岛素样生长因子-1从[(3.07±0.46)μg/L升高到(8.39±0.51)μg/L],观察组的血管内皮生长因子从[(176.69±20.36)ng/L升高到(288.91±20.47)ng/L],骨形态发生蛋白-2从[(43.11±6.03)ng/L升高到(94.87±6.68)ng/L],血清胰岛素样生长因子-1从[(3.09±0.42)μg/L升高到(12.61±2.35)μg/L],观察组的升高幅度大于对照组,数据差异均具有统计学意义(t=-13.335,-12.698,-11.902,P<0.05),在治疗后3 d,对照组的白细胞介素-6从[(9.16±1.21)ng/L升高到(18.76±2.68)ng/L],白细胞介素-10从[(62.34±6.74)ng/L升高到(87.64±7.79)ng/L],白细胞介素-18从[(18.76±2.37)ng/L升高到(30.56±2.22)ng/L],观察组的白细胞介素-6从[(9.18±1.19)ng/L升高到(14.28±2.13)ng/L],白细胞介素-10从[(63.15±6.55)ng/L升高到(75.49±6.51)ng/L],白细胞介素-18从[(18.97±2.46)ng/L升高到(24.62±2.71)ng/L],对照组的升高幅度大于观察组患者,数据差异均具有统计学意义(t=8.876、8.117、11.500,P<0.05),观察组的治疗效果优于对照组,数据差异具有统计学意义(z=-4.325,P<0.05),两组各项并发症发生率的数据差异均不具有统计学意义(χ~2=0.155、0.345、0.211、0.713,P>0.05)。结论:使用手术切开复位内固定联合桃红四物汤治疗肱骨髁间骨折,可以提升治疗效果,降低炎症反应程度,促进骨折恢复,值得在临床工作中推广。
Objective:To investigate the effect of open reduction and internal fixation combined with Taohong Siwu Decoction on intercondylar fracture of the humerus and its influence on inflammatory factors. Methods:Ninety-two patients with humeral intercondylar fractures treated in our hospital from February 2013 to May 2018 were selected. According to the random number method, the patients were divided into the control group and the observation group, with 46 patients in each group. The patients in the control group were treated with open reduction and internal fixation of the ulna olecranon osteotomy approach. The patients in the observation group were treated with Taohong Siwu Decoction on the basis of the treatment methods of the control group, and the treatment effect was compared. Result:After treatment, the vascular endothelial growth factor of the control group increased from(175.83±19.86)ng/L to 230.47±21.55)ng/L, bone morphogenetic protein-2 increased from(42.67±5.91) ng/L to(78.61±5.55)ng/L, and serum insulin-like growth factor-1 increased from(3.07±0.46)μg/L to(8.39±0.51)μg/L. The vascular endothelial growth factor in the observation group increased from(176.69±20.36)ng/L to(288.91±20.47)ng/L, bone morphogenetic protein-2 increased from(43.11±6.03)ng/L to(94.87±6.68)ng/L and serum insulin-like growth factor-1 increased from(3.09±0.42) μg/L to(12.61±2.35)μg/L. The increase of the patients in the observation group was larger than that in the control group and the difference was statistically significant(t=-13.335,-12.698,-11.902, P<0.05). On the 3 rd day after treatment, the interleukin-6 of the control group increased from(9.16±1.21)ng/L to(18.76±2.68)ng/L, interleukin-10 increased from(62.34±6.74)ng/L to(87.64±7.79)ng/L and interleukin-18 increased from(18.76±2.37)ng/L to(30.56±2.22)ng/L. Interleukin-6 in the observation group increased from(9.18±1.19) ng/L to(14.28±2.13)ng/L, interleukin-10 increased from(63.15±6.55)ng/L to(75.49±6.51) g/L, and interleukin-18 increased from(18.97±2.46)ng/L to(24.62±2.71)ng/L. The increase in the control group was larger than that in the observation group and the difference was statistically significant(t=8.876, 8.117, 11.500, P<0.05). The treatment effect of the observation group was better than that of the control group and the difference was statistically significant(z=-4.325, P<0.05). There was no statistically significant difference in the incidence of complications between the two groups(χ~2=0.155, 0.345, 0.211, 0.713, P>0.05). Conclusion:The treatment of humeral intercondylar fracture with open reduction and internal fixation combined with Taohong Siwu Decoction can improve the therapeutic effect, reduce the degree of inflammation and promote the recovery of fracture. It is worthy of popularizing in clinical work.
Objective:To investigate the effect of open reduction and internal fixation combined with Taohong Siwu Decoction on intercondylar fracture of the humerus and its influence on inflammatory factors. Methods:Ninety-two patients with humeral intercondylar fractures treated in our hospital from February 2013 to May 2018 were selected. According to the random number method, the patients were divided into the control group and the observation group, with 46 patients in each group. The patients in the control group were treated with open reduction and internal fixation of the ulna olecranon osteotomy approach. The patients in the observation group were treated with Taohong Siwu Decoction on the basis of the treatment methods of the control group, and the treatment effect was compared. Result:After treatment, the vascular endothelial growth factor of the control group increased from(175.83±19.86)ng/L to 230.47±21.55)ng/L, bone morphogenetic protein-2 increased from(42.67±5.91) ng/L to(78.61±5.55)ng/L, and serum insulin-like growth factor-1 increased from(3.07±0.46)μg/L to(8.39±0.51)μg/L. The vascular endothelial growth factor in the observation group increased from(176.69±20.36)ng/L to(288.91±20.47)ng/L, bone morphogenetic protein-2 increased from(43.11±6.03)ng/L to(94.87±6.68)ng/L and serum insulin-like growth factor-1 increased from(3.09±0.42) μg/L to(12.61±2.35)μg/L. The increase of the patients in the observation group was larger than that in the control group and the difference was statistically significant(t=-13.335,-12.698,-11.902, P<0.05). On the 3 rd day after treatment, the interleukin-6 of the control group increased from(9.16±1.21)ng/L to(18.76±2.68)ng/L, interleukin-10 increased from(62.34±6.74)ng/L to(87.64±7.79)ng/L and interleukin-18 increased from(18.76±2.37)ng/L to(30.56±2.22)ng/L. Interleukin-6 in the observation group increased from(9.18±1.19) ng/L to(14.28±2.13)ng/L, interleukin-10 increased from(63.15±6.55)ng/L to(75.49±6.51) g/L, and interleukin-18 increased from(18.97±2.46)ng/L to(24.62±2.71)ng/L. The increase in the control group was larger than that in the observation group and the difference was statistically significant(t=8.876, 8.117, 11.500, P<0.05). The treatment effect of the observation group was better than that of the control group and the difference was statistically significant(z=-4.325, P<0.05). There was no statistically significant difference in the incidence of complications between the two groups(χ~2=0.155, 0.345, 0.211, 0.713, P>0.05). Conclusion:The treatment of humeral intercondylar fracture with open reduction and internal fixation combined with Taohong Siwu Decoction can improve the therapeutic effect, reduce the degree of inflammation and promote the recovery of fracture. It is worthy of popularizing in clinical work.
引文
[1] 范亮全,徐天波,刘德国,等.骨肽注射液联合接骨七厘片治疗四肢骨折的效果评价[J].中国生化药物杂志,2017,37(8):73-74,77.
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[7] 熊福军,杨宏涛,贺西京,等.肱三头肌肘肌翻转入路与尺骨鹰嘴截骨入路治疗肱骨髁间骨折的疗效对比[J].创伤外科杂志,2017,19(11):825-829.
[8] 罗孝华,张红,张亮,等.桃红四物汤辅助经皮椎体成形术治疗老年骨质疏松性椎体压缩性骨折临床研究[J].国际中医中药杂志,2018,40(2):120-123.
[9] 蔡丽萍,何建飞,傅红飞,等.中药熏洗配合康复训练对胫骨平台骨折术后功能恢复的影响[J].中国中医药科技,2018,25(1):107-109.
[10] 欧建英,梁翎彦,黄裕桂,等.中药熏蒸对尺桡骨骨折内固定术后延迟愈合患者肘、腕关节功能和血液流变学的影响[J].中国康复医学杂志,2017,32(12):1370-1375.
[11] 邱贵兴.骨科诊疗常规[M].北京: 中国医药科技出版社,2013: 87.
[12] 国家中医药管理局.中药新药临床研究指导原则( 试行) [S].北京: 中国医药科技出版社,2002: 339-342.
[13] 罗伟渊,吴松,邓宇杰,等.三种不同入路在肱骨髁间骨折治疗中的应用疗效分析[J].创伤外科杂志,2017,19(10):762-765.
[14] 唐广满,肖俊,刘云鹏,等.双钢板内固定治疗肱骨髁间骨折的临床效果[J].临床骨科杂志,2017,20(5):582-585.
[15] 伍星.四肢骨折手法复位后中西医结合治疗对其骨折恢复的作用[J].中医药导报,2013(8):58-59.
[16] 郝伟.股骨粗隆间骨折患者行闭合复位防旋股骨近端髓内钉内固定术后应用骨肽注射液对骨代谢及骨密度的影响分析[J].中国基层医药,2017,24(22):3462-3465.
[17] 周雪峰,周家宁,马华松,等.不锈钢材质锁定钢板置入修复肱骨近端骨折:关节功能恢复及不良事件发生率[J].中国组织工程研究,2015(12):1812-1816.
[18] 吕平成.鹰嘴截骨钢板固定治疗肱骨髁间骨折[J].创伤外科杂志,2016,18(9): 566-567.
[19] 包德明.中西医结合对肱骨髁上髁间骨折患者IGF -Ⅰ和BMP -2 水平的影响[J].中医学报,2015,30(9): 1282-1284.
[20] 邓洪利,许兆辰,杨瑞泽,等.血清ALP 水平对肱骨干不同节段骨折愈合的意义[J].湖南中医杂志, 2016, 32(8): 86-88.
[21] 赵永见,牛凯,唐德志,等.桃仁药理作用研究近况[J]. 辽宁中医杂志,2015,42(4): 888-890.
[22] 胡波,裴昌录,李小川.注射用红花黄色素对股骨折患者炎症因子影响探讨[J].辽宁中医药大学学报, 2013,15(8): 201-203.
[23] 徐世红,谢兴文,李宁,等. 桃红四物汤含药血清对骨髓间充质干细胞增殖成骨分化的影响[J]. 中华中医药杂志,2013,28(9): 2713-2716.
[2] 李军,陈红卫,金国华,等.甘油果糖联合甘露醇治疗四肢骨折术后肿胀的疗效[J].中国生化药物杂志,2017(7):253-254.
[3] 郑金鑫,江汉,李晓东,等.尺骨鹰嘴截骨入路与肱三头肌舌形瓣入路联合骨化三醇治疗肱骨髁间骨折疗效观察及对患者预后治疗影响[J].中国生化药物杂志,2017,37(8):420-422.
[4] 哈斯鲁,张谢卓,刘利国,等.经尺骨鹰嘴截骨入路与肱三头肌舌形肌瓣入路治疗肱骨髁间骨折的有效性及安全性评价[J].山东医药,2015(31):66-68.
[5] 刘修信,王翀,任政,等.双钢板与Y型钢板置入修复肱骨髁间骨折:选择治疗入路的思考[J].中国组织工程研究,2014(40):6488-6494.
[6] 章维新,申才良.双钢板内固定术联合尺骨鹰嘴截骨治疗粉碎性肱骨髁间骨折的临床研究[J].中国现代医学杂志,2014,24(21):90-93.
[7] 熊福军,杨宏涛,贺西京,等.肱三头肌肘肌翻转入路与尺骨鹰嘴截骨入路治疗肱骨髁间骨折的疗效对比[J].创伤外科杂志,2017,19(11):825-829.
[8] 罗孝华,张红,张亮,等.桃红四物汤辅助经皮椎体成形术治疗老年骨质疏松性椎体压缩性骨折临床研究[J].国际中医中药杂志,2018,40(2):120-123.
[9] 蔡丽萍,何建飞,傅红飞,等.中药熏洗配合康复训练对胫骨平台骨折术后功能恢复的影响[J].中国中医药科技,2018,25(1):107-109.
[10] 欧建英,梁翎彦,黄裕桂,等.中药熏蒸对尺桡骨骨折内固定术后延迟愈合患者肘、腕关节功能和血液流变学的影响[J].中国康复医学杂志,2017,32(12):1370-1375.
[11] 邱贵兴.骨科诊疗常规[M].北京: 中国医药科技出版社,2013: 87.
[12] 国家中医药管理局.中药新药临床研究指导原则( 试行) [S].北京: 中国医药科技出版社,2002: 339-342.
[13] 罗伟渊,吴松,邓宇杰,等.三种不同入路在肱骨髁间骨折治疗中的应用疗效分析[J].创伤外科杂志,2017,19(10):762-765.
[14] 唐广满,肖俊,刘云鹏,等.双钢板内固定治疗肱骨髁间骨折的临床效果[J].临床骨科杂志,2017,20(5):582-585.
[15] 伍星.四肢骨折手法复位后中西医结合治疗对其骨折恢复的作用[J].中医药导报,2013(8):58-59.
[16] 郝伟.股骨粗隆间骨折患者行闭合复位防旋股骨近端髓内钉内固定术后应用骨肽注射液对骨代谢及骨密度的影响分析[J].中国基层医药,2017,24(22):3462-3465.
[17] 周雪峰,周家宁,马华松,等.不锈钢材质锁定钢板置入修复肱骨近端骨折:关节功能恢复及不良事件发生率[J].中国组织工程研究,2015(12):1812-1816.
[18] 吕平成.鹰嘴截骨钢板固定治疗肱骨髁间骨折[J].创伤外科杂志,2016,18(9): 566-567.
[19] 包德明.中西医结合对肱骨髁上髁间骨折患者IGF -Ⅰ和BMP -2 水平的影响[J].中医学报,2015,30(9): 1282-1284.
[20] 邓洪利,许兆辰,杨瑞泽,等.血清ALP 水平对肱骨干不同节段骨折愈合的意义[J].湖南中医杂志, 2016, 32(8): 86-88.
[21] 赵永见,牛凯,唐德志,等.桃仁药理作用研究近况[J]. 辽宁中医杂志,2015,42(4): 888-890.
[22] 胡波,裴昌录,李小川.注射用红花黄色素对股骨折患者炎症因子影响探讨[J].辽宁中医药大学学报, 2013,15(8): 201-203.
[23] 徐世红,谢兴文,李宁,等. 桃红四物汤含药血清对骨髓间充质干细胞增殖成骨分化的影响[J]. 中华中医药杂志,2013,28(9): 2713-2716.