益肾接骨汤配合支撑钢板治疗老年踝关节骨折
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摘要
目的:探讨益肾接骨汤配合支撑钢板治疗老年踝关节骨折的临床疗效。方法:将50例老年踝关节骨折患者采用随机数字表法分为两组,每组25例。对照组采用骨折切开复位内固定术,治疗组在此基础上服用益肾接骨汤。随访12个月,行骨密度及骨代谢指标检测,按照美国足踝外科协会踝-后足(American orthopedics foot ankle society,AOFAS)评分系统进行疗效分析。结果:所有病例均获得随访,术后3个月,治疗组骨源性碱性磷酸酶(bone alkaline phosphatase,BALP)含量较术前明显升高(P<0.05),抗酒石酸酸性磷酸酶(tartrate-resistant acid phosphatase,TRACP5b)含量较术前明显降低(P<0.05),治疗组骨密度以及AOFAS评分较术前明显改善(P<0.05),且均优于对照组(P<0.05)。结论:益肾接骨汤配合支撑钢板治疗老年踝关节骨折疗效显著,能改善骨代谢指标,提高骨密度,关节面复位精确,固定牢靠,利于关节功能恢复。
Objective: To explore the clinical efficacy of Yishen Jiegu Decoction combined with supporting plate in the treatment of elderly ankle fracture. Methods: 50 patients with ankle fractures were divided into two groups by random number table,25 in each group. The control group was treated with fracture open reduction and internal fixation. The treatment group took Yishen Jiegu Decoction on this basis. Following up for 12 months,bone mineral density and bone metabolic index were measured. The curative effect was analyzed according to the ankle-hind foot scoring system of American Orthopedics Foot Ankle Society( AOFAS). Results: All cases were followed up. Three months after operation,the bone alkaline phosphatase( BALP) content in the treatment group was significantly higher than that before operation( P < 0. 05),tartrate-resistant acid phosphatase( TRACP5 b) content was significantly lower than that before operation( P < 0. 05),and the bone mineral density and AOFAS score in the treatment group were significantly improved( P < 0. 05). They were superior to the control group( P < 0. 05). Conclusion: Yishen Jiegu Decoction combined with supporting plate in the treatment of elderly ankle fracture has a remarkable curative effect. It can improve bone metabolism index,increase bone mineral density,precise reduction of articular surface and firm fixation,which is conducive to the recovery of joint function.
Objective: To explore the clinical efficacy of Yishen Jiegu Decoction combined with supporting plate in the treatment of elderly ankle fracture. Methods: 50 patients with ankle fractures were divided into two groups by random number table,25 in each group. The control group was treated with fracture open reduction and internal fixation. The treatment group took Yishen Jiegu Decoction on this basis. Following up for 12 months,bone mineral density and bone metabolic index were measured. The curative effect was analyzed according to the ankle-hind foot scoring system of American Orthopedics Foot Ankle Society( AOFAS). Results: All cases were followed up. Three months after operation,the bone alkaline phosphatase( BALP) content in the treatment group was significantly higher than that before operation( P < 0. 05),tartrate-resistant acid phosphatase( TRACP5 b) content was significantly lower than that before operation( P < 0. 05),and the bone mineral density and AOFAS score in the treatment group were significantly improved( P < 0. 05). They were superior to the control group( P < 0. 05). Conclusion: Yishen Jiegu Decoction combined with supporting plate in the treatment of elderly ankle fracture has a remarkable curative effect. It can improve bone metabolism index,increase bone mineral density,precise reduction of articular surface and firm fixation,which is conducive to the recovery of joint function.
引文
[1]KOVAL K J,LURIE J,ZHOU W.Ankle fractures in the elderly:what you get depends on where you live who you see[J].J Orthop Trauma,2005,19(9):635-639.
[2]国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:167-168.
[3]马江涛,俞敏,俞高峰,等.快速康复外科理论在老年股骨转子间骨折治疗中的应用[J].中医正骨,2015,27(1):39-40.
[4]HARAGUCHI N,HARUYAMA H,TOGA H,et al.Pathoanatomy of posterior malleolar fractures of the ankle[J].J Bone Joint Surg Am,2006,88(5):1085-1092.
[5]CREVOISIER X,BAALBAKI R,DOS SANTOS T,et al.Ankle fractures in the elderly patient[J].Rev Med Suisse,2014,10(455):2420-2423.
[6]KURAR L.Clinical audit of ankle fracture management in the elderly[J].Ann Med Surg,2016,19(6):96-101.
[7]BüCHLER L,TANNAST M,BONEL H M,et al.Reliability of radiologicassessment of the fracture anatomy at the posterior tibial plafond in malleolar fractures[J].J Orthop Trauma,2009,23(3):208-212.
[8]GARDNER M J,BRODSKY A,BRIGGS S M,et al.Fixation of posterior malleolar fractures provides greater syndesmotic stability[J].Clin Orthop Relat Res,2006,447:165-171.
[9]DE VRIES J S,WIJGMAN A J,SIEREVELT I N,et al.Longterm results of ankle fractures with a posterior malleolar fragment[J].Foot Ankle Surg,2005,44(3):211-217.
[10]HARTFORD J M,GORCZYCA J T,MCNAMARA J L,et al.Tibiotalar contact area.Contribution of posterior malleolus and deltoid ligament[J].Clin Orthop Relat Res,1995,11(320):182-187.
[11]MCDANIEL W J,WILSON F C.Trimalleolar fractures of the ankle.An end result study[J].Clin Orthop Relat Res,1977(122):37-45.
[12]渠继武,史方悌,曹克银,等.后踝骨折钢板内固定治疗16例临床疗效分析[J].实用骨科杂志,2011,2(17):134-136.
[13]HUBER M,STUTZ P M,GERBER C.Open reduction and internal fixation of the posterior malleolus with a posterior antiglide plate using a postero-lateral approach-a preliminary report[J].Foot Ankle Surg,1996,2(2):95-103.
[14]李永舵,刘书茂,贾金生,等.后踝骨折内固定方法的选择:生物力学及临床应用研究[J].北京大学学报(医学版),2011,43(5):718-723.
[15]徐德利,林浩.中西医结合治疗四肢骨折临床研究[J].中医学报,2015,30(8):1132-1134.
[16]孙昶晟,周勇,罗权,等.扶元活血汤配合螺钉固定术治疗老年三踝骨折临床研究[J].中医学报,2016,31(9):1306-1308.
[17]黄和涛,潘建科,刘军,等.骨质疏松症用药规律研究[J].中医学报,2017,32(1):124-126.
[18]高俊,胡继红,张犧.骨碎补总黄丽对废用性骨质疏松大鼠BMSCs成脂分化的影响及机制探[J].山东医药,2015,55(35):28-30.
[19]沈自尹,黄建华.从淫羊霍激活内源性干细胞探讨“肾藏精”的科学涵义[J].中医杂志,2010,51(1):8-10.
[20]卢小玲,胡周静.益肾健骨汤治疗原发性骨质疏松症的疗效及对血清ALP、BGP、TRAP、β-CTx的影响[J].中医药导报,2018,24(8):119-121,124.
[2]国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:167-168.
[3]马江涛,俞敏,俞高峰,等.快速康复外科理论在老年股骨转子间骨折治疗中的应用[J].中医正骨,2015,27(1):39-40.
[4]HARAGUCHI N,HARUYAMA H,TOGA H,et al.Pathoanatomy of posterior malleolar fractures of the ankle[J].J Bone Joint Surg Am,2006,88(5):1085-1092.
[5]CREVOISIER X,BAALBAKI R,DOS SANTOS T,et al.Ankle fractures in the elderly patient[J].Rev Med Suisse,2014,10(455):2420-2423.
[6]KURAR L.Clinical audit of ankle fracture management in the elderly[J].Ann Med Surg,2016,19(6):96-101.
[7]BüCHLER L,TANNAST M,BONEL H M,et al.Reliability of radiologicassessment of the fracture anatomy at the posterior tibial plafond in malleolar fractures[J].J Orthop Trauma,2009,23(3):208-212.
[8]GARDNER M J,BRODSKY A,BRIGGS S M,et al.Fixation of posterior malleolar fractures provides greater syndesmotic stability[J].Clin Orthop Relat Res,2006,447:165-171.
[9]DE VRIES J S,WIJGMAN A J,SIEREVELT I N,et al.Longterm results of ankle fractures with a posterior malleolar fragment[J].Foot Ankle Surg,2005,44(3):211-217.
[10]HARTFORD J M,GORCZYCA J T,MCNAMARA J L,et al.Tibiotalar contact area.Contribution of posterior malleolus and deltoid ligament[J].Clin Orthop Relat Res,1995,11(320):182-187.
[11]MCDANIEL W J,WILSON F C.Trimalleolar fractures of the ankle.An end result study[J].Clin Orthop Relat Res,1977(122):37-45.
[12]渠继武,史方悌,曹克银,等.后踝骨折钢板内固定治疗16例临床疗效分析[J].实用骨科杂志,2011,2(17):134-136.
[13]HUBER M,STUTZ P M,GERBER C.Open reduction and internal fixation of the posterior malleolus with a posterior antiglide plate using a postero-lateral approach-a preliminary report[J].Foot Ankle Surg,1996,2(2):95-103.
[14]李永舵,刘书茂,贾金生,等.后踝骨折内固定方法的选择:生物力学及临床应用研究[J].北京大学学报(医学版),2011,43(5):718-723.
[15]徐德利,林浩.中西医结合治疗四肢骨折临床研究[J].中医学报,2015,30(8):1132-1134.
[16]孙昶晟,周勇,罗权,等.扶元活血汤配合螺钉固定术治疗老年三踝骨折临床研究[J].中医学报,2016,31(9):1306-1308.
[17]黄和涛,潘建科,刘军,等.骨质疏松症用药规律研究[J].中医学报,2017,32(1):124-126.
[18]高俊,胡继红,张犧.骨碎补总黄丽对废用性骨质疏松大鼠BMSCs成脂分化的影响及机制探[J].山东医药,2015,55(35):28-30.
[19]沈自尹,黄建华.从淫羊霍激活内源性干细胞探讨“肾藏精”的科学涵义[J].中医杂志,2010,51(1):8-10.
[20]卢小玲,胡周静.益肾健骨汤治疗原发性骨质疏松症的疗效及对血清ALP、BGP、TRAP、β-CTx的影响[J].中医药导报,2018,24(8):119-121,124.