益肾补骨汤促进骨质疏松性股骨转子间骨折患者股骨近端防旋髓内钉术后骨折愈合的效果及作用机制分析

目的]探究益肾补骨汤治疗骨质疏松性股骨转子间骨折患者股骨近端防旋髓内钉(PFNA)术后骨折愈合的临床效果及其潜在的作用机制.方法]将83例骨质疏松症性股骨转子间骨折拟行PFNA治疗的患者随机分为常规组42例和中药组41例.2组患者均给予PFNA手术治疗,术后均给予镇痛、抗生素预防感染、低分子肝素钠预防静脉血栓等常规...

Therapeutic Effect and Mechanism Analysis of Yishen Bugu Decoction on Promoting Fracture Healing in Patients with Osteoporotic Femoral Intertrochanteric Fracture after Proximal Femoral Nail Antirotation Fixation

Objective To observe the clinical effect of Yishen Bugu Decoction on fracture healing in the patients with osteoporotic femoral intertrochanteric fractures after fixation with proximal femoral nail antirotation(PFNA),and to explore its underlying therapeutic mechanism. Methods A total of 83 patients with osteoporotic femoral intertrochanteric fracture planning to undergo PFNA fixation were randomly divided into conventional therapy group(42 cases)and Chinese medicine group(41 cases). The patients in the two groups all had PFNA treatment,and then were given routine post-operative treatment of analgesic,antibiotic for preventing infection,low molecular weight heparin sodium for preventing venous thrombosis,etc.. Additionally,the conventional therapy group was given oral use of calcium carbonate D3 tablets and Chinese medicine group was given oral use of Yishen Bugu Decoction. The course of the treatment lasted for 3 months and then the patients were followed up for over 24 months. Before and after the operation,the pain visual analogue scale(VAS)scores,erythrocyte sedimentation rate(ESR), bone metabolism related indexes, fracture healing time and postoperative complications were compared in the two groups. After treatment,the time for fracture healing and the incidence of the postoperative complications in the two groups were compared. Results(1)During the trial,2 cases from conventional therapy group and one case from Chinese medicine group lost to follow-up,and eventually a total of 80 cases,40 cases from each group,completed the follow-up. The follow-up time averaged(41.9 ± 8.3)months.(2)Three days and one week after the operation, the pain VAS scores in the two groups were markedly decreased in comparison with those before treatment(P<0.05),and the effect on decreasing the scores in Chinese medicine group was superior to that in conventional therapy group(P<0.01).(3)One week and 10 weeks after the operation,ESR in the two groups was markedly decreased in comparison with that before treatment(P<0.05),and the effect on decreasing ESR one week after the operation in Chinese medicine group was superior to that in conventional therapy group(P<0.01).(4)The average time for fracture healing in Chinese medicine group was(11.0 ± 0.65)weeks,and was shorter than that in the conventional therapy group (12.2 ± 1.18)weeks], the difference being statistically significant(P<0.01).(5)Ten weeks after the operation, serum levels of total procollagen type 1 N-peptide(tPINP), osteocalcin(OC), bone alkaline phosphatase(BALP), insulin-like growth factor Ⅰ(IGF-Ⅰ)in Chinese medicine group and tPINP,OC and IGF-Ⅰ in conventional therapy group were increased in comparison with those one week after the operation(P<0.05), and Chinese medicine group had higher serum levels of tPINP,OC,BALP,and IGF-Ⅰ than conventional therapy group(P<0.05 or P<0.01).(6)Ten weeks after the operation, serum levels of tartrate resistant acid phosphatase 5 b(TRACP5 b), intact parathyroid hormone(iPTH),and collagen cross-linked N-telopeptide(sCTx)in the two groups were decreased in comparison with those one week after the operation(P<0.05), and Chinese medicine group had lower serum levels of iPTH,TRACP5 b,and sCTx than conventional therapy group(P<0.01).(7)The incidence of postoperative complications in Chinese medicine group was 5.0%(2/40),much lower than that of conventional therapy group 20.0%(8/40)],and the difference being statistically significant(P<0.05). Conclusion Yishen Bugu Decoction can significantly accelerate the fracture healing process in the patients with osteoporotic femoral intertrochanteric fractures after PFNA fixation, and can alleviate postoperative pain and reduce the risk of postoperative complications. The possible therapeutic mechanism is related with the regulation of bone metabolism by promoting osteogenesis and inhibiting osteoclastic bone resorption,and with the improvement of microcirculation at fracture ends.