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[1]方國輝,喻勤軍.補(bǔ)腎接骨湯聯(lián)合碳酸鈣D3片口服治療老年骨質(zhì)疏松性股骨轉(zhuǎn)子間骨折腎虛血瘀證[J].中醫(yī)正骨,2019,31(03):14-19.
　FANG Guohui,YU Qinjun.Oral applications of Bushen Jiegu Tang(補(bǔ)腎接骨湯)and calcium carbonate and Vitamin D3 tablets for treatment of kidney-deficiency-blood-stasis-type osteoporotic femoral intertrochanteric fractures in aged patients[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(03):14-19.
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補(bǔ)腎接骨湯聯(lián)合碳酸鈣D3片口服治療老年骨質(zhì)疏松性股骨轉(zhuǎn)子間骨折腎虛血瘀證()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期數(shù):
2019年03期
頁碼:
14-19
欄目:
臨床研究
出版日期:
2019-03-20

文章信息/Info

Title:
Oral applications of Bushen Jiegu Tang(補(bǔ)腎接骨湯)and calcium carbonate and Vitamin D3 tablets for treatment of kidney-deficiency-blood-stasis-type osteoporotic femoral intertrochanteric fractures in aged patients
作者:
方國輝; 喻勤軍
(臺州市黃巖區(qū)中醫(yī)院,浙江 臺州 318020)
Author(s):
FANG Guohui; YU Qinjun
Huangyan Hospital of Traditional Chinese Medicine,Taizhou 318020,Zhejiang,China
關(guān)鍵詞:
髖骨折;  骨質(zhì)疏松;  腎虛;  血瘀;  補(bǔ)腎接骨湯;  碳酸鈣;  骨保護(hù)素;  核因子κB受體活化因子;  轉(zhuǎn)化生長因子β1;  堿性磷酸酶;  抗酒石酸酸性磷酸酶5b;  臨床試驗(yàn)
Keywords:
hip fractures;  osteoporosis;  kidney deficiency;  blood stasis;  Bushen Jiegu Tang;  calcium carbonate;  osteoprotegerin;  receptor activator of nuclear factor-kappa B;  transforming growth factor beta1;  alkaline phosphatase;  tartrate resistant acid phosphatase 5b;  clinical trial
摘要:
目的:觀察補(bǔ)腎接骨湯聯(lián)合碳酸鈣D3片口服治療老年骨質(zhì)疏松性股骨轉(zhuǎn)子間骨折腎虛血瘀證的臨床療效,并探討其作用機(jī)制。方法:將107例老年骨質(zhì)疏松性股骨轉(zhuǎn)子間骨折股骨近端防旋髓內(nèi)釘(proximal femoral nail antirotation,PFNA)內(nèi)固定術(shù)后腎虛血瘀證患者隨機(jī)分為2組。55例采用補(bǔ)腎接骨湯聯(lián)合碳酸鈣D3片口服治療(聯(lián)合組),52例采用碳酸鈣D3片口服治療(碳酸鈣D3片組)。補(bǔ)腎接骨湯水煎服,每日1劑,連續(xù)服用12周; 碳酸鈣D3片口服,每日1片,連續(xù)服用12周。記錄并比較2組患者的骨折愈合時間、髖部疼痛視覺模擬量表(visual analogue scale,VAS)評分,并分別于治療前、治療結(jié)束后比較2組患者骨保護(hù)素(osteoprotegerin,OPG)、核因子-κB受體活化因子配體(receptor activator of nuclear factor-κB ligand,RANKL)、轉(zhuǎn)化生長因子(transforming growth factor,TGF)-β1、骨堿性磷酸酶(bone alkaline phosphatase,BALP)及抗酒石酸酸性磷酸酶5b(tartrate resistant acid phosphatase 5b,TRACP5b)血清含量。結(jié)果:①骨折愈合時間。聯(lián)合組患者骨折愈合時間短于碳酸鈣D3片組[(7.85±1.28)周,(8.73±1.18)周,t=3.692,P=0.000)]。②髖部疼痛VAS評分。時間因素和分組因素存在交互效應(yīng)(F=37.953,P=0.000); 2組患者髖部疼痛VAS評分總體比較,組間差異有統(tǒng)計學(xué)意義,即存在分組效應(yīng)(F=4.269,P=0.000); 治療前后不同時間點(diǎn)髖部疼痛VAS評分的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=13.274,P=0.000); 2組患者髖部疼痛VAS評分隨時間均呈下降趨勢,且2組的下降趨勢不完全一致[聯(lián)合組:(7.31±1.25)分,(4.13±0.83)分,(2.15±0.58)分,F=5.271,P=0.000; 碳酸鈣D3片組:(7.46±1.02)分,(5.08±0.96)分,(2.76±0.42)分,F=3.985,P=0.000]; 治療開始后1周2組患者髖部疼痛VAS評分比較,差異無統(tǒng)計學(xué)意義(t=0.678,P=0.499); 治療開始后3周、5周聯(lián)合組髖部疼痛VAS評分均低于碳酸鈣D3片組(t=5.485,P=0.000; t=6.201,P=0.000)。③骨愈合相關(guān)指標(biāo)。治療前2組患者OPG、RANKL、TGF-β1血清含量比較,組間差異均無統(tǒng)計學(xué)意義(t=0.253,P=0.800; t=0.352,P=0.726; t=1.345,P=0.181); 治療結(jié)束后2組患者OPG、RANKL、TGF-β1血清含量均高于治療前[OPG:(4.12±0.84)pmol·L-1,(8.57±1.33)pmol·L-1,t=20.980,P=0.000;(4.08±0.79)pmol·L-1,(7.16±1.25)pmol·L-1,t=15.020,P=0.000。RANKL:(14.63±3.37)nmol·L-1,(32.59±10.95)nmol·L-1,t=11.626,P=0.000;(14.85±3.10)nmol·L-1,(41.93±12.15)nmol·L-1,t=16.016,P=0.000。TGF-β1:(227.53±41.28)μg·L-1,(380.58±35.66)μg·L-1,t=20.807,P=0.000;(237.93±38.52)μg·L-1,(312.74±37.51)μg·L-1,t=10.034,P=0.000],聯(lián)合組患者OPG、TGF-β1血清含量均高于碳酸鈣D3片組(t=5.643,P=0.000; t=9.591,P=0.000),RANKL血清含量低于碳酸鈣D3片組(t=4.169,P=0.000)。④骨代謝相關(guān)指標(biāo)。治療前2組患者BALP、TRACP5b血清含量比較,組間差異無統(tǒng)計學(xué)意義(t=1.170,P=0.245; t=1.750,P=0.083); 治療結(jié)束后2組患者BALP血清含量均高于治療前[聯(lián)合組:(57.48±4.19)單位·L-1,(78.43±3.52)單位·L-1,t=28.392,P=0.000; 碳酸鈣D3片組:(56.43±5.07)單位·L-1,(65.39±4.85)單位·L-1,t=9.289,P=0.000],TRACP5b血清含量均低于治療前[聯(lián)合組:(7.02±0.47)單位·L-1,(4.28±0.30)單位·L-1,t=35.715,P=0.000; 碳酸鈣D3片組:(6.84±0.59)單位·L-1,(5.11±0.43)單位·L-1,t=17.088,P=0.000],聯(lián)合組患者BALP血清含量高于碳酸鈣D3片組(t=15.980,P=0.000),TRACP5b血清含量低于碳酸鈣D3片組(t=11.632,P=0.000)。結(jié)論:補(bǔ)腎接骨湯聯(lián)合碳酸鈣D3片口服可有效縮短老年骨質(zhì)疏松性股骨轉(zhuǎn)子間骨折腎虛血瘀證患者的骨折愈合時間,減輕患者術(shù)后疼痛,其作用機(jī)制可能與其改善骨代謝、促進(jìn)成骨細(xì)胞活化以及抑制破骨細(xì)胞過度活化有關(guān)。
Abstract:
Objective:To observe the clinical curative effects of oral application of Bushen Jiegu Tang(補(bǔ)腎接骨湯,BSJGT)and calcium carbonate and Vitamin D3 tablets for treatment of kidney-deficiency-blood-stasis-type osteoporotic femoral intertrochanteric fractures in aged patients and to explore its mechanism of action.Methods:One hundred and seven aged patients who suffered from kidney-deficiency-blood-stasis syndrome after proximal femoral nail antirotation(PFNA)internal fixation for treatment of osteoporotic femoral intertrochanteric fracture were randomly divided into 2 groups.Fifty-five patients were treated with oral application of BSJGT and calcium carbonate and Vitamin D3 tablets(combination therapy group),while the others were treated with oral application of calcium carbonate and Vitamin D3 tablets(monotherapy group).The BSJGT decoctions were taken one dose a day for consecutive 12 weeks.The calcium carbonate and Vitamin D3 tablets were taken one tablet a day for consecutive 12 weeks.The fracture healing time and hip pain visual analogue scale(VAS)scores were recorded and compared between the 2 groups.The serum contents of osteoprotegerin(OPG),receptor activator of nuclear factor-κB ligand(RANKL),transforming growth factor-β1(TGF-β1),bone alkaline phosphatase(BALP)and tartrate resistant acid phosphatase 5b(TRACP5b)were detected and compared between the 2 groups before the treatment and after the end of the treatment respectively.Results:The fracture healing time was shorter in combination therapy group compared to monotherapy group(7.85+/-1.28 vs 8.73+/-1.18 weeks,t=3.692,P=0.000).There was interaction between time factor and group factor in hip pain VAS scores(F=37.953,P=0.000).There was statistical difference in hip pain VAS scores between the 2 groups in general,in other words,there was group effect(F=4.269,P=0.000).There was statistical difference in hip pain VAS scores between different timepoints before and after the treatment,in other words,there was time effect(F=13.274,P=0.000).The hip pain VAS scores presented a time-dependent decreasing trend in both of the 2 groups,while the 2 groups were inconsistent with each other in the decreasing trend of hip pain VAS scores(combination therapy group:7.31+/-1.25,4.13+/-0.83,2.15+/-0.58 points,F=5.271,P=0.000; monotherapy group:7.46+/-1.02,5.08+/-0.96,2.76+/-0.42 points,F=3.985,P=0.000).There was no statistical difference in hip pain VAS scores between the 2 groups at 1 week after the beginning of the treatment(t=0.678,P=0.499).The hip pain VAS scores were lower in combination therapy group compared to monotherapy group at 3 and 5 weeks after the beginning of the treatment(t=5.485,P=0.000; t=6.201,P=0.000).There was no statistical difference in serum contents of OPG,RANKL and TGF-β1 between the 2 groups before the treatment(t=0.253,P=0.800; t=0.352,P=0.726; t=1.345,P=0.181).The serum contents of OPG,RANKL and TGF-β1 were higher after the end of the treatment compared to pre-treatment in the 2 groups(OPG:4.12+/-0.84 vs 8.57+/-1.33 pmol/L,t=20.980,P=0.000; 4.08+/-0.79 vs 7.16+/-1.25 pmol/L,t=15.020,P=0.000.RANKL:14.63+/-3.37 vs 32.59+/-10.95 nmol/L,t=11.626,P=0.000; 14.85+/-3.10 vs 41.93+/-12.15 nmol/L,t=16.016,P=0.000.TGF-β1:227.53+/-41.28 vs 380.58+/-35.66 μg/L,t=20.807,P=0.000; 237.93+/-38.52 vs 312.74+/-37.51 μg/L,t=10.034,P=0.000).The serum contents of OPG and TGF-β1 were higher and the serum content of RANKL was lower in combination therapy group compared to monotherapy group(t=5.643,P=0.000; t=9.591,P=0.000; t=4.169,P=0.000).There was no statistical difference in serum contents of BALP and TRACP5b between the 2 groups before the treatment(t=1.170,P=0.245; t=1.750,P=0.083).The serum content of BALP was higher and the serum content of TRACP5b was lower after the end of the treatment compared to pre-treatment in the 2 groups(combination therapy group:57.48+/-4.19 vs 78.43+/-3.52 unit/L,t=28.392,P=0.000; 7.02+/-0.47 vs 4.28+/-0.30 unit/L,t=35.715,P=0.000; monotherapy group:56.43+/-5.07 vs 65.39+/-4.85 unit/L,t=9.289,P=0.000; 6.84+/-0.59 vs 5.11+/-0.43 unit/L,t=17.088,P=0.000).The serum content of BALP was higher and the serum content of TRACP5b was lower in combination therapy group compared to monotherapy group(t=15.980,P=0.000; t=11.632,P=0.000).Conclusion:Oral application of BSJGT and calcium carbonate and Vitamin D3 tablet can effectively shorten fracture healing time and relieve postoperative pain in aged patients with kidney-deficiency-blood-stasis-type osteoporotic femoral intertrochanteric fractures,and its mechanisms of action may be that it can improve bone metabolism,promote osteoblast activation and inhibit osteoclast overactivation.

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(收稿日期:2018-11-08 本文編輯:時紅磊)
更新日期/Last Update: 2019-03-30