摘要
目的:探讨活络逐瘀方加减在股骨粗隆间骨折(ITF)术后的应用效果.方法:选取2016年1 月—2023 年 1 月吉安县中医院收治的 64 例ITF患者,按随机数字表法分为两组,各 32 例.两组均行股骨近端防旋髓内钉(PFNA)内固定术治疗,对照组术后行低分子肝素钙治疗,观察组加用活络逐瘀方加减治疗,持续 14 d.比较两组凝血功能、血液流变学指标、髋关节功能、下肢深静脉血栓(DVT)、不良反应.结果:术后 14 d,观察组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)为(12.09±1.18)、(30.49±2.28)、(19.82±1.32)s,均长于对照组的(10.86±1.13)、(28.76±2.15)、(17.44±1.22)s,D-二聚体(D-D)水平为(0.55±0.12)mg/L,低于对照组的(0.69±0.14)mg/L,差异均有统计学意义(P<0.05).术后14 d,观察组全血高切黏度(HBV)、全血低切黏度(LBV)、血浆黏度(PV)和红细胞沉降率(ESR)分别为(4.26±0.43)、(7.92±1.05)、(1.64±0.23)mPa·s、(11.02±1.21)mm/h,均低于对照组的(5.19±0.67)、(9.34±1.18)、(2.02±0.26)mPa·s、(13.38±1.29)mm/h,差异均有统计学意义(P<0.05).术后,观察组Harris髋关节功能评分中关节功能、畸形、疼痛程度、关节活动度评分及总分为(39.82±3.82)、(3.09±0.41)、(35.09±4.14)、(3.94±0.45)、(81.94±5.42)分,均高于对照组的(33.74±3.63)、(2.65±0.35)、(30.52±3.92)、(3.11±0.42)、(70.02±5.39)分,差异均有统计学意义(P<0.05).观察组下肢DVT发生率低于对照组,差异有统计学意义(P<0.05).两组不良反应发生率相比,差异无统计学意义(P>0.05).结论:活络逐瘀方加减联合低分子肝素钙在ITF术后应用效果显著,可调节机体凝血功能,纠正血液流变学指标,减少下肢DVT发生,安全可靠.
Abstract
Objective:To explore the application effect of modified Huoluo Zhuyu Formula in postoperative treatment of intertrochanteric fractures(ITF).Method:A total of 64 patients with ITF admitted to Ji'an County Traditional Chinese Medicine Hospital from January 2016 to January 2023 were selected,and were divided into two groups by random number table method,with 32 cases in each group.Both groups were treated with proximal femoral nail antirotation(PFNA)intramedullary nail fixation,while the control group was treated with Low Molecular Weight Heparin Calcium after surgery,the observation group was treated with modified Huoluo Zhuyu Formula for 14 days.The coagulation function,hemorheology indexes,hip joint function,lower limb deep vein thrombosis(DVT)and adverse reactions were compared between the two groups.Result:14 days after surgery,the prothrombin time(PT),activated partial thromboplastin time(APTT)and thrombin time(TT)in the observation group were(12.09±1.18),(30.49±2.28)and(19.82±1.32)s,which were longer than(10.86±1.13),(28.76±2.15)and(17.44±1.22)s in the control group,and the D-dimer(D-D)level was(0.55±0.12)mg/L,which was lower than(0.69±0.14)mg/L in the control group,the differences were statistically significant(P<0.05).At 14 d after surgery,the high shear whole blood viscosity(HBV),low shear whole blood viscosity(LBV),plasma viscosity(PV)and erythrocyte sedimentation rate(ESR)of the observation group were(4.26±0.43),(7.92±1.05),(1.64±0.23)mPa·s and(11.02±1.21)mm/h,respectively,which were lower than(5.19±0.67),(9.34±1.18),(2.02±0.26)mPa·s and(13.38±1.29)mm/h of the control group,the differences were statistically significant(P<0.05).After surgery,joint function,deformity,degree of pain,joint range of motion scores and total score of the Harris hip joint function score in the observation group were(39.82±3.82),(3.09±0.41),(35.09±4.14),(3.94±0.45)and(81.94±5.42)scores,which were all higher than(33.74±3.63),(2.65±0.35),(30.52±3.92),(3.11±0.42)and(70.02±5.39)scores in the control group,the differences were statistically significant(P<0.05).The incidence of lower limb DVT in the observation group was lower than that in the control group,the difference was statistically significant(P<0.05).There was not statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:The application of modified Huoluo Zhuyu Formula combined with Low Molecular Weight Heparin Calcium after ITF has significant effect,which can regulate the coagulation function of the body,correct hemorheology indicators,reduce the occurrence of DVT in lower limbs,and is safe and reliable.
维普
万方数据