[1]邹光翼,陈佳琦,梁伟,等.畲药活血通经方外敷在旋后外旋型Ⅲ度、Ⅳ度踝关节骨折术后治疗中的应用及作用机制研究[J].中医正骨,2020,32(12):31-37.
　ZOU Guangyi,CHEN Jiaqi,LIANG Wei,et al.A clinical study of external application of Huoxue Tongjing Fang(活血通经方)to postoperative treatment of supination-extorsion-type gradeⅢandⅣankle fractures and its mechanism of action[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(12):31-37.
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畲药活血通经方外敷在旋后外旋型Ⅲ度、Ⅳ度踝关节骨折术后治疗中的应用及作用机制研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期数:
2020年12期
页码:
31-37
栏目:
临床研究
出版日期:
2020-12-20

文章信息/Info

Title:
A clinical study of external application of Huoxue Tongjing Fang(活血通经方)to postoperative treatment of supination-extorsion-type gradeⅢandⅣankle fractures and its mechanism of action
作者:
邹光翼1; 陈佳琦1; 梁伟1; 鄢连和1; 朱美晓1; 魏永敏1; 王双虎1; 耿培武1; 华爱莲2; 叶静1; 童培建3
(1.丽水市人民医院,浙江 丽水 323000; 2.杭州市余杭区第一人民医院,浙江 杭州 311100; 3.浙江省中医院,浙江 杭州 310006)
Author(s):
ZOU Guangyi1; CHEN Jiaqi1; LIANG Wei1; YAN Lianhe1; ZHU Meixiao1; WEI Yongmin1; WANG Shuanghu1; GENG Peiwu1; HUA Ailian2; YE Jing1; TONG Peijian3
1.The People’s Hospital of Lishui City,Lishui 323000,Zhejiang,China
2.The First People’s Hospital of Yuhang,Hangzhou 311100,Zhejiang,China
3.Zhejiang Provincial Hospital of Traditional Chinese Medicine,Hangzhou 310006,Zhejiang,China
关键词:
踝关节;  骨折;  中药外敷;  白细胞介素-6;  白细胞介素-10;  临床试验
Keywords:
ankle joint;  fractures; bone;  external applications(TCD);  interleukin-6;  interleukin-10;  clinical trial
文献标志码:
A
摘要:
目的:探讨畲药活血通经方外敷在旋后外旋型Ⅲ度、Ⅳ度踝关节骨折术后治疗中的应用价值,并探讨其作用机制。方法:将80例行切开复位钢板内固定术的旋后外旋型Ⅲ度、Ⅳ度踝关节骨折患者随机分为2组,每组40例。常规治疗组术后用支具固定并抬高患肢,给予常规抗感染治疗; 术后第1天在手术切口周围持续冰敷,每天4次,每次1 h; 并于术后第1天开始足趾屈伸功能锻炼及踝关节功能锻炼,每次15 min,每天4次,共4周。畲药外敷组在常规治疗的基础上于术后第1天开始采用畲药活血通经方外敷患处,每日换药1次,共4周。分别于术后第1天、第7天和第14天记录并比较2组患者的足踝部疼痛视觉模拟量表(visual analogue scale,VAS)评分和足踝部周径,分别于术后第1天、第90天和第180天记录并比较2组患者的美国足与踝关节协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足功能评分,并分别于术后第1天、第7天和第14天记录并比较2组患者的白细胞介素(interleukin,IL)-6、IL-10的血清含量。结果:①足踝部疼痛VAS评分。时间因素和分组因素存在交互效应(F=1.430,P=0.000); 2组患者足踝部疼痛VAS评分总体比较,组间差异有统计学意义,即存在分组效应(F=2.144,P=0.033); 术后不同时间点足踝部疼痛VAS评分的差异有统计学意义,即存在时间效应(F=215.900,P=0.000); 2组患者术后的足踝部疼痛VAS评分均呈降低趋势[畲药外敷组:(7.53&#177;1.58)分,(4.78&#177;1.17)分,(2.70&#177;1.24)分,F=129.700,P=0.000; 常规治疗组:(7.45&#177;1.55)分,(5.65&#177;0.89)分,(3.70&#177;0.91)分,F=104.600,P=0.000],但2组的变化趋势不完全一致; 术后第1天2组患者足踝部疼痛VAS评分的差异无统计学意义(t=0.214,P=0.831); 术后第7天、第14天畲药外敷组足踝部疼痛VAS评分均低于常规治疗组(t=3.769,P=0.000; t=4.100,P=0.000)。②足踝部周径。时间因素和分组因素存在交互效应(F=107.200,P=0.000); 2组患者足踝部周径总体比较,组间差异有统计学意义,即存在分组效应(F=3.105,P=0.002); 术后不同时间点足踝部周径的差异有统计学意义,即存在时间效应(F=1.496,P=0.029); 2组患者术后的足踝部周径均呈降低趋势[畲药外敷组:(28.39&#177;0.83)cm,(27.07&#177;0.81)cm,(25.78&#177;0.57)cm,F=108.800,P=0.000; 常规治疗组:(28.31&#177;0.85)cm,(27.53&#177;0.90)cm,(26.84&#177;0.91)cm,F=27.520,P=0.000],但2组的变化趋势不完全一致; 术后第1天2组患者足踝部周径的差异无统计学意义(t=0.439,P=0.662); 术后第7天、第14天畲药外敷组足踝部周径均小于常规治疗组(t=2.368,P=0.020; t=6.240,P=0.000)。③AOFAS踝与后足功能评分。时间因素和分组因素存在交互效应(F=1.430,P=0.000); 2组患者AOFAS踝与后足功能评分总体比较,组间差异有统计学意义,即存在分组效应(F=4.913,P=0.000); 术后不同时间点AOFAS踝与后足功能评分的差异有统计学意义,即存在时间效应(F=1.668,P=0.000); 2组患者术后的AOFAS踝与后足功能评分均呈上升趋势[畲药外敷组:(34.50&#177;3.24)分,(80.83&#177;3.61)分,(85.78&#177;3.53)分,F=2 669.000,P=0.000; 常规治疗组:(34.48&#177;3.14)分,(74.13&#177;4.33)分,(83.88&#177;4.31)分,F=1 741.000,P=0.000],但2组的变化趋势不完全一致; 术后第1天2组患者AOFAS踝与后足功能评分的差异无统计学意义(t=0.035,P=0.972); 术后第90天、第180天畲药外敷组AOFAS踝与后足功能评分均高于常规治疗组(t=7.514,P=0.000; t=4.100,P=0.034)。④IL-10血清含量。时间因素和分组因素存在交互效应(F=1.373,P=0.006); 2组患者IL-10血清含量总体比较,组间差异有统计学意义,即存在分组效应(F=3.092,P=0.003); 术后不同时间点IL-10血清含量的差异有统计学意义,即存在时间效应(F=22.080,P=0.000); 2组患者术后的IL-10血清含量均呈下降趋势[畲药外敷组:(73.07&#177;17.65)pg·mL<sup>-1</sup>,(54.60&#177;7.43)pg·mL<sup>-1</sup>,(46.68&#177;4.92)pg·mL<sup>-1</sup>,F=18.310,P=0.000; 常规治疗组:(74.25&#177;13.41)pg·mL<sup>-1</sup>,(64.31&#177;13.08)pg·mL<sup>-1</sup>,(55.16&#177;11.79)pg·mL<sup>-1</sup>,F=7.260,P=0.002],但2组的变化趋势不完全一致; 术后第1天2组患者IL-10血清含量的差异无统计学意义(t=0.192,P=0.849); 术后第7天、第14天畲药外敷组IL-10血清含量均低于常规治疗组(t=2.328,P=0.029; t=2.395,P=0.025)。⑤IL-6血清含量。时间因素和分组因素存在交互效应(F=1.207,P=0.005); 2组患者IL-6血清含量总体比较,组间差异有统计学意义,即存在分组效应(F=2.797,P=0.007); 术后不同时间点IL-6血清含量的差异有统计学意义,即存在时间效应(F=18.680,P=0.000); 2组患者术后的IL-6血清含量均呈下降趋势[畲药外敷组:(13.05&#177;3.50)pg·mL<sup>-1</sup>,(10.04&#177;2.24)pg·mL<sup>-1</sup>,(8.25&#177;1.91)pg·mL<sup>-1</sup>,F=10.960,P=0.000; 常规治疗组:(13.83&#177;2.62)pg·mL<sup>-1</sup>,(11.90&#177;2.23)pg·mL<sup>-1</sup>,(9.96&#177;2.15)pg·mL<sup>-1</sup>,F=8.898,P=0.001],但2组的变化趋势不完全一致; 术后第1天患者IL-6血清含量的差异无统计学意义(t=0.644,P=0.526); 术后第7天、第14天畲药外敷组IL-6血清含量均低于常规治疗组(t=2.124,P=0.044; t=2.138,P=0.043)。结论:对于旋后外旋型Ⅲ度、Ⅳ度踝关节骨折患者,术后应用畲药活血通经方外敷治疗,与单纯常规治疗相比,能更好地缓解足踝部疼痛,减轻足踝部肿胀,促进踝关节功能的恢复; 其作用机制可能是通过降低IL-10和IL-6血清含量,从而减轻了炎症反应。
Abstract:
To explore the applied values of external application of Huoxue Tongjing Fang(活血通经方,HXTJF)to postoperative treatment of supination-extorsion-type gradeⅢandⅣankle fractures and to explore its mechanism of action.Methods:Eighty patients who received open reduction and plate internal fixation for treatment of supination-extorsion-type gradeⅢandⅣankle fractures were selected and randomly divided into conventional therapy group and HXTJF external application group,40 cases in each group.All patients in the 2 groups were treated with orthosis fixation,raising the injured limbs and anti-infection after the surgery,and the continuous ice compress was performed around the surgical incision on the postoperative day 1,four times a day,1 hour at a time.Meanwhile,all patients were instructed to perform toes flexion and extension functional exercises and ankle functional exercises since the postoperative day 1,four times a day,15 minutes at a time for consecutive 4 weeks.Moreover,the patients in HXTJF external application group were treated with external application of HXTJF at the fractured parts since the postoperative day 1,and the dressings chang were performed once a day for 4 weeks.The ankle pain visual analogue scale(VAS)scores,ankle circumferences and the serum contents of interleukin(IL)-6 and IL-10 were recorded and compared between the 2 groups on postoperative day 1,7 and 14 respectively.The American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot function scores were recorded and compared between the 2 groups on postoperative day 1,90 and 180 respectively.Results:There was interaction between time factor and group factor in ankle pain VAS scores(F=1.430,P=0.000).There was statistical difference in ankle pain VAS scores between the 2 groups in general,in other words,there was group effect(F=2.144,P=0.033).There was statistical difference in ankle pain VAS scores between different timepoints after the surgery,in other words,there was time effect(F=215.900,P=0.000).The postoperative ankle pain VAS scores presented a time-dependent decreasing trend in the 2 groups(HXTJF external application group:7.53+/-1.58,4.78+/-1.17,2.70+/-1.24 points,F=129.700,P=0.000; conventional therapy group:7.45+/-1.55,5.65+/-0.89,3.70+/-0.91 points,F=104.600,P=0.000),while the 2 groups were inconsistent with each other in the variation tendency.There was no statistical difference in ankle pain VAS scores between the 2 groups on postoperative day 1(t=0.214,P=0.831).The ankle pain VAS scores were lower in HXTJF external application group compared to conventional therapy group on postoperative day 7 and 14(t=3.769,P=0.000; t=4.100,P=0.000).There was interaction between time factor and group factor in ankle circumferences(F=107.200,P=0.000).There was statistical difference in ankle circumferences between the 2 groups in general,in other words,there was group effect(F=3.105,P=0.002).There was statistical difference in ankle circumferences between different timepoints after the surgery,in other words,there was time effect(F=1.496,P=0.029).The postoperative ankle circumferences presented a time-dependent decreasing trend in the 2 groups(HXTJF external application group:28.39+/-0.83,27.07+/-0.81,25.78+/-0.57 cm,F=108.800,P=0.000; conventional therapy group:28.31+/-0.85,27.53+/-0.90,26.84+/-0.91 cm,F=27.520,P=0.000),while the 2 groups were inconsistent with each other in the variation tendency.There was no statistical difference in ankle circumferences between the 2 groups on postoperative day 1(t=0.439,P=0.662).The ankle circumferences were smaller in HXTJF external application group compared to conventional therapy group on postoperative day 7 and 14(t=2.368,P=0.020; t=6.240,P=0.000).

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备注/Memo

备注/Memo:
基金项目:丽水市科技计划项目(2016GYX45)
通讯作者:邹光翼 E-mail:176019634@qq.com
更新日期/Last Update: 2021-06-17