[1]陈强,何智南,李强,等.黄连解毒汤加减治疗跟骨骨折术前肿胀的临床研究[J].中医正骨,2024,36(04):5-10,20.
　CHEN Qiang,HE Zhinan,LI Qiang,et al.A clinical study of modified Huanglian Jiedu Tang(黄连解毒汤)for treatment of preoperative swelling of calcaneal fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(04):5-10,20.
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黄连解毒汤加减治疗跟骨骨折术前肿胀的临床研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期数:
2024年04期
页码:
5-10,20
栏目:
临床研究
出版日期:
2024-04-20

文章信息/Info

Title:
A clinical study of modified Huanglian Jiedu Tang(黄连解毒汤)for treatment of preoperative swelling of calcaneal fractures
作者:
陈强; 何智南; 李强; 袁海涛; 胡和军; 邓雄伟
南昌市洪都中医院,江西 南昌 330038
Author(s):
CHEN Qiang; HE Zhinan; LI Qiang; YUAN Haitao; HU Hejun; DENG Xiongwei
Nanchang Hongdu Hospital of TCM,Nanchang 330038,Jiangxi,China
关键词:
黄连解毒汤;  骨折;  跟骨;  肿胀;  炎症因子;  骨折并发症
Keywords:
Huang Lian Jie Du Tang;  fractures; bone;  calcaneus;  swelling;  inflammatory factor;  fracture complication
摘要:
目的:观察黄连解毒汤加减治疗跟骨骨折术前肿胀的临床疗效和安全性,并探讨其可能的作用机制。方法:将符合要求的70例SandersⅡ～Ⅳ型跟骨骨折患者随机分为2组,每组35例。2组患者入院后均给予石膏托外固定制动、抬高患肢、静脉滴注甘露醇注射液、皮下注射那屈肝素钙等常规治疗。常规治疗组在此基础上口服地奥司明片,每次0.9 g,每日1次,晚餐后服用,共服用7 d; 黄连解毒汤组在常规治疗基础上口服黄连解毒汤加减,早晚各1次,共服用7 d。比较2组患者的患肢肿胀率、疼痛视觉模拟量表(visual analogue scale,VAS)评分、血清C反应蛋白(C-reactive protein,CRP)水平、血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平、血清白细胞介素-6(interleukin 6,IL-6)水平、中医证候积分及并发症发生情况。结果:①患肢肿胀率。2组患者的患肢肿胀率随时间变化均呈先升高后降低的趋势(F=246.771,P=0.000; F=282.982,P=0.000); 治疗前2组患者患肢肿胀率的差异无统计学意义(t=0.596,P=0.553); 治疗第3天和治疗第7天,黄连解毒汤组患者的患肢肿胀率均低于常规治疗组(t=2.147,P=0.035; t=2.799,P=0.007)。②疼痛VAS评分。2组患者的疼痛VAS评分随时间变化均呈逐渐降低的趋势(F=262.877,P=0.000; F=462.471,P=0.000); 治疗前2组患者疼痛VAS评分的差异无统计学意义(t=0.432,P=0.667); 治疗第3天和治疗第7天,黄连解毒汤组患者的疼痛VAS评分均低于常规治疗组(t=3.200,P=0.002; t=8.735,P=0.000)。③血清CRP水平。2组患者的血清CRP水平随时间变化均呈先升高后降低的趋势(F=1 355.001,P=0.000; F=2 271.167,P=0.000); 治疗前2组患者血清CRP水平的差异无统计学意义(t=-0.470,P=0.570); 治疗第3天和治疗第7天,黄连解毒汤组患者的血清CRP水平均低于常规治疗组(t=4.575,P=0.000; t=25.065,P=0.000)。④血清TNF-α水平。2组患者的血清TNF-α水平随时间变化均呈先升高后降低的趋势(F=366.536,P=0.000; F=811.863,P=0.000); 治疗前2组患者血清TNF-α水平的差异无统计学意义(t=-1.019,P=0.312); 治疗第3天和治疗第7天,黄连解毒汤组患者的血清TNF-α水平均低于常规治疗组(t=3.222,P=0.002; t=17.223,P=0.000)。⑤血清IL-6水平。2组患者的血清IL-6水平随时间变化均呈先升高后降低的趋势(F=895.505,P=0.000; F=1 184.801,P=0.000); 治疗前2组患者血清IL-6水平的差异无统计学意义(t=1.606,P=0.113); 治疗第3天和治疗第7天,黄连解毒汤组患者的血清IL-6水平均低于常规治疗组(t=4.432,P=0.000; t=9.249,P=0.000)。⑥中医证候积分。治疗前2组患者的中医证候积分比较,差异无统计学意义(t=-0.595,P=0.554); 治疗第7天,2组患者的中医证候积分均较治疗前减小(t=24.128,P=0.000; t=40.200,P=0.000); 治疗第7天黄连解毒汤组的中医证候积分低于常规治疗组(t=9.272,P=0.000)。⑦并发症。2组各有2例患者发生下肢深静脉血栓,应用那屈肝素钙联合华法林治疗1周后血栓变小或吸收; 黄连解毒汤组2例发生胃肠道不适、常规治疗组2例出现皮疹,均未予药物治疗,症状自行消失。2组患者并发症发生率的差异无统计学意义(χ2=0.000,P=1.000)。结论:黄连解毒汤加减可有效减轻跟骨骨折患者的术前肿胀和疼痛,而且具有较高的安全性,其作用机制可能与其降低患者血清炎症因子水平有关。
Abstract:
Objective:To observe the clinical outcome and safety of modified Huanglian Jiedu Tang(黄连解毒汤,HLJDT)in treatment of preoperative swelling in patients with calcaneal fractures,and to explore its underlying mechanism.Methods:Seventy patients with Sanders typeⅡ-Ⅳcalcaneal fractures were enrolled in the study and were randomized into conventional treatment group and HLJDT treatment group,35 ones in each group.All patients in the 2 groups were treated with conventional treatment including plaster fixing,braking,raising the injured limbs,intravenous drip infusion of mannitol injection and subcutaneous injection of nadroparin calcium after the hospital admission.In addition,the patients in conventional treatment group were treated with oral application of diosmin tablets,once a day(after supper),0.9 g at a time for consecutive 7 days; and the patients in HLJDT treatment group were treated with oral application of modified HLJDT,twice a day in the morning and evening respectively for consecutive 7 days.The swelling rate of the affected limb,pain visual analogue scale(VAS)score,serum levels of C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)and interleukin 6(IL-6),TCM syndrome score and complications were compared between the 2 groups.Results:①The swelling rate of the affected limbs presented a upward firstly and downward subsequently trend over time in the 2 groups(F=246.771,P=0.000; F=282.982,P=0.000).The comparison of swelling rate of the affected limbs between the 2 groups revealed no significant differences before the treatment(t=0.596,P=0.553); while,after 3- and 7-day treatment,the swelling rate of the affected limbs was lower in HLJDT treatment group compared to conventional treatment group(t=2.147,P=0.035; t=2.799,P=0.007).②The pain VAS score presented a gradual downward trend over time in the 2 groups(F=262.877,P=0.000; F=462.471,P=0.000).There was no statistical difference in the pain VAS score between the 2 groups before the treatment(t=0.432,P=0.667); while,after 3- and 7-day treatment,the pain VAS score was lower in HLJDT treatment group compared to conventional treatment group(t=3.200,P=0.002; t=8.735,P=0.000).③The serum level of CRP presented a upward firstly and downward subsequently trend over time in the 2 groups(F=1 355.001,P=0.000; F=2 271.167,P=0.000).The difference was not statistically significant in serum level of CRP between the 2 groups before the treatment(t=-0.470,P=0.570); while,after 3- and 7-day treatment,the serum level of CRP was lower in HLJDT treatment group compared to conventional treatment group(t=4.575,P=0.000; t=25.065,P=0.000).④The serum level of TNF-α presented a upward firstly and downward subsequently trend over time in the 2 groups(F=366.536,P=0.000; F=811.863,P=0.000).The difference was not statistically significant in serum level of TNF-α between the 2 groups before the treatment(t=-1.019,P=0.312); while,after 3- and 7-day treatment,the serum level of TNF-α was lower in HLJDT treatment group compared to conventional treatment group(t=3.222,P=0.002; t=17.223,P=0.000).⑤The serum level of IL-6 presented a upward firstly and downward subsequently trend over time in the 2 groups(F=895.505,P=0.000; F=1 184.801,P=0.000).The difference was not statistically significant in serum level of IL-6 between the 2 groups before the treatment(t=1.606,P=0.113); while,after 3- and 7-day treatment,the serum level of IL-6 was lower in HLJDT treatment group compared to conventional treatment group(t=4.432,P=0.000; t=9.249,P=0.000).⑥There was no statistical difference in the TCM syndrome score between the 2 groups before the treatment(t=-0.595,P=0.554).The TCM syndrome score decreased in the 2 groups on the 7th day after the beginning of the treatment compared to pre-treatment(t=24.128,P=0.000; t=40.200,P=0.000),and it was lower in HLJDT treatment group compared to conventional treatment group(t=9.272,P=0.000).⑦The lower extremity deep venous thrombosis was found in 2 patients in each group,and the thrombus became smaller or absorbed after treatment with natroparin calcium and warfarin for 1 week; moreover,2 patients experienced gastrointestinal discomfort in HLJDT treatment group,and 2 ones experienced rash in conventional treatment group,and the symptoms disappeared spontaneously without any medication treatment.There was no statistical difference in complication incidences between the 2 groups(χ2=0.000,P=1.000).Conclusion:The modified HLJDT can effectively alleviate preoperative swelling and pain in patients with calcaneal fractures,and it exhibits a high level of safety.It may exert the effects by reducing the serum level of inflammatory factors in patients.

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(收稿日期:2023-09-07 本文编辑:李晓乐)

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备注/Memo

备注/Memo:
基金项目:江西省中医药中青年骨干人才(第一批)培养计划项目(赣中医药科教字〔2020〕2号); 南昌市科学技术局医疗卫生引导性科技计划项目(洪科字〔2023〕336号); 南昌市市级重点专科建设项目(洪卫体改字〔2023〕10号)
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更新日期/Last Update: 1900-01-01