李金岭，连振刚，宋 伟，王建华，吴永东，李占鹏

(张家口市第一医院，河北 张家口 075000)



活血通脉胶囊对老年股骨粗隆间骨折术后炎症因子的影响

李金岭，连振刚，宋 伟，王建华，吴永东，李占鹏

(张家口市第一医院，河北 张家口 075000)

目的 探讨活血通脉胶囊对老年股骨粗隆间骨折术后炎症因子的影响。方法 选取2015年5月—2016年5月在我院行股骨近端防旋髓内钉(PFNA)治疗的80例老年股骨粗隆间骨折患者为研究对象，按随机数字表法分为治疗组与对照组,各40例,2组采用硬膜外或全身麻醉下行闭合复位PFNA内固定术,术后常规抗凝、抗感染、功能锻炼等，治疗组在对照组基础上口服活血通脉胶囊1粒/次,2次/d，连续治疗2周；于术前和用药后1、7、14 d分别抽取空腹外周静脉血，ELISA法检测C反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)水平；血生化仪测定血红蛋白(HGB)含量;记录术后疼痛缓解时间、下地活动时间、骨折愈合时间。结果 2组术后各炎症因子水平呈先升后降趋势，用药后1 d达高峰，用药后7、14 d逐渐降低，各时间点比，P<0.05，其中IL-10用药后1 d 2组无统计学意义，其余时间点治疗组CRP、IL-6、IL-10、TNF-α水平均低于对照组(P<0.05)；2组用药后HGB呈先降后升趋势，用药后1 d降至最低，用药后7、14 d逐渐上升，各时间点比较，P<0.05，其中治疗组HGB变化程度优于对照组(P<0.05)；治疗组疼痛缓解时间、下地活动时间、骨折愈合时间均短于对照组(P<0.05)。结论 活血通脉胶囊可明显减轻老年股骨粗隆间骨折患者围术期炎症反应，有效促进骨折愈合，减少隐性失血引起的HGB下降，减少并发症的发生。

活血通脉胶囊；老年；股骨粗隆间骨折；术后；炎症因子

股骨粗隆间骨折是股骨颈基底部至小粗隆水平间的骨折,是老年人常见骨折之一，由于粗隆部血运较丰富，骨折后极少发生不愈合，但易发生髋内翻，由于老年患者体质虚弱，保守治疗卧床时间较长，易引起诸多并发症，其病死率也较高,因此除患者存在手术禁忌证外，一般采用手术内固定治疗[1]。股骨粗隆间骨折临床治疗多以手术为主[2-3]。有报道,骨折后机体应激反应会分泌诸多炎症因子，炎症因子在一定程度上反应疾病的转归与预后[4-5]。笔者为观察活血通脉胶囊对老年股骨粗隆间骨折术后炎症因子的影响，对2015年5月—2016年5月收治的80例老年股骨粗隆间骨折股骨近端防旋髓内钉(PFNA)内固定患者资料进行分析。现报道如下。

1 资料与方法

1．1 一般资料 选取2015年5月—2016年5月在我院行PFNA治疗的80例老年股骨粗隆间骨折患者为研究对象，符合《中医病证诊断疗效标准》中股骨粗隆间骨折诊断标准[6]，患者及家属知情同意并签署同意书，排除凝血功能障碍及正在使用抗凝药物、既往有下肢深静脉血栓及术前发现存在血栓者、合并其他部位骨折者等。按随机数字表法分为治疗组与对照组，各40例，治疗组男25例，女15例；年龄63～82岁，平均(75．3±1．4)岁。对照组男27例，女13例；年龄63～83岁，平均(76．1±1．2)岁。2组一般资料比较,差异无统计学意义(P>0．05)，具有可比性。

1．2 方法 2组均由相同医师进行手术，采用硬膜外或全身麻醉下行闭合复位PFNA内固定术，术后常规抗凝、抗感染、功能锻炼等，治疗组在对照组基础上口服活血通脉胶囊(安徽金太阳生化药业，国药准字Z20100036)1粒/次，2次/d，连续治疗2周。

1．3 观察指标 于术前和用药后1、7、14 d分别抽取空腹外周静脉血,ELISA法检测C反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)水平；血生化仪测定血红蛋白(HGB)含量;记录术后疼痛缓解时间、下地活动时间、骨折愈合时间。

2 结果

2．1 2组用药前后血清CRP、IL-6、IL-10、TNF-α水平比较 见表1。

表1 2组用药前后血清CRP、IL-6、IL-10、TNF-α水平比较

注:与对照组比较，#P<0．05

2．2 2组用药前后HGB含量比较 见表2。

g/L

注:与对照组比较，#P<0．05

2．3 2组疼痛缓解时间、下地活动时间、骨折愈合时间比较 见表3。

组 别疼痛缓解/d下地活动/d骨折愈合/月治疗组47.2±6.3#50.6±5.7#4.1±1.5#对照组62.5±5.8 71.3±5.4 5.5±1.7

注:与对照组比较，# P<0．05

3 小结

中医学认为，老年股骨粗隆间骨折属肝肾亏虚、气滞血虚证[7-10]。活血通脉胶囊主要成分为水蛭，具有破血逐瘀、活血散瘀、通经、通脉止痛功效，对老年股骨粗隆间骨折有较显著疗效[11-16]。本研究显示，活血通脉胶囊可明显减轻老年股骨粗隆间骨折患者围手术期炎症反应，有效促进骨折愈合，减少隐性失血引起的HGB下降及并发症的发生。

[1]张伟强,祁宝昌,邓鹏飞,等.老年股骨粗隆间骨折治疗的临床进展[J].中国老年学杂志,2015,35(1):266-268.

[2]郭永智,桑庆华,于晨,等.PFNA与DHS内固定治疗骨质疏松性股骨粗隆间骨折的Meta分析[J].中国骨与关节损伤杂志,2014,29(6):537-540.

[3]闫军,周劲松,李雷,等.闭合复位加长型股骨近端防旋髓内钉内固定治疗股骨干骨折合并同侧股骨粗隆间骨折[J].中国微创外科杂志,2015,15(2):163-166.

[4]张逸凌,沈景,毛智,等.股骨粗隆间骨折内固定手术隐性失血的相关因素分析[J].中国修复重建外科杂志,2014,28(5):610-615.

[5]陈欢.活血通脉胶囊对老年股骨粗隆间骨折患者炎症因子及术后并发症的影响[J].新中医,2015,47(8):114-115.

[6]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:170.

[7]张长青,张春啸,张文治,等.PFNA与PFN内固定治疗老年股骨粗隆间骨折的临床疗效评价[J].生物骨科材料与临床研究,2014,11(5):51-54.

[8]朱云森,江敞,李俊.氨甲环酸对老年股骨转子间骨折髓内固定术围手术期隐性失血的影响[J].中医正骨,2015,27(6):16-18.

[9]谢学文,梁泳聪,张兆华,等.加味补中益气汤对高龄股骨粗隆间骨折患者围手术期血清IL-6,IL-10,TNF-α的影响[J].中国中医骨伤科杂志,2016,24(4):30-33.

[10]郑银驹,范回生,张杰.活血解毒饮对骨折术后患者血沉,C反应蛋白,TNF-α及IL-1的影响[J].中医药导报,2015,21(12):54-55.

[11]黄建立.骨肽注射液对四肢骨折患者血清骨代谢及炎性状态的影响[J].海南医学院学报,2014,20(9):1234-1236.

[12]王信颖,虞陆超,金东旭,等.联合检测血清γ-谷氨酰转肽酶、碱性磷酸酶、超敏C反应蛋白在高龄股骨粗隆骨折患者中的临床意义[J].中国实验诊断学,2015,19(6):894-896.

[13]田守权,黄传焕,曾启清,等.高龄患者股骨粗隆间骨折的中西医治疗进展[J].中医药临床杂志,2014,26(2):217-219.

[14]郭锋,张志辉,陈棉智,等.骨前康颗粒对PFNA治疗老年股骨粗隆间骨折围手术期隐性失血的影响[J].中西医结合研究,2015,7(3):132-134.

[15]张志辉,郭锋,陈棉智.骨前康颗粒对PFNA治疗老年股骨粗隆间骨折围手术期隐性失血的影响[J].新中医,2015,47(1):114-115.

[16]刘天盛,苏彬,王宇强,等.活血通脉胶囊联合周期性充气加压预防髋部骨折手术后深静脉栓塞[J].武警医学院学报,2008,17(5):415-416.

Huoxuetongmai capsule on inflammatory cytokines in elderly patients after femoral intertrochanteric fracture surgery

LI Jinling,LIAN Zhengang,SONG Wei,WANG Jianhua,WU Yongdong,LI Zhanpeng

(The First Hospital of Zhangjiakou,Zhangjiakou 075000,Hebei Province,China)

Objective To explore the effect of Huoxuetongmai capsule on the inflammatory cytokines in elderly patients after femoral intertrochanteric fracture surgery.Methods A total of 80 elderly patients with femoral intertrochanteric fracture who were admitted in our hospital from May,2015 to May,2016 for PFNA were included in the study and randomized into the observation group and the control group with 40 cases in each group.The patients in the two groups were performed with PFNA internal fixation of closed reduction under epidural or general anesthesia,and were given routine anti-coagulation,anti-infection,and functional exercise after operation.On this basis,the patients in the observation group were given Huoxuetongmai capsule,1 capsule/time,2 times/d,continuously for 2 weeks.The fasting peripheral venous blood before operation,1,7,and 14d after medication was extracted.ELISA was used to detect CRP,IL-6,IL-10,and TNF-α levels.The blood biochemical analyzer was used to determine HGB content.The postoperative pain relieving time,out-of-bed activity time,and fracture healing time were recorded.Results The comparison of serum CRP,IL-6,IL-10,and TNF-α levels before operation between the two groups was not statistically significant (P>0.05).After operation,the serum CRP,IL-6,IL-10,and TNF-α levels were elevated first and reduced later,reached the peak 1d after medication,were gradually reduced 7d and 14d after medication,and the comparison among each timing point was statistically significant (P<0.05).The comparison of IL-10 1d after medication between the two groups was not statistically significant (P>0.05).The serum CRP,IL-6,IL-10,and TNF-α levels in the rest timing points in the observation group were significantly lower than those in the control group (P<0.05).The comparison of HGB content before operation between the two groups was not statistically significant (P>0.05).After medication,HGB was reduced first and elevated later,reduced the lowest 1d after medication,and was gradually elevated 7d and 14d after medication,and the comparison among each timing point was statistically significant (P<0.05).The change degree of HGB in the observation group was significantly superior to that in the control group (P<0.05).The pain relieving time,out-of-bed activity time,and fracture healing time in the observation group were significantly shorter than those in the control group (P<0.05).Conclusion Huoxuetongmai capsule in the treatment of elderly patients with femoral intertrochanteric fracture can significantly alleviate the perioperative inflammatory reaction,effectively promote the fracture healing,reduce the decreased HGB caused by hidden hemorrhage,and lessen the occurrence of complications.

Huoxuetongmai capsule;elderly;femoral intertrochanteric fracture;postoperative;inflammatory cytokine

10.13463/j.cnki.cczyy.2016.06.040

张家口市科技攻关计划项目(1521047D)。

李金岭(1982-)，男，大学本科，主治医师，主要从事临床外科研究。

R274.9

A

2095-6258(2016)06-1217-03

2016-07-18)