口服骨痿康颗粒对中老年股骨颈骨折术后的影响

Effect of oral Guwei Kang granules on femoral neck fracture after cannulated screw fixation in elderly

摘要:

[目的] 探讨口服骨痿康颗粒对中老年股骨颈骨折术后临床效果的影响,提供中医特色干预方案。[方法] 选取2022年6月—2024年12月股骨颈骨折行闭合复位空心钉内固定术的76例患者,采用随机数字表法将患者分为中药组和常规组,各38例。常规组予抗凝、止痛、康复训练等西医常规治疗,中药组在常规治疗的基础上加服骨痿康颗粒6个月。比较两组临床及影像学资料。[结果] 中药组术后下地行走时间[d,(27.8±2.8) vs (34.3±3.7),P<0.001]、恢复负重活动时间[d,(39.3±2.0) vs (45.7±2.9),P<0.001]均显著早于常规组。术后3个月及末次随访时,中药组的VAS评分[分,(3.5±0.5) vs (4.5±0.5),P<0.001;(1.1±0.4) vs (2.5±0.5),P<0.001]、Harris评分[分,(79.7±3.9) vs (72.1±3.0),P<0.001;(94.3±2.7) vs (89.8±4.9),P<0.001]、髋关节伸-屈ROM [°,(106.6±6.9) vs (95.9±7.3),P<0.001;(125.7±4.2) vs (116.6±4.4),P<0.001]及内旋-外旋ROM [°,(45.0±2.4) vs (39.6±2.7),P<0.001;(60.3±2.2) vs (50.9±4.6),P<0.001]均显著优于常规组。影像学上,术后3个月和末次随访时两组ARCO分期、骨折愈合及股骨头塌陷情况的差异均无统计学意义(P>0.05),但是,中药组顶尖距均显著小于常规组[mm,(22.7±1.1) vs (23.4±1.1),P<0.001;(23.5±1.0) vs (24.2±0.8),P<0.001]。[结论] 中老年股骨颈骨折术后加服骨痿康颗粒,可缩短康复进程、缓解疼痛、改善髋关节功能,减少内固定物松动风险,对降低股骨头坏死具有积极作用。

Abstract:

[Objective] To explore the clinical consequence of oral Guwei Kang granules on femoral neck fractures after cannulated screw fixation in the elderly, and to provide a traditional Chinese medicine intervention plan. [Methods] A total of 76 patients who had femoral neck fractures treated by closed reduction and cannulated screw fixation from June 2022 to December 2024 were selected, and divided into the traditional Chinese medicine (TCM) group and the conventional group by the random number table method, with 38 cases in each group. The conventional group received conventional Western medicine treatments such as anticoagulation, analgesia, and rehabilitation training, while the TCM group was given oral Guwei Kang granules in addition to the conventional treatment for 6 months. The clinical and imaging data of the two groups were compared. [Results] The TCM group proved significantly earlier than the conventional group in terms of postoperative ambulation time [days, (27.8±2.8) vs (34.3±3.7), P<0.001] and the time to resume weight-bearing activities [days, (39.3±2.0) vs (45.7±2.9), P<0.001]. At 3 months after surgery and the last follow-up, the TCM group was also significantly superior to the conventional group in terms of VAS score [points, (3.5±0.5) vs (4.5±0.5), P<0.001; (1.1±0.4) vs (2.5±0.5), P<0.001], Harris score [points, (79.7±3.9) vs (72.1±3.0), P<0.001; (94.3±2.7) vs (89.8±4.9), P<0.001], hip flexion-extension ROM [°, (106.6±6.9) vs (95.9±7.3), P<0.001; (125.7±4.2) vs (116.6±4.4), P<0.001] and hip internal-external rotation ROM [°, (45.0±2.4) vs (39.6±2.7), P<0.001; (60.3±2.2) vs (50.9±4.6), P<0.001]. On imaging, there were no statistically significant differences in the ARCO staging, fracture healing, and femoral head collapse between the two groups at 3 months after surgery and the last follow-up (P>0.05), but the tip-apex distance in the TCM group was significantly smaller than that in the conventional group accordingly [mm, (22.7±1.1) vs (23.4±1.1), P<0.001; (23.5±1.0) vs (24.2±0.8), P<0.001]. [Conclusion] Adding oral Guwei Kang granules after cannulated screw fixation of femoral neck fractures can shorten the rehabilitation process, relieve pain, improve hip function, reduce the loosening of internal fixation devices, and may have a positive effect on preventing femoral head necrosis.