组合式外固定架联合复元活血汤治疗老年高危肱骨近端骨折的临床观察

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摘要目的探讨组合式外固定架联合复元活血汤治疗老年高危肱骨近端骨折临床效果。方法选取2019年10月至2020年10月在河北省中医院骨伤一科收治的60例老年高危肱骨近端骨折患者为研究对象，按照随机数字表法将其分为对照组和试验组，各30例。两组均行组合式外固定架治疗，试验组在组合式外固定架治疗基础上配合复元活血汤，两组均6个月后拆除固定装置，试验组停止服药。观察两组骨折愈合情况、肿胀程度、视觉模拟评分法（VAS）评分、Neer肩关节功能评分及D-二聚体水平。结果试验组骨折愈合时间短于对照组，差异有统计学意义（P ＜ 0.05）。两组术后3周、3个月及6个月的VAS评分均低于术前1 d和术后1 d，Neer肩关节功能评分均高于术前1 d和术后1 d；术后3、6个月时的VAS评分均低于术后3周，Neer肩关节功能评分均高于术后3周；术后6个月时的VAS评分均低于术后3个月，Neer肩关节功能评分均高于术后3个月，差异有统计学意义（P ＜ 0.05）。试验组术后3周、3个月、6个月的VAS评分均低于同期对照组，Neer肩关节功能评分均高于同期对照组，差异有统计学意义（P ＜ 0.05）。两组术后3、7、14 d的D-二聚体水平均低于术前1 d和术后1 d，术后7、14 d时的D-二聚体水平均低于术后3 d，术后14 d时的D-二聚体水平均低于术后7 d，差异有统计学意义（P ＜ 0.05）。试验组术后3、7、14 d的D-二聚体水平均低于同期对照组，差异有统计学意义（P ＜ 0.05）。试验组术后3周的肿胀程度轻于对照组，差异有统计学意义（P ＜ 0.05）。结论组合式外固定架联合复元活血汤治疗老年高危肱骨近端骨折，有助于加快局部血液循环，缓解术后肿胀，促进骨折的愈合，减轻术后疼痛，缩短术后功能恢复时间。

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	张毅立1 田雅峰2 董军格2 杨名帅2 董少阳1 薛鹏宇1 陈宝生1 樊金瑞1

关键词 ：肱骨近端骨折, 复元活血汤, 老年, 高危, 组合式外固定架

Abstract：Objective To investigate the clinical effects of combined external fixator combined with Fuyuan Huoxue Decoction on the treatment of high-risk elderly patients with proximal humerus fractures. Methods A total of 60 elderly high risk patients with proximus humeraus fractures admitted to the First Department of Orthopedics, Hebei Hospital of Traditional Chinese Medicine from October 2019 to October 2020 were selected as the research subjects, and they were divided into control group and experimental group according to random number table method, with 30 cases in each group. Both groups were treated with combined external fixator. The experimental group was treated with Fuyuan Huoxue Decoction on the basis of combined external fixator treatment. After six months, the fixation device in both groups were removed, and the experimental group stopped taking medication. The fracture healing time, swelling degree, visual analogue scale (VAS) score, Neer shoulder function score, and D-dimer level of the two groups were observed. Results The fracture healing time of the experimental group was shorter than that of the control group, and the difference was statistically significant (P ＜ 0.05). In both two groups, VAS scores at three weeks, three months, and six months after surgery were lower than those at one day before surgery and one day after surgery, and Neer shoulder function scores were higher than those at one day before surgery and one day after surgery; VAS scores at three and six months after surgery were lower than those at three weeks after surgery, and Neer shoulder function scores were higher than those at three weeks after surgery; VAS scores at six months after surgery were lower than those at three months after surgery, and Neer shoulder function scores were higher than those at three months after surgery, the differences were statistically significant (P ＜ 0.05). VAS scores of the experimental group were lower than those of the control group at three weeks, three months, and six months after surgery, and Neer shoulder function scores were higher than those of the control group at the same period, the differences were statistically significant (P ＜ 0.05). The D-dimer levels of both groups were lower at 3, 7, and 14 d after surgery than those at one day before surgery and one day after surgery, the D-dimer levels at 7, 14 d after surgery were lower than those at 3 d after surgery, the D-dimer levels at 14 d after surgery were lower than those at 7 d after surgery, the differences were statistically significant (P ＜ 0.05). The D-dimer levels of the experimental group were lower than those of the control group at 3, 7, and 14 d after surgery, the differences were statistically significant (P ＜ 0.05). The degree of swelling in the experimental group three weeks after surgery was lighter than that in the control group, and the difference was statistically significant (P ＜ 0.05). Conclusion Combined external fixator combined with Fuyuan Huoxue Decoction for the treatment of elderly high-risk patients with proximal humerus fractures can help to accelerate local blood circulation, relieve postoperative swelling, promote fracture healing, relieve postoperative pain, and shorten postoperative functional recovery time.

Key words： Proximal humerus fracture Fuyuan Huoxue Decoction Elderly High risk Combined external fixator

基金资助:河北省中医药管理局科研计划项目（2020078）。

通讯作者: 田雅峰（1968.7-），男，教授，硕士生导师，河北省中医院骨伤一科主任；研究方向：创伤外科，脊柱外科。

作者简介: 张毅立（1995.3-），男，河北中医学院2019级中西医结合骨伤专业在读硕士研究生；研究方向：中西医结合治疗肩关节创伤。

引用本文:

张毅立1 田雅峰2 董军格2 杨名帅2 董少阳1 薛鹏宇1 陈宝生1 樊金瑞1. 组合式外固定架联合复元活血汤治疗老年高危肱骨近端骨折的临床观察[J]. 中国医药导报, 2022, 19(3): 75-78,86.
ZHANG Yili1 TIAN Yafeng2 DONG Junge2 YANG Mingshuai2 DONG Shaoyang1 XUE Pengyu1 CHEN Baosheng1 FAN Jinrui1. Clinical observation of combined external fixator combined with Fuyuan Huoxue Decoction in the treatment of elderly high-risk patients with proximal humerus fractures#br#. 中国医药导报, 2022, 19(3): 75-78,86.

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