摘要
目的:观察益气活血通络方对骨搬移术后骨代谢及人可溶性细胞间黏附分子1 (human soluble intercellular adhesion molecule 1,sICAM-1)、可溶性血管细胞黏附分子1(soluble vascular cell adhesion molecule 1,sVCAM-1)的影响。方法:50例需要骨搬移术的四肢骨髓炎或外伤性四肢骨骼缺损患者,按随机数字表法随机分为对照组和观察组,每组各25例。对照组患者给予骨搬移术;观察组在对照组治疗基础上,于骨搬移过程开始后第1天给予益气活血通络方。采用双能X线吸收测定法对患者骨搬移术后和骨折愈合过程中骨延长段的矿化骨质密度(bone mineral density,BMD)。于骨搬移过程开始第1天、第1周、第1个月、骨搬移术结束及骨质矿化结束时,采用疼痛视觉模拟评分(visual analogue scale,VAS)对患者的疼痛程度进行评估。记录患者骨折临床愈合和骨质矿化所需要的时间。分别于骨搬移术后第1周、6周和12周时,采用双抗体夹心法测定患者骨代谢相关参数的水平,包括血小板衍生生长因子(platelet derived growth factor,PDGF)、人胰岛素生长因子1(insulin growth factor 1,IGF-1)和碱性磷酸酶(alkaline phosphatase,ALP)水平,采用酶联免疫吸附法测定患者血清中sICAM-1和sVCAM-1水平。结果:观察组患者骨搬移术后第1个月、2个月、4个月,骨搬移术结束和骨质矿化结束时的延长骨段BMD水平显著高于对照组(P<0.05),且对照组和观察组患者搬移第2个月、4个月,骨搬移术结束和骨质矿化结束时的延长骨段BMD水平均显著高于骨搬移术后第1个月(P<0.05)。观察组患者骨搬移术后第1周、骨搬移术后第1个月、骨搬移结束和骨质矿化结束时的VAS显著低于对照组(P<0.05),且对照组和观察组患者搬移第1个月、骨搬移结束和骨质矿化结束时的VAS显著低于骨搬移术后第1天(P<0.05)。观察组患者骨折临床愈合和骨质矿化所需要的时间均显著低于对照组(P<0.05)。骨搬移术后第6周和骨搬移术后第12周,对照组和观察组患者血清中PDGF、IGF-1和ALP水平均显著高于骨搬移术后第1周,且观察组患者血清中PDGF、IGF-1和ALP水平升高幅度显著高于对照组(P<0.05)。骨搬移术后第6周和第12周,对照组和观察组患者血清sICAM-1和sVCAM-1水平比较,差异有统计学意义(P<0.05);骨搬移术后第6周和第12周,对照组患者血清sICAM-1和sVCAM-1水平及观察组患者血清中sVCAM-1水平显著高于骨搬移术后1周(P<0.05);骨搬移术后第6周和第12周后,观察组患者血清sICAM-1水平显著高于骨搬移术后第1周(P<0.05)。结论:益气活血通络方可以明显提高患者骨搬移术后和骨折愈合过程中骨延长段的BMD,提高骨代谢水平,降低骨搬移术后的疼痛程度,缩短骨折临床愈合和骨质矿化所需要的时间,抑制sICAM-1和sVCAM-1水平的过度增加。
Objective:To observe the effects of Yiqi Huoxue Tongluo Recipe on bone metabolism and human soluble intercellular adhesion molecule 1(sICAM-1) and soluble vascular cell adhesion molecule 1(sVCAM-1) after bone transport surgery.Methods:50 patients with extremity osteomyelitis or traumatic extremity bone defects requiring bone transport surgery were randomly divided into control group and observation group according to the random number method,with 25 cases in each group.Patients in the control group were given bone transport surgery.On the basis of the treatment of the control group,the observation group was given Yiqi Huoxue Tongluo Recipe on the first day after the surgery.The dual-energy X-ray absorptiometry was used to determine the bone mineral density(BMD) of the extended segment of the bone during the process of bone transport and fracture healing.On the first day,the first week,the first month,the end of bone transport,and the end of bone mineralization,the visual analogue scale(VAS) of pain was used to evaluate the patient′s pain degree.The time required for the clinical healing of the patient′s fracture and bone mineralization was recorded.And at 1,6,and 12 weeks after bone transfer,the double-antibody sandwich method was used to determine the levels of parameters related to bone metabolism in patients,including platelet derived growth factor(PDGF) and Insulin growth factor 1(IGF-1),and alkaline phosphatase(ALP) levels.Enzyme-linked immunosorbent assay was used to determine the levels of sICAM-1 and sVCAM-1 in patients′ serum.Results:The BMD level of the extended bone segment of the observation group was significantly higher than that of the control group at 1 month,2 months,4 months,the end of bone transport,and the end of bone mineralization(P<0.05),And the BMD level of the extended bone segment of the patients in the control group and the observation group after 2 months,4 months,the end of bone migration and the end of bone mineralization was significantly higher than that at 1 month of bone migration(P<0.05).The VAS of patients in the observation group at the time of bone transport for 1 week,bone transport for 1 month,the end of bone transport,and the end of bone mineralization were significantly lower than those of the control group(P<0.05),and the VAS of patients in the control group and the observation group at the end of the transport for 1 month,the end of bone transport and the end of bone mineralization were significantly lower than the first day of bone transport(P<0.05).The time required for clinical fracture healing and bone mineralization in the observation group was significantly lower than that in the control group(P<0.05).At 6 weeks and 12 weeks after bone transport,the serum levels of PDGF,IGF-1,and ALP in the control group and observation group were significantly higher than 1 week after bone transport,And the increase in serum PDGF,IGF-1 and ALP levels in the observation group was significantly higher than that in the control group(P<0.05).At 6 weeks and 12 weeks after bone transport,there was a statistically significant difference in serum sICAM-1 and sVCAM-1 levels between the control group and the observation group(P<0.05).At 6 weeks and 12 weeks after bone transport,the serum sICAM-1 and sVCAM-1 levels in the control group and the observation group were significantly higher than 1 week after bone transport(P<0.05).After 6 weeks and 12 weeks of bone transport,the serum sICAM-1 level of the observation group was significantly higher than 1 week after bone transport(P<0.05).Conclusion:Yiqi Huoxue Tongluo Recipe can significantly increase the BMD of the bone extension in the process of bone transport and fracture healing,increase the level of bone metabolism,reduce the pain of bone transfer process,shorten the time required for clinical healing of fractures,and bone mineralization,and inhibit the excessive increase of sICAM-1 and sVCAM-1 levels.
作者
陈江非
王新卫
张磊
倘艳锋
CHEN Jiangfei;WANG Xinwei;ZHANG Lei;TANG Yanfeng(Luoyang Orthopedic-Traumatological Hospital of Henan Province/Henan Provincial Orthopedic Hospital,Luoyang Henan China 471000)
出处
《中医学报》
CAS
2021年第12期2667-2672,共6页
Acta Chinese Medicine
基金
河南省中医药科学研究专项课题项目(20-21ZY1061)。
关键词
益气活血通络方
骨搬移术
骨代谢
人可溶性细胞间黏附分子1
可溶性血管细胞黏附分子1
矿化骨质密度
Yiqi Huoxue Tongluo Recipe
bone transport surgery
bone metabolism
human soluble intercellular adhesion molecule 1
soluble vascular cell adhesion molecule 1
mineralized bone density
