摘要
目的:观察阿法骨化醇联合补中益气汤口服治疗老年股骨颈骨折股骨头置换术后肌减少症脾胃虚弱证的临床疗效。方法:将80例老年股骨颈骨折股骨头置换术后肌减少症脾胃虚弱证患者随机分为2组,阿法骨化醇组40例、联合治疗组40例。阿法骨化醇组术后1 d口服阿法骨化醇片,每日0. 5μg,连续服用60 d;联合治疗组术后1 d在阿法骨化醇组的治疗基础上口服补中益气汤,每日1剂,早晚各温服200 mL,连续服用60 d。分别于治疗前、治疗30 d后、治疗60 d后测定患者的握力,并采用简易躯体能力测试(short physical performance battery,SPPB)量表评价临床综合疗效。结果:握力测试结果,时间因素和分组因素存在交互效应(F=13. 453,P=0. 006); 2组患者握力总体比较,组间差异有统计学意义,即存在分组效应(F=17. 537,P=0. 000);治疗前后不同时间点握力的差异有统计学意义,即存在时间效应(F=23. 812,P=0. 000); 2组患者握力随时间变化均呈增高趋势,但2组的增高趋势不完全一致[(19. 13±3. 21) kg,(20. 71±2. 18) kg,(21. 91±3. 16) kg,F=16. 634,P=0. 000;(18. 72±4. 15) kg,(22. 04±3. 56) kg,(23. 51±3. 82) kg,F=51. 427,P=0. 000];治疗前,2组患者握力的组间差异无统计学意义(t=0. 341,P=0. 367);治疗30 d、60 d后,联合治疗组的握力均大于阿法骨化醇组(t=2. 252,P=0. 013; t=2. 631,P=0. 005)。2组患者治疗60 d后的SPPB评分均较治疗30 d后增高[(6. 63±1. 85)分,(7. 91±2. 26)分,t=1. 871,P=0. 033;(7. 85±2. 17)分,(9. 23±2. 25)分,t=2. 930,P=0. 002],治疗30 d、60 d后联合治疗组的SPPB评分均高于阿法骨化醇组(t=1. 927,P=0. 029; t=6. 620,P=0. 000)。结论:阿法骨化醇联合补中益气汤口服治疗老年股骨颈骨折股骨头置换术后肌减少症脾胃虚弱证,可以改善肌肉功能、提高肌力,且效果优于单纯口服阿法骨化醇治疗。
Objective：To observe the clinical curative effects of oral applications of alfaealeidol and Buzhong Yiqi Tang（补中益气汤, BZYQT） for treatment of spleen - stomach - deficiency - type sareopenia appeared after femoral head replacement in aged patients with fem- oral neck fractures. Methods ： Eighty- aged patients with spleen - stomach - deficiency - type sareopenia appeared after femoral head re- placement for treatment of femoral neck fractures were randomly divided into monotherapy group and combination therapy group ,40 eases in each group. The patients in the 2 groups were treated with oral application of alfaealcidol since postoperative day- 1,0.5 μg a day- for consec- utive 60 day-s, moreover, the patients in combination therapy group were treated with oral application of warm BZYQT,200 mL at a time, one dose a day-, in the morning and evening respectively for consecutive 60 day-s. The grip strengths of patients in the 2 groups were measured before the treatment and after 30- and 60-day treatment respectively, and the clinical comprehensive curative effects were evaluated by using short physical performance battery-（SPPB） scale. Results ：The grip strength test results showed that there was interaction between time factor and group factor（ F = 13. 453 ,P = 0.006）. There was statistical difference in grip strength between the 2 groups in general,in other words, there was group effect（ F = 17. 537 ,P = 0.000）. There was statistical difference in grip strength between different timepoints before and af- ter the treatment,in other words, there was time effect （ F = 23. 812, P = 0. 000）. The grip strength presented a time-dependent increasing trend in both of the 2 groups,while the 2 groups were inconsistent with each other in the increasing trend of grip strength（ 19.13 ＋/- 3.21, 20.71 ＋/-2.18,21.91 ＋/-3.16 kg,F = 16.634,P = 0. 000;18.72 ＋/-4.15,22.04 ＋/-3.56,23.51 ＋/-3.82 kg,F =51.427,P =0. 000）.There was no statistical difference in grip strength between the 2 groups before treatment（ t = 0.341 ,P = 0. 367）. The grip strengths were grea- ter in combination therapy- group compared to monotherapy group after 30- and 60-day treatment （ t = 2. 252, P = 0. 013 ; t = 2. 631, P = 0.005）. The SPPB scores measured after 60-day treatment were higher than that measured after 30-day- treatment in both of the 2 groups （6.63 ＋/- 1.85 vs 7.91 ＋/- 2.26 points, t = 1.871,P = 0. 033 ; 7.85 ＋/- 2.17 vs 9.23 ＋/- 2.25 points, t = 2. 930, P = 0. 002）, and the SPPB scores were higher in combination therapy group compared to monotherapy group after 30- and 60-day treatment （ t = 1. 927, P = 0.029;t = 6. 620 ,P = 0.000）. Conclusion： Oral applications of alfacalcidol and BZYQT can improve muscle function and muscle strength in treatment of spleen-stomach-deficiency-Iype sareopenia appeared after femoral head replacement in aged patients with femoral neck frac- tures,and its curative effect is better than that of monotherapy of oral application of alfacalcidol.
作者
邓森
蔡桦
DENG Sen;CAI Hua(Gaozhou Hospital of Traditional Chinese Medicine,Gaozhou 525200,Guangdong,China;The Orthopedic Hospital Affiliated to Guangzhou University of Chinese Medicine,Guangzhou 510240,Guangdong,China)
出处
《中医正骨》
2018年第11期28-31,共4页
The Journal of Traditional Chinese Orthopedics and Traumatology
关键词
股骨颈骨折
关节成形术
置换
髋
肌减少症
补中益气汤
痿证
维生素D
老年人
临床试验
femoral neck fractures
arthroplasty
replacement
hip
sarcopenia
Buzhong Yiqi Tang
flaccidity syndrome
vitamin D
aged
clinical trial
