摘要
目的:探讨八仙逍遥汤对急性跟腱断裂术后风寒湿阻型关节僵硬的疗效,以及对肌腱生长相关因子转化生长因子-β1(TGF-β1),胰岛素样生长因子-1(IGF-1),表皮生长因子(EGF)的影响。方法:选取新鲜闭合性跟腱断裂患者66例,根据入院顺序依据随机数字表法将患者分为治疗组与对照组,每组33例,所有患者均行手术切开修补治疗,术后长腿支具固定,第4周调整为靴形支具并调整支具跖屈角度,固定满6周去除支具开展加速康复功能锻炼。治疗组在功能锻炼的基础上给予八仙逍遥汤熏洗患侧跟腱45 d,2次/d,对照组仅进行功能锻炼。比较两组患者去除支具时,术后3,6,12个月Leppilahti跟腱修复评分,美国足踝外科协会踝与后足功能评分(AOFAS),末次随访时评估患侧小腿三头肌肌力恢复状况;治疗前后分别检测血清TGF-β1,IGF-1,EGF水平,比较中医证候评分、症状评价、足背屈角度变化、临床总体疗效。结果:两组患者在不同的处理措施下评分变化不同步,去除支具后治疗组测得3次Leppilahti,AOFAS评分均高于对照组(P<0.05);末次随访时治疗组肌力优良率93.94%(31/33)高于对照组72.73%(24/33)(χ^(2)=0.031,P<0.05),治疗组患肢肌力恢复优于对照组;治疗后两组患者的TGF-β1,IGF-1,EGF水平均明显高于治疗前(P<0.05),治疗后与对照组比较,治疗组TGF-β1,IGF-1,EGF水平均升高且高于对照组(P<0.05);治疗组足背屈角度、中医证候评分均优于对照组(P<0.05)。治疗组总有效率90.91%(30/33)高于对照组75.76%(25/33)(χ^(2)=6.981,P<0.05)。治疗过程中两组患者均无不良反应发生。结论:八仙逍遥汤外用熏洗治疗可改善急性跟腱断裂术后风寒湿阻型关节僵硬的症状、中医证候,提升关节功能评分、小腿三头肌肌力等指标,升高TGF-β1,IGF-1,EGF水平,增强跟腱强度和韧性,临床疗效优于单纯的功能锻炼。
Objective: To investigate the efficacy of Baxian Xiaoyaotang(BXT)in treating ankylosis of wind-cold-dampness obstruction syndrome after acute Achilles tendon rupture surgery and its effects on transforming growth factor-β1(TGF-β1),insulin-like growth factor-1(IGF-1),and epidermal growth factor(EGF). Method:According to the visiting sequence,66 patients with fresh closed Achilles tendon rupture were included and randomly divided into a treatment group(n=33)and a control group(n=33). Patients in both groups underwent surgical repair,followed by immobilization in long-leg brace,which was then replaced by the boot brace in the fourth week,with the plantar-flexion angle adjusted correspondingly. Six weeks later,the brace was removed for accelerated functional rehabilitation training. On this basis,patients in the treatment group were further instructed to fumigate and wash the affected Achilles tendon with BXT,twice a day,for 45 d. The Leppilahti Achilles tendon performance scores and American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot scores between the two groups were compared at the time of brace removal and the third,sixth,and twelfth months after surgery. The strength of triceps surae on the affected side was evaluated at the last follow-up visit. The serum TGF-β1,IGF-1,and EGF levels were detected before and after treatment. The windcold-dampness obstruction syndrome scores,symptom scores,the changes in foot dorsiflexion angle,and the overall clinical efficacy were compared. Result: The changes in scores of patients receiving different treatment measures did not synchronize. After the removal of brace,the Leppilahti Achilles tendon performance score and AOFAS ankle-hindfoot score determined at three time points in the treatment group were higher than those in the control group(P<0.05). At the last follow-up visit,the good-to-excellent rate of muscle strength in the treatment group was 93.94%(31/33),higher than 72.73%(24/33)in the control group(χ^(2)=0.031,P<0.05),implying that the strength of triceps surae in the treatment group was better recovered. After treatment,the serum TGF-β1,IGF-1,and EGF levels in both groups were increased in contrast to those before treatment(P<0.05),and these levels in the treatment group were all higher than those in the control group(P<0.05). The foot dorsiflexion angle and the wind-cold-dampness obstruction syndrome score in the treatment group were superior to those in the control group(P<0.05). The overall response rate of the treatment group was 90.91%(30/33),higher than75.76%(25/33)of the control group(χ^(2)=6.981,P<0.05). No adverse reactions occurred during the treatment.Conclusion: The external fumigation and washing with BXT alleviates both the clinical symptoms and traditional Chinese medicine(TCM)syndrome,improves the joint function score,triceps surae strength,and other indicators,elevates the serum TGF-β1,IGF-1,and EGF levels,and enhances the strength and toughness of Achilles tendon of patients with ankylosis due to wind-cold-dampness obstruction after the acute Achilles tendon rupture surgery. Its clinical efficacy is better than that of functional rehabilitation training.
作者
程帅榜
曹玉净
齐秀春
李扬
朱梓宾
刘超
CHENG Shuai-bang;CAO Yu-jing;QI Xiu-chun;LI Yang;ZHU Zi-bin;LIU Chao(The Second Clinical School of Henan University of Chinese Medicine,Zhengzhou 450046,China;The Second Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450002,China)
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2021年第12期103-110,共8页
Chinese Journal of Experimental Traditional Medical Formulae
基金
河南省中医药科学研究专项课题(2017ZY1018)。
