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活血接骨膏对骨折患者骨转化标志物及术后康复效果的影响
刘建博,夏洪乐,徐晓腾,李宝芬
河北省沧州中西医结合医院沧州 061000;沧州市中心医院沧州 061000;河北省沧州中西医结合医院沧州 061000;李宝芬全国老药工传承工作室沧州 061000
摘要:
目的:探讨活血接骨膏对骨折患者骨转化标志物及术后康复效果的影响。方法:采用随机数字表法将河北省沧州中西医结合医院2023年1月—2024年4月收治的60 例胫腓骨远端骨折患者分为对照组和观察组,每组30例。对照组予以常规治疗,观察组予以常规治疗联合活血接骨膏治疗。比较两组临床疗效、骨转化标志物水平、炎症因子水平、不良反应,并进行术后康复效果和成本效益分析。结果:治疗后,观察组的总有效率(93.33%)高于对照组73.33%(P <0.05);观察组骨钙素N端中分子片段(NMTD)、骨特异碱性磷酸酶(BsAP)水平高于对照组,Ⅰ型原胶原氨基端前肽(P1NP)、肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-1及IL-6水平低于对照组(P <0.05)。观察组术后1、3个月的VAS评分低于对照组(P <0.05);观察组术后1、3、6个月的美国足踝外科医师协会足踝量表(AOFAS)评分均高于对照组(P <0.05),观察组术后1周、1个月、3个月的肿胀水平低于对照组(P <0.05)。观察组与对照组的不良反应总发生率(13.33% vs 3.33%)差异无统计学意义(P >0.05)。观察组平均总费用为36 797.25元,对照组为36 484.63元;观察组的质量调整生命年(QALYs)为2.799,对照组QALYs为2.199,增量效应为0.600,增量成本效益比(ICER)为521.03(312.62/0.600)。结论:活血接骨膏应用于胫腓骨远端骨折患者中具有良好的成本效果,可有效控制患者炎症因子水平,缓解患者疼痛及肿胀体征,促进骨转化及骨形成,利于患者术后踝关节功能恢复,且不增加患者术后不良反应的发生风险。
关键词:  骨折  活血接骨膏  骨转化标志物  术后康复  成本效益分析
DOI:10.3969/j.issn.1007-6948.2025.06.006
投稿时间:2025-06-04
基金项目:河北省中医药管理局科研计划项目(2023446)
Effective of Huoxue Jiegu ointment on bone turnover markers and postoperative rehabilitation effect in fracture patients
LIU Jian-bo,XIA Hong-le,XU Xiao-teng
Abstract:
Objective To explore the effect of Huoxue Jiegu ointment on the markers of bone transformation in patients with fracture, and make a longitudinal analysis of the postoperative rehabilitation effect. Methods 60 patients with distal tibiofibular fractures admitted to Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Hebei Province, between January 2023 and April 2024 were enrolled. Using a random number table method, they were divided into a control group receiving conventional treatment and an observation group receiving conventional treatment combined with Huoxue Jiegu Ointment, with 30 cases in each group. The clinical efficacy, levels of bone turnover markers, levels of inflammatory factors, adverse reactions, postoperative rehabilitation effects, and cost-effectiveness analysis were compared between the two groups. Results After treatment, the total effective rate of the observation group (93.33%) was higher than that of the control group (73.33%), with a statistically significant difference (P <0.05). Regarding laboratory indicators: the levels of NMTD and BsAP in the observation group were higher than those in the control group, while the levels of P1NP, TNF-α, IL-1, and IL-6 were lower than those in the control group, all with statistically significant differences (P <0.05). For postoperative functional and symptom assessments: the Visual Analogue Scale (VAS) scores of the observation group at 1 month and 3 months postoperatively were lower than those of the control group (P <0.05); the American Orthopaedic Foot and Ankle Society (AOFAS) scores of the observation group at 1 month, 3 months, and 6 months postoperatively were higher than those of the control group (P <0.05); the swelling level of the observation group at 1 week, 1 month, and 3 months postoperatively was lower than that of the control group (P <0.05).The total incidence of adverse reactions was 13.33% in the observation group and 3.33% in the control group, with no statistically significant difference between the two groups (P >0.05).In terms of economic and health outcome indicators: the average total cost was 36 797.25 yuan in the observation group and 36 484.63 yuan in the control group. The Quality-Adjusted Life Years (QALYs) were 2.799 in the observation group and 2.199 in the control group, with an incremental effect of 0.600 and an Incremental Cost-Effectiveness Ratio (ICER) of 521.03 (calculated as 312.62/0.600) Conclusion The application of Huoxue Jiegu ointment in patients with distal tibia and fibula fractures can effectively control the level of inflammatory factors, relieve the symptoms of pain and swelling, promote bone transformation and bone formation, facilitate the recovery of ankle joint function after operation, and do not increase the risk of postoperative adverse reactions.
Key words:  Fracture  Huoxue Jiegu ointment  bone turnover markers  postoperative rehabilitation  cost-effectiveness analysis

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