七叶皂苷钠对四肢骨折患者术后肢体肿胀程度及骨痂生长的影响

doi:10.3760/cma.j.cn441417-20250226-19024

摘要/Abstract

摘要：

目的　探究七叶皂苷钠对四肢骨折患者术后肢体肿胀程度、骨痂生长的影响。方法　本研究为前瞻性研究。选取2021年1月至2024年1月在河南省中医院行手术治疗的四肢骨折患者102例，按随机数字表法分为对照组和观察组，各51例。对照组男33例，女18例，年龄（54.50±11.00）岁，骨折至就诊时间（4.25±0.48）h。观察组男30例，女21例，年龄（53.00±11.23）岁，骨折至就诊时间（4.25±0.45）h。对照组予以注射用甘露醇静脉滴注治疗，250 ml/次，1次/d。观察组予以七叶皂苷钠20 mg+500 ml生理盐水静脉滴注治疗，1次/d。两组均连续治疗1周。比较两组治疗前和治疗1周后的肢体肿胀、视觉模拟评分法（VAS）、骨痂形成评分以及炎症因子、骨代谢指标、治疗安全性。采用χ²、t检验进行统计分析。结果　治疗1周后，观察组的肢体肿胀、VAS评分分别为（0.75±0.13、1.68±0.31）分，对照组分别为（0.96±0.16、2.45±0.41）分，差异均有统计学意义（t=7.275、10.698，均P<0.001）；观察组的骨痂量、骨痂密度以及骨痂边缘评分分别为（3.50±0.34、3.30±0.21、3.29±0.18）分，均高于对照组的（2.86±0.30、2.71±0.18、2.75±0.15）分，差异均有统计学意义（t=10.080、15.234、16.459，均P<0.001）；观察组的肿瘤坏死因子-α（TNF-α）、C反应蛋白（CRP）、降钙素原（PCT）、白细胞介素-6（IL-6）水平均低于对照组，碱性磷酸酶（ALP）、骨钙素（BGP）、骨保护素（OPG）、Ⅰ型前胶原羧基端肽（PⅠCP）水平均高于对照组（均P<0.05）。两组不良反应总发生率差异无统计学意义（χ²=0.297，P=0.586）。结论　七叶皂苷钠有助于缓解四肢骨折患者术后肢体肿胀，促进骨痂生长，调节炎症因子及骨代谢水平，且安全性较高。

关键词:

四肢, 骨折, 七叶皂苷钠, 肢体肿胀, 骨痂生长

Abstract:

Objective　To investigate the effects of sodium aesculin on limb swelling and callus growth in patients with limb fracture after operation. Methods　This study is a prospective analysis. A total of 102 patients who underwent surgical treatment for limb fractures at Henan Provincial Hospital from January 2021 to January 2024 were selected and randomly divided into a control group and an observation group, with 51 cases in each group. The control group consisted of 33 males and 18 females, with an average age of (54.50±11.00) years and a time from fracture to treatment of (4.25±0.48) hours. The observation group included 30 males and 21 females, with an average age of (53.00±11.23) years and a time from fracture to treatment of (4.25±0.45) hours. The control group received intravenous infusion of mannitol at 250 ml per dose, once daily. The observation group received intravenous infusion of sodium aesculin 20 mg + 500 ml sodium chloride solution, once daily. Both groups were treated continuously for one week. Limb swelling, visual analog scale (VAS) scores, callus formation scores, inflammatory factors, bone metabolism indicators, and treatment safety were compared before and after one week of treatment. Statistical analysis was performed using χ² and t tests. Results　After one week of treatment, limb swelling and VAS scores in the observation group were (0.75±0.13, 1.68±0.31) points, while in the control group they were (0.96±0.16, 2.45±0.41) points, with statistically significant differences (t=7.275, 10.698; both P<0.001). The callus volume, callus density, and callus margin scores in the observation group were (3.50±0.34, 3.30±0.21, 3.29±0.18) points, all higher than those in the control group [(2.86±0.30, 2.71±0.18, 2.75±0.15) points], with statistically significant differences (t=10.080, 15.234, 16.459; all P<0.001). Levels of tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) in the observation group were lower than those in the control group, while alkaline phosphatase (ALP), bone gamma-carboxyglutamic acid-containing protein (BGP), osteoprotegerin (OPG), and carboxy terminal peptide of type Ⅰ procollagen(PⅠCP) levels were higher in the observation group than in the control group (all P<0.05). There was no statistically significant difference in the overall incidence of adverse reactions between the two groups (χ²=0.297, P=0.586). Conclusion　Sodium aesculin is safe in alleviating limb swelling, promoting callus growth, regulating inflammatory factors and bone metabolism in patients with limb fracture.

Key words:

Limbs, Fracture, Sodium aesculin, Limb swelling, Bone callus growth

范小红梁拓李丽媛吴桂月李光辉.

七叶皂苷钠对四肢骨折患者术后肢体肿胀程度及骨痂生长的影响 [J]. 国际医药卫生导报, 2025, 31(19): 3288-3292.

Fan Xiaohong, Liang Tuo, Li Liyuan, Wu Guiyue, Li Guanghui.

Effect of sodium aesculin on limb swelling degree and callus growth in patients with limb fracture after operation [J]. International Medicine and Health Guidance News, 2025, 31(19): 3288-3292.

参考文献

[1] 张勇,李瑞语,查兴胜. 桥接组合式内固定系统治疗成人四肢骨折疗效及对骨折愈合时间、功能评分及并发症的影响[J]. 临床和实验医学杂志,2023,22(8):847-850. DOI:10.3969/j.issn.1671-4695.2023.08.017.
[2] 雷博艺,魏聪聪,曹雪飞. 切开与闭合复位空心钉内固定术对股骨颈骨折患者的影响[J]. 国际医药卫生导报,2024,30(24):4226-4230. DOI:10.3760/cma.j.issn.1007-1245.2024.24.033.
[3] 马寒星,王连成. 健脾生血方联合克氏针固定治疗髌骨骨折疗效及对患者VAS疼痛评分、Bostman评分的影响[J]. 陕西中医,2020,41(7):926-928. DOI:10.3969/j.issn.1000-7369.2020.07.026.
[4] 吴鹏飞,李森. 活血化瘀方辅助外科手术治疗四肢骨折的应用价值探究[J]. 世界中西医结合杂志,2021,16(3):500-504. DOI:10.13935/j.cnki.sjzx.210319.
[5] 田中青. 自拟活血止痛方治疗胫骨平台骨折对患者骨代谢及关节恢复情况的影响[J]. 中国中西医结合外科杂志,2020,26(6):1124-1128. DOI:10.3969/j.issn.1007-6948.2020.06.020.
[6] 刘健,张昊,刘凯恒,等. 甘露醇、七叶皂苷钠单用或联合治疗胫腓骨骨折肢体肿胀的临床疗效分析[J]. 长春中医药大学学报,2023,39(4):440-443. DOI:10.13463/j.cnki.cczyy.2023.04.019.
[7] 郑伟,倪和悟,李德. 七叶皂苷钠对髌骨骨折术后患肢肿胀患者血清炎性因子及肢体肿胀程度的影响[J]. 中国现代药物应用,2024,18(17):111-113. DOI:10.14164/j.cnki.cn11-5581/r.2024.17.030.
[8] 陈孝平,汪建平.外科学[M].8版.北京:人民卫生出版社,2013:646-661.
[9] 王亦璁.骨与关节损伤[M].3版.北京:人民卫生出版社,2007:192-193.
[10] Kalmet PHS, Meys G, V Horn YY,et al. Permissive weight bearing in trauma patients with fracture of the lower extremities: prospective multicenter comparative cohort study[J]. BMC Surg, 2018, 18(1):8. DOI: 10.1186/s12893-018-0341-3.
[11] 毛利娟,贺占坤,李京. 桃红四物汤合五味消毒饮对四肢骨折患者肢体肿胀、骨折愈合时间的影响[J]. 实用医院临床杂志,2022,19(2):86-89. DOI:10.3969/j.issn.1672-6170.2022.02.024.
[12] 王甜甜,刘媛媛,任红,等. 放血疗法联合短波疗法对胫腓骨骨折术前肢体肿胀疼痛的疗效观察[J]. 中国临床医生杂志,2024,52(11):1319-1322. DOI:10.3969/j.issn.2095-8552.2024.11.014.
[13] 谭智灵,唐国强,方松,等. 盐酸甲氯芬酯联合七叶皂苷钠对急性脑出血患者脑水肿体积以及血清学指标水平的影响[J]. 中国医刊,2023,58(5):509-512. DOI:10.3969/j.issn.1008-1070.2023.05.012.
[14] 宋月江,张皓,刘子亮. 七叶皂苷钠联合地奥司明片治疗混合痔PPH手术术后肛缘水肿及疼痛临床观察[J]. 新中医,2016,48(11):60-62. DOI:10.13457/j.cnki.jncm.2016.11.026.
[15] 陈锦富,吴多庆,陈余兴. 老年胫骨骨折患者术后骨痂与血清ALP、IGF-1、sICAM-1及β-CTX水平的相关性[J]. 分子诊断与治疗杂志,2022,14(3):521-524. DOI:10.3969/j.issn.1674-6929.2022.03.040.
[16] 疏建. 改良前外侧结合内侧入路手术对SchatzkerⅤ、Ⅵ型胫骨平台骨折的治疗疗效[J]. 川北医学院学报,2023,38(2):257-261. DOI:10.3969/j.issn.1005-3697.2023.02.027.
[17] 李鑫,华豪,陈晓东,等. 右美托咪定复合臂丛神经阻滞超前镇痛对关节镜下桡骨远端骨折术后镇痛、炎症反应和早期康复的影响[J]. 中国临床医生杂志,2022,50(4):474-477. DOI:10.3969/j.issn.2095-8552.2022.04.030.
[18] 王耀荣,高小明,李风莲,等. 针刺疗法联合骨化三醇、维生素D对老年骨折术后患者疼痛及肢体功能的影响[J]. 中国老年学杂志,2025,45(4):841-845. DOI:10.3969/j.issn.1005-9202.2025.04.019.
[19] 谢婷,李娅,王宁,等. 七叶皂苷钠联合骨肽注射液对老年跟骨骨折术后肢体肿胀的疗效及血清BALP BGP的影响[J]. 河北医学,2023,29(2):236-242. DOI:10.3969/j.issn.1006-6233.2023.02.011.
[20] 冯万立,王小明,陈广儒,等. 补肾健骨汤联合夹板外固定治疗桡骨远端骨折的临床效果及对骨折愈合、骨代谢指标的影响[J]. 解放军医药杂志,2020,32(11):94-97. DOI:10.3969/j.issn.2095-140X.2020.11.021.
[21] 吴鹏飞,李森,徐子卿. 续骨强筋方辅助经皮微创内固定术对四肢骨折患者血清碱性磷酸酶、骨保护素表达及骨折愈合的影响[J]. 世界中西医结合杂志,2022,17(7):1355-1359. DOI:10.13935/j.cnki.sjzx.220716.
[22] 张骏,陈定爽,刘东旭. 伤科骨愈汤联合交锁髓内钉内固定治疗胫腓骨骨折临床疗效研究[J]. 中华中医药学刊,2020,38(6):156-160. DOI:10.13193/j.issn.1673-7717.2020.06.037.
[23] Fu Q, Bustamante-Gomez NC, Reyes-Pardo H,et al. Reduced osteoprotegerin expression by osteocytes may contribute to rebound resorption after denosumab discontinuation[J]. JCI Insight, 2023, 8(18):e167790. DOI: 10.1172/jci.insight.167790.
[24] 吴二丰,张建平,吴静龙,等. 双能量CT参数联合血清Ⅰ型前胶原N端前肽和Ⅰ型胶原羧基端肽β特殊序列鉴别诊断脊柱肺癌骨转移瘤和骨髓瘤的价值[J]. 中国医师进修杂志,2022,45(3):257-262. DOI:10.3760/cma.j.cn115455-20210716-00919.
[25] Bhattoa HP, Cavalier E, Eastell R, et al. Analytical considerations and plans to standardize or harmonize assays for the reference bone turnover markers PINP and β-CTX in blood[J]. Clin Chim Acta, 2021, 515:16-20. DOI: 10.1016/j.cca.2020.12.023.