龍千里 姬芝栩 龍征忠 張臻福

1.貴州省臺江縣人民醫(yī)院 556300 2.貴州省臺江縣民族醫(yī)院

Colles fracture (extension type distal radius fractures) is one of the osteoporotic elderly women are most prone to fracture.in 2006 January to 2012 December, we will be old female Colles fracture admitted 124 patients matched treatment group was given orally according to the prescription of the Miao folk to produce a called Xianlinggubao capsules drug formulation, matched control treatment, and the detection of serum ALP, P and TCa, report as follows now.

1 Clinical data and methods

1.1Case selection

In order to enhance the accuracy, reduce the misjudgment, not included in this study the following patients:①The less than 55 years old; ②The injured more than 24 hours; ③The open fracture; ④The unstable fracture fixation splint; ⑤Combined with vascular, nerve damage, or injury before the joint dysfunction; ⑥The suffering from thyroid function abnormalities, diabetes, tuberculosis, anemia, malignant tumor, liver and kidney function abnormal; ⑦The non completion of treatment according to the requirements of the project, observation, incomplete medical records, there is a lack of scholars.

1.2Object and method

1.2.1Object:Older women fresh closed stable type Colles fractures in 124 cases, after visiting use the same technique to give the reset.The causes of injury were slipped back hand stays, age: 55 to 84 years old, the average age of (65±8.8); in 24 hours after injury may be manipulative reduction, splint fixation, the average (8.6±5.9) H.Among them, the treatment group age: 55 to 81 years old, the average age of (65.7±9.9); the control group of age: 55 to 84 years old, the average age of (64.4±7.5).Before treatment, two groups of age, serum ALP,TCa and P fracture displacement, limb swelling, wrist joint contour integral, manipulative reduction and so on, were tested fort, no significant difference(P> 0.05), so the two groups comparable.

1.2.2Method:This research adopts the prospective, paired, controlled trial design, all cases were treated by closed reduction, the wrist will not fixed, forearm fixed with small splints.All cases were treated by closed reduction, the wrist will not fixed, forearm fixed with small splints.the treatment group oral Xianlinggubao capsule treatment, the control group was not given oral Xianlinggubao capsule, the other treatment was the same, paired up to 62 pairs.Treatment before the patient or family member to explain the treatment program, reading the informed consent, the implementation of the agreement signed.Treatment before the patient or family member to explain the treatment program, reading the informed consent, the implementation of the agreement signed.After treatment, in 4 weeks, 8 weeks and 12 weeks the patient serum biochemical index test and X-ray examination,According to the standard of callus score:① 0 points: no callus shadow found, fracture line was visible; ②1 points: visible to the callus shadow, fracture line is fuzzy; ③2 points: obviously the growth of callus, the fracture line was significant fuzzy;④3 points: the fracture line faintly visible, to near extinction;⑤4 points: the fracture line disappeared completely.

1.3Treatment method

1.3.1Manipulative reduction and Small splint external fixation:Manipulative reduction using the folded top traction reduction manipulation, make smooth reading completed.Selection of Hebei province Xinzheng of orthopedics repair equipment factory production of distal radius shapeable splint.In accordance with the forearm of long, short, coarse and fine,choosing the suitable type (large, medium, small) in the extensor flexor, ulnar, radial side each place a fixed.

1.3.2Medication The control group was given Sanqi capsule (country medicine accurate Z20020117, Sichuan Shuzhong Pharmaceutical Co., Ltd.production), the treatment group oral Xianlinggubao capsule(country medicine accurate Z20025337, Guizhou Tongjitang Pharmaceutical Co., Ltd production),3 capsules once, 2 times a day, and the two groups were orally for 3 months.During treatment were no other nourishing, relieving pain, calcium preparations or other medicine to protect against osteoporosis.

1.3.3Postoperative treatment:After external fixation, elbow flexion 90 degrees, the forearm in neutral position chest suspension, with the forearm with column plate.Ask the patient for fist, elbow, finger and shoulder flexion exercises, pay attention to swelling and peripheral finger blood supply situation, the timely adjustment of the tightness of a strapping.6 weeks after the lifting of splint fixation, topical relaxating tendons and removing obstruction Chinese herbal fumigation and washing.

1.4Statistical processing

2 Result

2.1The effect on serum ALP

After 4 weeks of treatment, two groups of ALP were significantly increased, the peak in 8 weeks.Comparison of two groups increased, the difference was statistically significant (t>1.9996,P=0.0000<0.01), that oral Xianlinggubao capsule can enhance serum ALP activity; After 12 weeks of decline in different degrees, the treatment group decreased greatly, indicating that the treatment group fractures healed.(see Table 1)

Table 1 Effect of Xianlingubao on serum ALP in patients with fracture (u/L,

Note:tdouble tail critical value 1.9996

2.2The effect on serum TCa

4 weeks, 8 weeks, two groups of TCa were compared with those before treatment (visit the next day,the same below) increased (P< 0.001), 4 weeks of treatment group than the control group increased more significantly (t>1.9996，P=0.0000<0.01), that oral Xianlinggubao capsule can promote the increment of TCa in fracture healing.8 weeks has decreased, the difference between the two groups had no statistical significance (t=1.7225< 1.9996,P=0.09> 0.05).At 12 weeks, decreased more significantly, there was significant difference between two groups (t=6.6453>1.9996,P=0.0000<0.001).(see Table 2)

Table 2 Comparison of serum calcium concentration before and after the treatment between the

Note:tdouble tail critical value 1.9996

2.3The effect on serum P

The concentration of serum P in two groups were higher than that before treatment (P< 0.01), the treatment group compared with the control group at the same time, the treatment group increasedsignificantly, the differences were statistically significant, suggesting that oral Xianlinggubao Capsuleon fracture healing in the promotion effect of P increased.(see Table 3)

Table 3 Comparison of serum phosphorus concentration before and after the treatment between the two

Note:tdouble tail critical value 1.9996

2.4TCa and P product value comparison

Table 4 shows that increased 4 ～ 8 weeks TCa, P concentration of product in different degrees, but the difference between the two groups was statistically significant (P<0.01).At 8 weeks of treatmentgroup increased most significantly, the value reached the peak, thus speeding up the calcium and phosphorus in the form of bone salt deposition in bone tissue.At 12 weeks, two groups were decreased, the calcium phosphorus product value of two groups had no statistically significant difference.

Table 4 Comparison of calcium and phosphorus level between the two groups

Note:tdouble tail critical value 1.999

2.5X-ray callus score comparison

From table 5 we can see, the treatment group for 4 weeks, 8 weeks, 12 weeks, X-ray score was significantly higher than that of control group at the same time, that oral Xianlinggubao capsule can promote the growth of callus.

Table 5 Comparison of callus score in X-ray between the two groups

Note:tdouble tail critical value 1.9996.

3 Discussion

3.1ALP is produced by osteoblasts after penetration into the blood, it is an early marker of osteoblast differentiation, bone formation is required for enzyme.Promotion of in organic phosphate ions and calcium ions to form calcium phosphate deposition in bone tissue.It can be used as functional markers of osteoblasts, and can reflect the differentiation.The changes of activity indirectly reflect the bone remodeling activity change and osteoblast activityis weak, it is an important index of the observation of fracture healing[1-3].

3.2Serological examination showed that the treatment group increased ALP content in serum, TCa, P and calcium phosphorus product were changed significantly.Calcium is one of the most important elements in the process of fracture healing, usually calcium tocalcium salt crystals contained in the form of matrix vesicles, once secreted into the surroundin gorganic matter, settling down in the surrounding collagen fibers,participate in the completion of the bone organic matter calcification, the formation of bone.The contents of calcium and phosphorus in blood directly affects osteogenesis (calcium salt deposition in bone) and osteolysis(calcium salt dissolved in bone),they restrict each other, mutual influence the product of calcium and phosphorus is maintained at a certain level.When more than a certain limit, inorganic salt deposition in bone[4-5].Two of the product ([Ca]×[P]) was between 30 and 40, when ([Ca]×[P]) > 40, calcium and phosphorus to form of bone salt deposition in bone tissue; if ([Ca]×[P]) < 35 interfere with bone calcification, and even can make the bone salt dissolution and affects osteogenesis.Therefore, increasing the calcium phosphorus product, deposition of calcium salt favorable and bone formation.

3.3The treatment group taking Xianlingubao capsule can improve serum TCa, P and ALP level and the peak arrived ahead of time.Clinical observation of patients with local pain and swelling of the lighter, the swelling subsided quickly, it can early functional activities.X-ray at the same time observation of callus with higher scores and in the hematoma absorption machine, calcium salt deposition, bone trabecula moulding and reconstruction were better than the control group, and 3 months later serum ALP decreased rapidly, the control group decreased slowly, the treatment group fractures have been healed, the control group is still in the state of most fracture healing, and X-ray film to the growth state of the bone scab anastomosis, also with some domestic reports consistent[6-8].Can think, the elderly women with osteoporosis Colles fracture taking Xianlingubao capsule by effect of serum ALP and TCa, P concentration changes and Improve blood circulation around the fracture,shorten the time of fracture healing, to has a clear role in promoting fracture healing.