Treatment Of Osteoporosis Secondary To Plate Internal Fixation Of Ankle Fracture With Additions And Subtractions Of Gu Yuan Tang

OBJECTIVE:To provide a clinical basis for the treatment of osteoporosis secondary to internal fixation of ankle fracture plates with Chinese medicine by observing the efficacy of the treatment with the additions and subtractions of Gu Yuan Tang on patients with osteoporosis secondary to internal fixation of ankle fracture plates.METHOD:Information on 79 cases of secondary OP after internal fixation of ankle fracture plates admitted to the Department of Orthopaedics of the Affiliated Hospital of Shandong University of TCM from December 2019 to December 2021 was selected.,exclusion and shedding criteria and randomly divided into a treatment group（additions and subtractions of Gu Yuan Tang combined with anti-osteoporosis drug treatment）of 39 cases and a control group（anti-osteoporosis drug treatment alone）of 40 cases.9 cases were detached during treatment and,ultimately,there were 35 cases in the treatment group and35 in the control group.The patients in the two groups were counted separately before treatment,at week 4 and week 12 of treatment in terms of serum biochemical indexes such as Ca²⁺,PHOS^-,ALP,PTH,25-Hydroxy vitamin D,VAS score,BMD score s of the medial shaft,ankle mobility such as dorsiflexion,plantar flexion,inversion and valgus,AOFAS score and improvement of TCM symptoms such as pain,swelling,stiffness and functional limitation,etc.The statistical data were statistically processed and correlated using SPSS25.0 software,and statistical graphs were plotted using Graph Pad Prism 9 to assess the efficacy of the additions and subtractions of Gu Yuan Tang on osteoporosis secondary to internal fixation of ankle fracture plates and draw relevant conclusions.RESULT:1.General data situation results:there was no significant difference between the two groups in terms of gender,age,cause of injury,route of admission,nature of wound,fracture site,fracture typing and grading（P>0.05）.2.Bone density of the midshaft bone:by Friedman’s test,there was a statistically significant difference between the two groups before and after treatment（P<0.001）;by Mann-Whitney U test,there was no statistically significant difference between the two groups at week 4（Z=-0.444,P=0.657）and week 12（Z=-0.316,P=0.752）of treatment.3.Ankle mobility results:valgus angle:there was a statistical difference between the two groups before and after treatment（P<0.001）;between the groups,there was no statistical difference at week 4（Z=-0.012,P=0.990）,and at week 12,there was a statistical difference between the control group 29.43°±1.84°and the treatment group 30.69°±1.66°（Z=-2.723,P=0.006）.Internal rotation angle:statistically different between the two groups before and after treatment（P<0.001）;comparison between groups showed that at week 4（Z=-4.026,P<0.001）,24.14°±1.48°in the control group and 25.63°±1.26°in the treatment group,and at week 12（Z=-5.144,P<0.001）,27.51°±2.2°in the control group and 29.26°±2.2°in the treatment group,29.26°±0.89°in the treatment group,all statistically different.Back extension angle:statistically different between the two groups before and after treatment by generalised estimating equation,interaction effect analysis（P<0.001）;between group comparison,no statistical difference at week 4 of treatment（LS mean0.009,95%CI:-0.03-0.048,P=0.652）and at week 12 of treatment[LS mean-0.848,95%CI:-1.305-（-0.391）],23.7°±3.25°in the control group and 24.2°±3.83°in the treatment group,a statistically significant difference（P<0.001）.Plantarflexion angle:both groups were statistically different when compared within their respective groups（P<0.001）;between-group comparisons,the Mann-Whitney U test showed no statistical difference between the two groups at week 4（Z=-1.590,P=0.112）and week 12（Z=-1.294,P=0.196）of treatment.AOFAS score:by Friedman’s rank sum test showed a statistical difference between the two groups（P<0.001）;between-group comparisons showed no statistical difference at week 4（Z=-1.791,P=0.073）and week 12（Z=-1.161,P=0.246）of treatment.4.Laboratory indicators:PTH levels:by generalized estimating equation,interaction effect analysis,there was a statistical difference between the two groups in the pre-and post-group comparisons（P=0.001）;between groups,there was no statistical difference at week 4 of treatment（LS mean-0.161,95%CI:-1.313-0.991,P=0.785）and at week 12 of treatment（LS mean 3.982,95%CI:2.709-5.256,P<0.001）,statistically different from 46.91±12.73pg/ml in the control group and 43.14±14.29pg/ml in the treatment group.25-Hydroxy vitamin D levels:both groups were statistically different in their respective intra-group comparisons（P<0.001）;between-group comparisons were not statistically different at week 4 of treatment（Z=-0.535,P=0.593）and week 12 of treatment（Z=-0.752,P=0.452）.PHOS^-levels:both groups were statistically different in their respective intra-group comparisons（P<0.001）;between-group comparisons were statistically different at week 4of treatment（P=0.027）and not at week 12 of treatment（P=0.080）.Ca²⁺levels:both groups were statistically different in their respective intra-group comparisons（P<0.001）;between-group comparisons by Mann-Whitney U-test showed that neither week 4 nor week 12 of treatment were The Mann-Whitney U test showed that there was no statistical difference between groups at week 4 and week 12 of treatment.ALP levels:statistically different between the two groups by Friedman’s test（P<0.001）;not statistically different between the groups by Mann-Whitney U test at week 4 and week 12 of treatment.5.VAS scores:both groups were statistically different within their respective groups by Friedman’s test（P<0.001）;comparison between groups by Mann-Whitney U test showed no statistical difference at week 4 of treatment（Z=-0.844,P=0.399）and week 12 of treatment（Z=-0.652,P=0.286）.6.Improvement in TCM symptoms:TCM symptoms score:by generalized estimating equation and interaction effect analysis,both groups were statistically different in their respective intra-group comparisons（P<0.001）;between-group comparisons,there was no statistical difference at week 4 of treatment（LS mean-0.12,95%CI:-0.152-0.127,P=0.864）and week 12 of treatment（LS mean 0.845,95%CI:0.18-1.51,P=0.013）,statistically different from 18.1±3.90 in the control group and 16.7±2.94 in the treatment group.The improvement of the Chinese medical symptoms:3 in the treatment group were significantly effective,31 effective and 1 invalid;1 in the control group was significantly effective,32 effective and 2 invalid.Both groups had efficacy and the efficacy of the treatment group was significantly better than that of the control group.CONCLUSION:1.In terms of serum biochemical indicators such as Ca²⁺,PHOS^-,ALP,PTH and 25-Hydroxy vitamin D,the longitudinal comparison shows that all the indicators in both groups have improved to a certain extent after treatment,especially the serum Ca²⁺level,which has the most obvious change;the horizontal comparison shows that the improvement of osteoporosis in the treatment group is more significant.2.In terms of ankle joint mobility and AOFAS score,the trend of the change in the line reflects that the ankle joint mobility has improved in both groups and the ankle joint function is gradually recovering;the comparison of the magnitude of the change in the line shows the difference in the efficacy of the two methods,especially at the 6th week of treatment,the change in the treatment group is more obvious and the data are close to the normal range.3.In terms of the improvement of bone density,VAS score and Chinese medicine symptoms in the middle axis,the longitudinal comparison showed that the bone density level of patients in both groups was much higher than before treatment,and the VAS score and Chinese medicine symptoms were much lower than before treatment,indicating that the osteoporosis,pain and Chinese medicine symptoms of patients in both groups had improved to a certain extent;meanwhile,the horizontal comparison showed that the efficacy of the treatment group was better than that of the control group The treatment group was more effective than the control group.4.The Gu Yuan Tang has significant efficacy on osteoporosis secondary to plate internal fixation of ankle fracture,and has obvious effect on the improvement of osteoporosis,and also has positive significance on the healing of the fracture site.