| Objective:The research aimed to observe and compare the clinical efficacy of chinese herbs combined with platelet-rich plasma and separate application for the treatment of femoral neck fracture after internal fixation,so as to provide evidence for clinical treatment femoral neck fracture after operation.Methods:During the period from Jan.2015 to Dec.2016,114 patients of femoral neck fracture treated in our hospital were chosen and randomly divided into three groups,38cases in each group.The diagnosis and inclusion criteria of femoral neck fracture were all conformed.All patients were treated with closed reduction and hollow screw internal fixation.According to the exclusion criteria of cases,100 cases were finally included in the observation of clinical efficacy,among which group A was treated with chinese herbs orally for 8 weeks with 6g each time and one time per night after operation,group B was treated with PRP injection of fractured end during the operation,two weeks and three weeks after the operation,and group C was given chinese herbs combined with PRP treatment,who were administered chinese herbs orally for 8 weeks with 6g each time and one time per night after operation,and while PRP injection of fractured end during the operation,two weeks and three weeks after the operation.The Harris hip function score,clinical healing time of fracture,bone mineral density(g/cm~2),the fracture nonunion rate and the rate of femoral head necrosis were recorded after regular follow-up such as regular hip X-ray or CT,MRI,bone density testing and physical examination,so as to compare the efficacy of the three groups.Results:1.Three different treatments had different effects on the hip function of patients at different time after operation.(1)From 3 months to 9 months after operation,the hip joint function score of the chinese herbs combined with PRP group was better than that of the PRP group,and the PRP group was better than that of the Chinese herbs group,the difference was statistically significant(P<0.05).(2)12 months and 18 months after operation,the hip joint function score of the chinese herbs combined with PRP group was superior to that of the other two groups(P<0.05),but there was no significant difference between them(P>0.05).(3)The excellent rate of hip joint function were 58.82%,63.64%and 87.88%18 months after the operation respectively.The excellent rate of the Chinese herbs combined with PRP group was significantly higher than that of the other two groups(P<0.05),but there was no significant difference between them(P>0.05).2.The median time of fracture healing of the three groups were 19(6)weeks,17(3.5)weeks and 13(3)weeks respectively.The median time of fracture healing in the chinese herbs combined with PRP group was significantly shorter than that in the other two groups(P<0.05),but there was no significant difference between them(P>0.05).The treatment with Chinese herbs combined with PRP could shorten the time of fracture healing and the time of healing was relatively concentrated.3.The results of bone density detection showed that:(1)9 months after operation,the difference of BMD(g/cm~2)was not the same among the three groups.The BMD of the chinese herbs combined with PRP group was significantly higher than that of the other two groups(P<0.05).There was no significant difference between them(P>0.05).(2)The T scores of the three groups were in the range of-2.5SD and-1.0SD after 9months of operation,and the bone mass decreased according to the diagnostic criteria of bone density;but the difference of T scores among the three groups was not the same after 9 months of operation(P<0.05).The T value of the chinese herbs combined with PRP group was significantly higher than that of the other two groups(P<0.05).There was no significant difference between them(P>0.05).4.The comparison of the incidence of postoperative complications:The incidence of fracture nonunion:(1)The incidence of fracture nonunion were 88.24%,78.79%and 66.67%respectively 3months after operation.The difference among the three groups was not significant(P>0.05);(2)The incidence of fracture nonunion were 41.18%,30.30%and 6.06%respectively 6months after operation,and they were 26.47%,21.21%and 3.03%respectively 9 months after operation.6 months and 9 months after operation,the difference among the three groups were not the same(P<0.05).The nonunion rate of the chinese herbs combined with PRP group was lower than that of the other two groups(P<0.05),but there was no significant difference between them(P>0.05).The incidence of femoral head necrosis:(1)The incidence of femoral head necrosis were 11.76%,9.09%and 0 respectively 9months after operation.There was no significant difference among the three groups(P>0.05).(2)12 months after operation,they were 26.47%,21.21%and 3.03%respectively,and 18months after operation were 29.41%,27.27%,and 6.06%respectively.12 months and 18months after operation,the differences among the three groups were not the same(P<0.05).The necrosis rate of the chinese herbs combined with PRP group was lower than that of the other two groups(P<0.05).There was no significant difference between them(P>0.05).Conclusion:The curative effect of chinese herbs combined with PRP for the treatment of femoral neck fractures after internal fixation is better than that of separate application,as it can significantly improve the hip joint function and the long-term curative effect is stable,shorten the healing time of fracture,decrease the loss of bone mass after surgery,reduce the fracture nonunion rate and long-term femoral head necrosis rate,which can obviously improve the quality of life of patients. |
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