中西医结合方案(接骨续损汤联合督灸)对老年股骨骨折延迟愈合患者的干预效果及机制研究OA

Objective:To investigate the effects of Jiegu Xusun decoction combined with Du Jiu(Du moxibustion)on mi-crocirculation,osteoclast remodeling,serum leptin,and Runx2 in elderly patients with delayed union of femoral fractures.Methods:A total of 96 elderly patients with delayed union of femoral fractures,who were admitted from August 2023 to October 2024,were selected and randomly divided into a control group and a study group using a random number table method.Both groups received conventional Western medical intervention.The control group was treated with Du Jiu on this basis,while the study group received Jiegu Xusun decoction on the basis of the treatment of the control group.The treatment course lasted 12 weeks.Before and after the treatment,the laser Doppler perfusion unit(LDFU)was detected by laser Doppler flowmeter,the nailfold capillaries were observed under a microscope to evaluate the nailfold microcircula-tion score,and the serum type Ⅰ collagen carboxyl-terminal peptide(CTX-Ⅰ)was detected by electrochemilumines-cence.Serum tartrate-resistant acid phosphatase(TRAP),leptin and core binding factor 2(Runx2)were determined by enzyme-linked immunosorbent assay(ELISA).X-ray callus score was performed by the Lane-Sandhu method.Harris hip score and Oxford hip score(OHS)were used to evaluate the hip joint recovery of patients.Record adverse reactions and evaluate clinical efficacy.The two groups were followed up for one year to compare the study rates of complications.Results:The clinical treatment of the research group was superior to that of the control group(P＜0.05).The LDFU of the study group increased from(46.73±10.56)PU to(74.68±11.86)PU,while the control group increased from(45.26±8.52)PU to(60.41±10.25)PU.The difference between the groups was statistically significant(P＜0.05).The total nailfold microcirculation score in the study group decreased from(8.11±1.32)points to(3.82±0.80)points,whereas that in the control group decreased from(8.10±1.25)points to(6.31±1.12)points.The difference between the groups was statistically significant(P＜0.05).The serum CTX-Ⅰ of the study group decreased from(1.90±0.33)ng/mL to(0.96±0.24)ng/mL,and TRAP decreased from(15.43±2.44)U/L to(9.73±1.86)U/L;The serum CTX-Ⅰ of the control group decreased from(1.86±0.35)ng/mL to(1.34±0.22)ng/mL,and the TRAP decreased from(15.20±2.38)U/L to(12.35±2.21)U/L;There was a statistically significant difference between the groups(P＜0.05).The serum leptin of the study group decreased from(8.62±1.30)ng/mL to(5.41±1.18)ng/mL,and Runx2 increased from(23.05±5.24)ng/mL to(36.62±5.22)ng/mL;The serum leptin of the control group decreased from(8.46±1.13)ng/mL to(6.83±1.24)ng/mL,and Runx2 increased from(22.75±4.56)ng/mL to(30.54±5.15)ng/mL;There was a statistically significant difference between the groups(P＜0.05).The X-ray callus score of the study group increased from(1.78±0.40)points to(4.52±0.45)points,the Harris score increased from(63.14±7.25)points to(80.36±5.74)points,and the OHS score increased from(22.03±4.20)points to(36.52±5.32)points.The X-ray callus score of the control group increased from(1.75±0.35)points to(2.98±0.42)points,the Harris score in-creased from(62.53±6.83)points to(75.63±5.68)points,and the OHS score increased from(21.56±3.46)points to(29.73±4.26)points.There was a statistically significant difference between the groups(P＜0.05).In the study group,BMD increased from(0.64±0.06)g/cm2 to(0.75±0.09)g/cm2,Tb.Th increased from(0.11±0.03)mm to(0.17±0.04)mm,BV increased from(0.87±0.12)cm3 to(1.57±0.25)cm3,and Tb.Th decreased from(0.38±0.06)mm to(0.27±0.05)mm.In the control group,BMD increased from(0.65±0.04)g/cm2 to(0.71±0.08)g/cm2,Tb.Th increased from(0.12±0.03)mm to(0.14±0.03)mm,BV increased from(0.85±0.10)cm3 to(1.34±0.22)cm3,and Tb.Th decreased from(0.37±0.07)mm to(0.30±0.05)mm.The intergroup differences were statistically significant(P＜0.05).The recurrence rate of complications in the study group was 4.17％,which was lower than that in the control group(16.67％),and the difference was statistically significant(P＜0.05).The improvement in BMD in the study group(0.52±0.18)was greater than that in the control group(0.41±0.12)(t=3.523,P＜0.05),and the SF-36 score(82.36±6.45)was higher than that in the control group(77.56±7.12)(t=3.462,P＜0.05).The incidence of adverse reactions was 8.33％in the control group and 12.50％in the study group.There was no statistically significant difference between the two groups(x2=0.447,P＞0.05).Conclusion:The combination of Jiegu Xusun decoction and Du Jiu has a posi-tive clinical therapeutic effect on elderly patients with delayed union of femoral fractures.Its mechanism is closely associated with inhibition of osteoclast activity,promotion of angiogenesis,and regulation of the leptin/Runx2 signaling pathway.