【目的】探讨补肝益肾强骨方在老年不稳定性股骨粗隆间骨折肝肾亏虚型患者治疗中的应用价值。 【方法】将138例老年 不稳定性股骨粗隆间骨折肝肾亏虚型患者随机分为观察组和对照组，每组各69例。对照组给予西医常规治疗，观察组在对 照组的基础上联合补肝益肾强骨方治疗，疗程为12周。观察2组患者治疗前后Harris评分、中医证候总积分以及血清白细胞 介素6 （IL-6） 、D-二聚体 （D-D） 、前列腺素E2 （PGE2） 、血管内皮生长因子 （VEGF） 、转化生长因子β1 （TGF-β1） 、护骨素 （OPG） 、Ⅰ型胶原氨基端延长肽 （tPINP） 、骨形态发生蛋白2 （BMP-2） 水平的变化情况，比较2组患者的临床疗效及术后开始 负重时间、骨折愈合时间情况。 【结果】（1） 治疗12周后，观察组的总有效率为94.20% （65/69） ，对照组为82.61% （57/69） ，组 间比较，观察组的疗效明显优于对照组 （χ2 = 9.173，P＜0.05） 。 （2） 治疗后，2组患者的Harris评分均较治疗前升高 （P＜0.05） ， 中医证候总积分均较治疗前降低 （P＜0.05） ，且观察组对Harris评分的升高幅度及对中医证候总积分的降低幅度均明显优于 对照组 （P＜0.05） 。 （3） 观察组的骨折愈合时间和术后开始负重时间均较对照组明显缩短，组间比较，差异均有统计学意义 （P＜0.05） 。 （4） 治疗后，2组患者血清IL-6、D-D、PGE2水平均较治疗前降低 （P＜0.05） ，血清VEGF、TGF-β1水平均较治疗 前升高 （P＜0.05） ，且观察组对血清IL-6、D-D、PGE2水平的降低幅度及对血清VEGF、TGF-β1水平的升高幅度均明显优于 对照组 （P＜0.05） 。 （5） 治疗后，2组患者的血清BMP-2、OPG、tPINP水平均较治疗前升高 （P＜0.05） ，且观察组对血清BMP-2、 OPG、tPINP水平的升高幅度均明显优于对照组 （P＜0.05） 。 【结论】对于老年不稳定性股骨粗隆间骨折肝肾亏虚型患者而言， 联合补肝益肾强骨方治疗有助于减轻炎症反应，调控骨代谢，促进髋关节功能改善，进而提高临床疗效。

Abstract：Objective To evaluate the clinical value of Bugan Yishen Qianggu Formula for the treatment of elderly patients with unstable intertrochanteric femur fractures of liver and kidney deficiency type. Methods A total of 138 elderly patients with unstable femoral intertrochanteric fracture of liver and kidney deficiency type were randomly divided into observation group and control group，with 69 cases in each group. The control group was treated with routine western medicine，and the observation group was treated with Bugan Yishen Qianggu Formula on the basis of treatment for the control group. The course of treatment for the two groups lasted for 12 weeks. Before and after treatment，the two groups were observed in the changes of Harris score，overall score of traditional Chinese medicine （TCM） symptoms，and serum levels of interleukin 6 （IL-6） ，D-dimer （D-D） ，prostaglandin E2 （PGE2） ，vascular endothelial growth factor （VEGF） ，transforming growth factor β1 （TGF-β1） ，osteoprotegerin （OPG） ，total procollagen type 1 intact N-terminal propeptide （tPINP） and bone morphogenetic protein 2 （BMP-2） . The clinical efficacy，postoperative weight-bearing time and fracture healing time were compared between the two groups. Results （1）After 12 weeks of treatment，the total effective rate of the observation group was 94.20% （65/69） and that of the control group was 82.61% （57/69） . The intergroup comparison showed that the efficacy of the observation group was significantly superior to that of the control group （χ2 = 9.173，P＜0.05） . （2） After treatment，the Harris scores in the two groups were increased （P＜0.05） and the total scores of TCM symptoms were decreased compared with those before treatment （P＜0.05），and the increase of the Harris scores and the decrease of the total scores of TCM symptoms in the observation group were superior to those in the control group （P＜0.05） . （3） The fracture healing time and postoperative weight-bearing time of the observation group were significantly shorter than those of the control group，and the differences between the two groups were statistically significant （P＜0.05） . （4） After treatment，the levels of serum IL-6，D-D and PGE2 in the two groups were lower （P＜0.05） and the levels of serum VEGF and TGF-β1 were higher than those before treatment （P＜0.05） . The decrease of serum IL-6，D-D and PGE2 levels and the increase of serum VEGF and TGF- β1 levels in the observation group were significantly superior to those in the control group （P＜0.05） . （5） After treatment，the levels of serum BMP-2，OPG and tPINP in the two groups were higher than those before treatment （P＜0.05）， and the increase of serum BMP-2，OPG and tPINP levels in the observation group was significantly superior to that in the control group（P＜0.05） . Conclusion For the treatment of elderly patients with unstable intertrochanteric femur fractures of liver and kidney deficiency type，the combined use of Bugan Yishen Qianggu Formula is beneficial to relieve the inflammatory response，regulate bone metabolism，and promote the improvement of hip joint function，thus to enhance the clinical efficacy.

R274.12

江西省中医药管理局科技计划项目 （编号：20223839）