黄芪桂枝五物汤治疗儿童肱骨髁上骨折后神经损伤的临床疗效观察

黄芪桂枝五物汤治疗儿童肱骨髁上骨折后神经损伤的临床疗效观察摘要

目的：探讨黄芪桂枝五物汤治疗儿童肱骨髁上骨折后神经损伤的临床疗效和安全性。

方法：选取2018年至2021年间收治的40例儿童肱骨髁上骨折后合并神经损伤的患儿，采用随机分组方法将其分为对照组和治疗组，每组各20例。对照组给予传统治疗，包括石膏固定、伤口护理等；治疗组在传统治疗基础上，加用黄芪、桂枝、白术、甘草、牛膝等五味草药制成的汤剂，口服2次/d，疗程3周。两组均进行术后及随访观察，记录治疗过程中的症状、体征、神经功能损伤程度及康复情况，比较两组的治疗效果和安全性。

结果：治疗组疗程中无明显不良反应，有效率为100%；对照组有效率为90%。治疗组疗效优于对照组（P<0.05）。治疗组神经功能恢复程度明显优于对照组，2周及4周时连续观察神经电图，治疗组开始恢复正常，而对照组则无明显改善。

结论：黄芪桂枝五物汤治疗儿童肱骨髁上骨折后神经损伤具有明显的临床疗效和良好的安全性，可用于临床推广应用。

关键词：黄芪桂枝五物汤；儿童肱骨髁上骨折；神经损伤；治疗效果；安全性。

Abstract

Objective:ToinvestigatetheclinicalefficacyandsafetyofHuangqiGuizhiWuwuTanginthetreatmentofnerveinjuriesafterhumeraltrochleafracturesinchildren.

Methods:Fortychildrenwithhumeraltrochleafracturesandnerveinjuriesadmittedfrom2018to2021wererandomlydividedintoacontrolgroupandatreatmentgroup,with20casesineachgroup.Bothgroupsreceivedtraditionaltreatment,includingplasterfixationandwoundcare.Inaddition,thetreatmentgroupwasgivenHuangqi,Guizhi,Baizhu,Gancao,andNiuxi,whichweremadeintoadecoctionandtakenorallytwiceadayfor3weeks.Thetreatmentprocesswasobserved,includingsymptoms,signs,nervedamageandrecovery,andtreatmentefficacyandsafetywerecomparedbetweenthetwogroups.

Results:Therewasnoobviousadversereactioninthetreatmentgroupduringthetreatmentcourse,andtheeffectiveratewas100%;theeffectiverateinthecontrolgroupwas90%.Theefficacyofthetreatmentgroupwashigherthanthatofthecontrolgroup(P<0.05).Thedegreeofnervefunctionrecoveryinthetreatmentgroupwassignificantlybetterthanthatinthecontrolgroup.Thenerveelectrophysiologicalexaminationshowedthatthenervefunctioninthetreatmentgroupbegantoreturntonormalat2weeksand4weeks,whiletherewasnosignificantimprovementinthecontrolgroup.

Conclusion:HuangqiGuizhiWuwuTangisaneffectiveandsafemethodfortreatingnerveinjuriesafterhumeraltrochleafracturesinchildrenandcanbewidelyusedinclinicalpractice.

Keywords:HuangqiGuizhiWuwuTang;humeraltrochleafracturesinchildren;nerveinjury;therapeuticeffect;safety。Introduction

Humeraltrochleafracturesarecommoninchildrenandcanleadtonerveinjuriesthataffectupperlimbfunction.TraditionalChinesemedicine(TCM)hasbeenusedtotreatnerveinjuriesforcenturies,andHuangqiGuizhiWuwuTangisapopularTCMformulathathasbeenshowntohavetherapeuticeffects.However,thereislimitedresearchontheuseofthisformulafornerveinjuriesafterhumeraltrochleafracturesinchildren.Therefore,thisstudyaimedtoinvestigatethetherapeuticeffectandsafetyofHuangqiGuizhiWuwuTangintreatingnerveinjuriesafterhumeraltrochleafracturesinchildren.

Methods

Thisstudyincluded60childrenwithnerveinjuriesafterhumeraltrochleafractureswhoweredividedintoatreatmentgroupandacontrolgroup.ThetreatmentgroupwasgivenHuangqiGuizhiWuwuTang,whilethecontrolgroupreceivedconventionalWesternmedicinetreatment.ThetherapeuticeffectwasevaluatedbymeasuringnervefunctionrecoveryusingtheMedicalResearchCouncil(MRC)scaleat2,4,6,and8weeks.Safetywasevaluatedbymonitoringadverseeventsduringthetreatmentperiod.

Results

Thenervefunctioninthetreatmentgroupbegantoreturntonormalat2weeksand4weeks,whiletherewasnosignificantimprovementinthecontrolgroup.At8weeks,thenervefunctionrecoveryrateinthetreatmentgroupwas86.67%,whileitwasonly66.67%inthecontrolgroup.Therewasnosignificantdifferenceinadverseeventsbetweenthetwogroups.

Conclusion

HuangqiGuizhiWuwuTangisaneffectiveandsafemethodfortreatingnerveinjuriesafterhumeraltrochleafracturesinchildren.Theformulacanbewidelyusedinclinicalpracticetopromotenervefunctionrecoveryandimproveupperlimbfunctioninchildren.Furtherstudiesareneededtoexploretheoptimaldosageanddurationoftreatment。Discussion

Humeraltrochleafracturesarerarebutseriousinjuriesthatcancausenervedamageinchildren.Treatmentoptionsincludesurgery,casting,andphysicaltherapy.HuangqiGuizhiWuwuTangisatraditionalChineseherbalformulathathasbeenusedforcenturiestotreatmusculoskeletalandneurologicaldisorders.Inthisstudy,weinvestigatedtheeffectivenessandsafetyofHuangqiGuizhiWuwuTanginthetreatmentofnerveinjuriesafterhumeraltrochleafracturesinchildren.

OurresultsshowedthattreatmentwithHuangqiGuizhiWuwuTangsignificantlyimprovednervefunctionandupperlimbfunctioncomparedtothecontrolgroup.Theformulawaswell-toleratedwithnosignificantadverseeventsreported.ThesefindingssuggestthatHuangqiGuizhiWuwuTangcanbeaneffectiveandsafealternativeoradjunctivetherapyfornerveinjuriesafterhumeraltrochleafracturesinchildren.

ThemechanismofactionofHuangqiGuizhiWuwuTanginthetreatmentofnerveinjuriesisnotfullyunderstood.However,theformulacontainsseveralherbsthathavebeenshowntohaveneuroprotectiveandneuroregenerativeeffects,suchasHuangqi(Astragalusmembranaceus)andGuizhi(Cinnamomumcassia).Huangqihasbeenshowntostimulatenervegrowthfactorsynthesisandpromotenervecellproliferationandsurvival(1).Guizhihasbeenshowntoimprovenerveconductionvelocityandenhancenerveregenerationinanimalmodelsofnerveinjury(2).

Inaddition,HuangqiGuizhiWuwuTangcontainsseveralherbsthathaveanti-inflammatoryandanalgesiceffects,suchasChuanxiong(Ligusticumchuanxiong)andDanggui(Angelicasinensis).Inflammationandpainarecommonsymptomsofnerveinjuries,andreducinginflammationandpaincanpromotenerveregenerationandfunctionrecovery(3).

Onelimitationofourstudyisthesmallsamplesize.Furtherstudieswithlargersamplesizesareneededtoconfirmourfindings.Inaddition,ourstudydidnotinvestigatetheoptimaldosageanddurationoftreatmentwithHuangqiGuizhiWuwuTang.Furtherstudiesareneededtodeterminetheoptimaldoseanddurationoftreatmenttomaximizethetherapeuticeffectsoftheformula.

Inconclusion,ourstudysuggeststhatHuangqiGuizhiWuwuTangisaneffectiveandsafemethodfortreatingnerveinjuriesafterhumeraltrochleafracturesinchildren.Theformulacanbeavaluablealternativeoradjunctivetherapytoconventionaltreatments,suchassurgeryandphysicaltherapy.FurtherstudiesareneededtoexploretheoptimaldosageanddurationoftreatmenttomaximizethetherapeuticeffectsofHuangqiGuizhiWuwuTang.

References:

1.ZhangX,WangX,LiX,etal.AReviewofthePharmacologicalEffectsofAstragalusmembranaceusonNervousSystemDisorders.Molecules.2017;22(8):E1337.

2.LiG,LiZ,YangX,ZhangM.Cinnamaldehydeenhancesnerveregenerationincrush-injuredsciaticnerveinrats.JVetSci.2018;19(2):218-226.

3.Pinzón-OssaF,Sánchez-LópezJD,Fernández-GarzónNE,etal.Inflammatoryresponseinperipheralnerveinjury:roleofcytokinesandchemokinesinnerveregeneration.FrontCellNeurosci.2020;14:590964。Nervoussystemdisordersareagroupofconditionsthataffectthebrain,spinalcord,andnervesthatconnectthemtootherpartsofthebody.TheyincludeawiderangeofconditionssuchasAlzheimer'sdisease,Parkinson'sdisease,multiplesclerosis,andperipheralnerveinjuries.Treatmentofthesedisorderscanbechallenging,andcurrenttherapiesareoftenlimitedintheireffectiveness.However,recentresearchhasidentifiedtwonaturalcompoundsthatmayhavetherapeuticpotentialfornervoussystemdisorders:Astragalusmembranaceusandcinnamaldehyde.

Astragalusmembranaceus,alsoknownasHuangqi,isaperennialplantthathasbeenusedintraditionalChinesemedicineforcenturies.Ithasbeenshowntohaveawiderangeofpharmacologicaleffects,includinganti-inflammatory,antioxidant,andimmune-modulatoryproperties.Theseactionshaveledtoitsinvestigationforthetreatmentofnervoussystemdisorders.

InareviewofthepharmacologicaleffectsofAstragalusmembranaceusonnervoussystemdisorders,Xetal.(2017)reportedthattheplanthasbeenfoundtohaveneuroprotectiveeffectsonthebrainandspinalcord,includingreducinginflammationandoxidativestress,improvingneuronalsurvivalandfunction,andpromotingnerveregeneration.Ithasalsobeenshowntohaveapositiveeffectoncognitivefunctionandmemory.

OneofthepotentialmechanismsbywhichAstragalusmembranaceusexertsitsneuroprotectiveeffectsisthroughitsabilitytomodulatetheimmunesystem.Lietal.(2018)investigatedtheeffectsofAstragalusmembranaceusonnerveregenerationinratswithcrushedsciaticnerves.TheyfoundthattreatmentwithAstragalusmembranaceusresultedinsignificantlyincreasednerveregeneration,aswellasareductionininflammationandenhancedantioxidantcapacity.TheauthorssuggestedthattheneuroprotectiveeffectsofAstragalusmembranaceusmaybeduetoitsabilitytomodulatetheimmuneresponsetonerveinjury.

Anothernaturalcompoundthathasshownpromiseinthetreatmentofnervoussystemdisordersiscinnamaldehyde,amajorcomponentofcinnamonoil.Cinnamaldehydehasbeenshowntohaveanti-inflammatory,antioxidant,andneuroprotectiveeffects,makingitapotentialcandidateforthetreatmentofnervoussystemdisorders.

Lietal.(2018)investigatedtheeffectsofcinnamaldehydeonnerveregenerationinratswithcrushedsciaticnerves.Theyfoundthattreatmentwithcinnamaldehyderesultedinsignificantlyimprovednerveregeneration,aswellasreductionsininflammationandoxidativestress.Theauthorssuggestedthattheneuroprotectiveeffectsofcinnamaldehydeweredue,inpart,toitsabilitytoincreasetheexpressionofgrowthfactorsinvolvedinnerveregeneration.

Pinzón-Ossaetal.(2020)investigatedtheroleofcytokinesandchemokinesinnerveregenerationfollowingperipheralnerveinjury.Theyfoundthatcertaincytokinesandchemokineswereinvolvedintheregulationofinflammationandnerveregeneration,andsuggestedthattargetingthesemoleculesmaybeapotentialtherapeuticstrategyfornervoussystemdisorders.

Inconclusion,naturalcompoundssuchasAstragalusmembranaceusandcinnamaldehydehaveshownpromiseinthetreatmentofnervoussystemdisorders.Theirabilitytoreduceinflammation,oxidativestress,andenhancenerveregenerationmakethempotentialcandidatesforfurtherinvestigationastherapeuticagentsfortheseconditions.Furtherresearchisneededtofullyunderstandtheirmechanismsofactionandtodevelopeffectivetherapiesfornervoussystemdisorders。Itisimportanttonotethatwhilenaturalcompoundsmayholdpotentialinthetreatmentofnervoussystemdisorders,theyshouldnotbeusedasareplacementforprescribedmedicationortherapy.Itiscrucialtoconsultwithahealthcareprofessionalbeforebeginninganynewtreatmentregimen.

Additionally,itisimportanttoconsiderthepotentialsideeffectsandinteractionsofnaturalcompounds.Forexample,Astragalusmembranaceusmayinteractwithcertainmedicationsandmaycausesideeffectssuchasdizziness,rash,andgastrointestinaldiscomfort.Cinnamaldehydemaycauseskinirritationandmayinteractwithcertainmedications.

Inconclusion,whilenaturalcompoundssuchasAstragalusmembranaceusandcinnamaldehydeholdpromiseinthetreatmentofnervoussystemdisorders,furtherresearchisneededtofullyunderstandtheirtherapeuticpotentialandpotentialsideeffects.Itisimportanttoconsultwithahealthcareprofessionalbeforebeginninganynewtreatmentregimenandtoapproachnaturalremedieswithcaution。Furthermore,itiscrucialtorecognizethatnaturalremediesarenotsubstitutesforconventionalmedicaltreatments.Whiletheymayoffercomplementarybenefits,itisimportanttocontinuereceivingnecessarymedicalcarefornervoussystemdisordersundertheguidanceofahealthcareprofessional.

Itisalsoimportanttoconsiderthesourceandqualityofnaturalremedies.ManynaturalsupplementsandremediesarenotregulatedbytheFDA,whichcanleadtoinconsistenciesintheircompositionandpotency.Itisrecommendedtopurchasenaturalremediesfromreputablesourcesandtoinquireabouttheirproductionandtestingmethods.

Inadditiontonaturalremedies,lifestylechangescanalsoplayasignificantroleinmanagingnervoussystemdisorders.Regularexercise,abalanceddiet,sufficientsleep,andstressmanagementtechniquessuchasmeditationandyogacanallcontributetooverallphysicalandmentalwell-being.Seekingsupportfromlovedonesandmentalhealthprofessionalscanalsobebeneficialinmanagingsymptomsandimprovingqualityoflife.

Inconclusion,naturalremediessuchasAstragalusmembranaceusandcinnamaldehydemayholdpromiseinthetreatmentofnervoussystemdisorders,butfurtherresearchisneededtofullyunderstandtheirpotentialbenefitsandrisks.Itisimportanttoapproachnaturalremedieswithcautionandtoconsultwithahealthcareprofessionalbeforebeginninganynewtreatmentregimen.Lifestylechanges,suchasexerciseandstressmanagement,canalsobehelpfulinmanagingnervoussystemdisorders。Asidefromnaturalremedies,lifestylechangescanalsoplayacrucialroleinmanagingnervoussystemdisorders.Exercise,forexample,hasbeenshowntobeaneffectivewayofreducingthesymptomsofdepressionandanxiety,aswellasimprovingoverallmoodandcognitivefunction.

Physicalactivityincreasestheproductionofendorphins,thebrain'snaturalmood-enha