中药内服外敷联合解剖钢板固定治疗膝关节周围骨折的临床观察
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摘要
目的:探讨中药内服外敷联合解剖钢板固定治疗膝关节周围骨折的临床效果。方法:选择2015年7月—2017年5月在医院进行治疗的膝关节周围骨折患者64例,采用随机数字的方法将患者分为两组,对照组和观察组,每组32例患者,对照组患者使用解剖钢板固定手术联合康复训练的方法治疗,观察组患者在对照组患者治疗方法的基础上加用中药内服外敷联合治疗,对治疗的效果进行对比。结果:经过治疗后,两组患者的各项主要证候积分,关节伸直缺失程度评分,膝关节稳定度评分,白细胞介素-6,肿瘤坏死因子-α,碱性磷酸酶和骨钙素水平均出现降低,膝关节活动度评分出现上升,观察组患者的变化幅度均大于对照组患者,数据差异均具有统计学意义(t=9.357,11.806,12.338,15.104,2.330,-4.284,4.654,7.223,9.112,8.685,3.912,P<0.05),对照组患者中,治疗效果为显效的10例,有效的14例,无效的8例,观察组患者中,治疗效果为显效的17例,有效的13例,无效的2例,观察组患者的治疗效果优于对照组患者,治疗总有效率高于对照组,数据差异具有统计学意义(z=-3.651,χ~2=4.267,P<0.05)。结论:使用中药内服外敷联合解剖钢板固定治疗膝关节周围骨折患者,可以加快患者的恢复速度,降低症状反应,提升治疗效果,值得在临床范围内推广。
Objective:To investigate the clinical effect of internal and external application of Chinese medicine combined with anatomical plate fixation in the treatment of fractures around the knee joint. Methods:Sixty-four patients with knee joint fractures treated in our hospital from July 2015 to May 2017 were selected. The patients were randomly divided into the control group and the observation group, with 32 patients in each group. The patients in the control group were treated with the method of anatomical plate fixation and rehabilitation training. The patients in the observation group were combined with the combination of traditional Chinese medicine and external application on the basis of the treatment method of the control group, and the effect of the treatment was compared. Result:After treatment, the main syndrome scores of the two groups, the degree of joint extension loss, the stability of the knee joint, the level of interleukin-6, tumor necrosis factor-α, alkaline phosphatase and osteocalcin were all decreased. The knee joint activity score increased and the changes of the patients in the observation group were all greater than those of the control. The data was statistically significant(t=9.357, 11.806, 12.338, 15.104, 2.330,-4.284, 4.654, 7.223, 9.112, 8.685, 3.912, P<0.05) in the observation group. In the control group, 10 patients were effective, 14 were effective, and 8 were invalid. Among the patients in the observation group, the curative effect was 17, 13 effective and 2 ineffective. The curative effect of the observation group was better than that of the control group. The total effective rate of the treatment was higher than that of the control group. The difference of the data was statistically significant(z=-3.651, χ~2=4.267, P<0.05). Conclusion:The use of traditional Chinese medicine and external application combined with anatomical plate fixation for the treatment of the patients with periarticular fractures of the knee can accelerate the recovery of the patients, reduce the response to the symptoms and improve the therapeutic effect. It is worth promoting in the clinical scope.
Objective:To investigate the clinical effect of internal and external application of Chinese medicine combined with anatomical plate fixation in the treatment of fractures around the knee joint. Methods:Sixty-four patients with knee joint fractures treated in our hospital from July 2015 to May 2017 were selected. The patients were randomly divided into the control group and the observation group, with 32 patients in each group. The patients in the control group were treated with the method of anatomical plate fixation and rehabilitation training. The patients in the observation group were combined with the combination of traditional Chinese medicine and external application on the basis of the treatment method of the control group, and the effect of the treatment was compared. Result:After treatment, the main syndrome scores of the two groups, the degree of joint extension loss, the stability of the knee joint, the level of interleukin-6, tumor necrosis factor-α, alkaline phosphatase and osteocalcin were all decreased. The knee joint activity score increased and the changes of the patients in the observation group were all greater than those of the control. The data was statistically significant(t=9.357, 11.806, 12.338, 15.104, 2.330,-4.284, 4.654, 7.223, 9.112, 8.685, 3.912, P<0.05) in the observation group. In the control group, 10 patients were effective, 14 were effective, and 8 were invalid. Among the patients in the observation group, the curative effect was 17, 13 effective and 2 ineffective. The curative effect of the observation group was better than that of the control group. The total effective rate of the treatment was higher than that of the control group. The difference of the data was statistically significant(z=-3.651, χ~2=4.267, P<0.05). Conclusion:The use of traditional Chinese medicine and external application combined with anatomical plate fixation for the treatment of the patients with periarticular fractures of the knee can accelerate the recovery of the patients, reduce the response to the symptoms and improve the therapeutic effect. It is worth promoting in the clinical scope.
引文
[1] 刘松,陈伟,朱燕宾,等.2003年至2012年河北医科大学第三医院成人腕骨骨折的流行病学调查与分析[J].中华创伤骨科杂志,2017,19(11):973-977.
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[5] 赵先彬,陈妍,李国华,等.早期功能介入对膝关节周围骨折术后关节僵硬患者康复影响[J].陕西医学杂志,2017,46(4):494-495.
[6] 惠艳萍.膝关节周围骨折术后的康复护理方法及效果[J].世界临床医学,2017,11(6):167.
[7] 张岩.膝关节周围骨折患者施行早期康复护理的效果观察[J].中国医药指南,2017,15(2):255-256.
[8] 熊盛杰.膝关节周围骨折术后现代康复治疗的临床分析[J].临床医药文献电子杂志,2016,3(35):6933-6934.
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[10] 马炬雷,徐云钦,李强,等.复杂胫骨平台伴后髁骨折的手术治疗[J].中国骨与关节损伤杂志,2017,32(10):1081-1083.
[11] 罗春海.MSCT 图像后处理技术在膝关节创伤中的临床应用[J].实用放射学杂志,2015(10):1701-1703,1711.
[12] 丁铃,陈郁,顾龙殿,等.激光治疗联合康复训练促进胫骨平台骨折术后关节功能恢复的效果观察[J].中国骨与关节损伤杂志,2018,33(2):176-177.
[13] 霍永峰,殷照阳,徐刚,等.胫骨外髁非负重区截骨治疗胫骨平台后外侧髁骨折[J].重庆医学,2018,47(7):919-922,925.
[14] 姚正强.骨折后膝关节粘连性僵硬采用中西医结合治疗的效果观察[J].医药前沿,2018,8(6):105.
[15] 吴慧敏,唐华,熊志,等.全膝关节置换术治疗老年重度膝关节炎伴胫骨平台骨折[J].临床骨科杂志,2018,21(1):62-63.
[16] Kuhle J,Angele P,Balcarek P,et al.Treatment of osteochondral fractures of the knee: A meta-analysis of available scientific evidence[J].Int Orthop,2013,37( 12) : 2385-2394.
[17] 张丽红,孟立芳. 膝关节周围骨折术后综合康复训练的临床效果[J]. 现代中西医结合杂志,2015,24(27): 3054-3056.
[18] 陈小珍,王人彦.解剖钢板内固定治疗股骨髁间骨折[J].中医正骨,2007,19(12):59.
[19] 潘秀琴,张松勤.持续性被动运动锻炼联合自我效能干预对膝关节周围骨折患者术后康复效果及生活质量的影响[J].临床心身疾病杂志,2018,24(3):92-95.
[20] 蔡丽萍,何建飞,傅红飞,等.中药熏洗配合康复训练对胫骨平台骨折术后功能恢复的影响[J].中国中医药科技,2018,25(1):107-109.
[21] 刘经端,古恩鹏.中医阴阳动态平衡理论在骨折治疗中的探索[J].医学与哲学,2016,37(2):76-78.
[22] 叶长青,汪涛,张海林,等.损伤控制理论和四柱分型理论在高能量胫骨平台骨折治疗中的应用[J].中医正骨,2018,30(1):59-61,66.
[23] 王常海,李峰.针刀“动态平衡”理论在膝骨性关节炎中的探讨[J].中华中医药学刊,2007,25(1):73-75.
[2] 李东超.微创内固定系统对车祸导致膝关节周围骨折患者膝功能的治疗效果[J].山西医药杂志,2017,46(23):2902-2905.
[3] 谌少波,杨保良,双峰,等.微创内固定系统治疗膝关节周围骨折失误分析[J].浙江临床医学,2017,19(8):1451-1452.
[4] 陈长生,赵占稳.膝关节周围骨折合并血管神经损伤的保肢治疗效果观察[J].中国实用医药,2017,12(19):91-92.
[5] 赵先彬,陈妍,李国华,等.早期功能介入对膝关节周围骨折术后关节僵硬患者康复影响[J].陕西医学杂志,2017,46(4):494-495.
[6] 惠艳萍.膝关节周围骨折术后的康复护理方法及效果[J].世界临床医学,2017,11(6):167.
[7] 张岩.膝关节周围骨折患者施行早期康复护理的效果观察[J].中国医药指南,2017,15(2):255-256.
[8] 熊盛杰.膝关节周围骨折术后现代康复治疗的临床分析[J].临床医药文献电子杂志,2016,3(35):6933-6934.
[9] 中华人民共和国卫生部.中药新药临床研究指导原则第一辑[S].北京,1997:251-254.
[10] 马炬雷,徐云钦,李强,等.复杂胫骨平台伴后髁骨折的手术治疗[J].中国骨与关节损伤杂志,2017,32(10):1081-1083.
[11] 罗春海.MSCT 图像后处理技术在膝关节创伤中的临床应用[J].实用放射学杂志,2015(10):1701-1703,1711.
[12] 丁铃,陈郁,顾龙殿,等.激光治疗联合康复训练促进胫骨平台骨折术后关节功能恢复的效果观察[J].中国骨与关节损伤杂志,2018,33(2):176-177.
[13] 霍永峰,殷照阳,徐刚,等.胫骨外髁非负重区截骨治疗胫骨平台后外侧髁骨折[J].重庆医学,2018,47(7):919-922,925.
[14] 姚正强.骨折后膝关节粘连性僵硬采用中西医结合治疗的效果观察[J].医药前沿,2018,8(6):105.
[15] 吴慧敏,唐华,熊志,等.全膝关节置换术治疗老年重度膝关节炎伴胫骨平台骨折[J].临床骨科杂志,2018,21(1):62-63.
[16] Kuhle J,Angele P,Balcarek P,et al.Treatment of osteochondral fractures of the knee: A meta-analysis of available scientific evidence[J].Int Orthop,2013,37( 12) : 2385-2394.
[17] 张丽红,孟立芳. 膝关节周围骨折术后综合康复训练的临床效果[J]. 现代中西医结合杂志,2015,24(27): 3054-3056.
[18] 陈小珍,王人彦.解剖钢板内固定治疗股骨髁间骨折[J].中医正骨,2007,19(12):59.
[19] 潘秀琴,张松勤.持续性被动运动锻炼联合自我效能干预对膝关节周围骨折患者术后康复效果及生活质量的影响[J].临床心身疾病杂志,2018,24(3):92-95.
[20] 蔡丽萍,何建飞,傅红飞,等.中药熏洗配合康复训练对胫骨平台骨折术后功能恢复的影响[J].中国中医药科技,2018,25(1):107-109.
[21] 刘经端,古恩鹏.中医阴阳动态平衡理论在骨折治疗中的探索[J].医学与哲学,2016,37(2):76-78.
[22] 叶长青,汪涛,张海林,等.损伤控制理论和四柱分型理论在高能量胫骨平台骨折治疗中的应用[J].中医正骨,2018,30(1):59-61,66.
[23] 王常海,李峰.针刀“动态平衡”理论在膝骨性关节炎中的探讨[J].中华中医药学刊,2007,25(1):73-75.