针刺联合体外冲击波治疗骨不连疗效观察
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摘要
目的观察针刺联合体外冲击波治疗骨不连的临床疗效。方法将60例骨不连患者随机分成A组、B组和C组,每组20例。A组采用切开复位内固定等常规治疗,B组采用体外冲击波治疗,C组采用针刺联合体外冲击波治疗。比较3组临床疗效。结果 A组愈合率为60.0%,B组愈合率为65.0%,C组愈合率为95.0%。C组愈合率与A组和B组比较,差异均有统计学意义(P<0.05);B组愈合率与A组比较差异无统计学意义(P>0.05)。结论针刺联合体外冲击波是治疗骨不连的有效方法,值得临床应用。
Objective To investigate the clinical efficacy of acupuncture plus extracorporeal shock wave in treating nonunion. Method Sixty nonunion patients were randomized to groups A, B and C, with 20 cases in each group.Group A received conventional open reduction and internal fixation; group B, extracorporeal shock wave; group C,acupuncture plus extracorporeal shock wave. The clinical therapeutic effects were compared between the three groups.Result The healing rate was 80.0% in the treatment group and 60.0% in group A, 65.0% in group B and 95.0% in group C. There was a statistically significant difference in the healing rate between group C and group A or B(P<0.05)and no between groups B and A(P>0.05). Conclusion Acupuncture plus extracorporeal shock wave is an effective way to treat nonunion. It is worthy of clinical application.
Objective To investigate the clinical efficacy of acupuncture plus extracorporeal shock wave in treating nonunion. Method Sixty nonunion patients were randomized to groups A, B and C, with 20 cases in each group.Group A received conventional open reduction and internal fixation; group B, extracorporeal shock wave; group C,acupuncture plus extracorporeal shock wave. The clinical therapeutic effects were compared between the three groups.Result The healing rate was 80.0% in the treatment group and 60.0% in group A, 65.0% in group B and 95.0% in group C. There was a statistically significant difference in the healing rate between group C and group A or B(P<0.05)and no between groups B and A(P>0.05). Conclusion Acupuncture plus extracorporeal shock wave is an effective way to treat nonunion. It is worthy of clinical application.
引文
[1]李宏宇,梁斌,李丽春,等.冲击波治疗四肢骨折内固定术后骨不连的临床分析[J].中国临床新医学,2010,3(12):1168-1172.
[2] Ogden JA, Alvarez RG, Levitt R, et al. Shock wave therapy(Orthotripsy)in musculoskeletal disorders[J].Clin Orthop Relat Res, 2001,(387):22-40.
[3]沈保磊,刘国浚,王耀生,等.体外冲击波治疗骨不连与骨折延迟愈合的应用进展[J].中国现代药物应用,2015,9(22):273-274.
[4]周伟,何明武,姚忠军.针药结合治疗骨折延迟愈合疗效观察[J].现代中西医结合杂志,2014,23(24):2701-2703.
[5] Saggini R, Di Stefano A, Saggini A, et al. Clinical application of shock wave therapy in musculoskeletal disorders:part I[J]. J Biol Regul Homeost Agents, 2015,29(3):533-545.
[6] Alkhawashki HM. Shock wave therapy of fracture nonunion[J]. Injury, 2015,46(11):2248-2252.
[7]杨军,史展,邢更彦.体外冲击波疗法治疗肌肉骨骼系统疾病研究的相关进展[J].中国医学前沿杂志(电子版),2014,6(1):34-39.
[8] Rompe JD, Rosendahl T, Sch?llner C, et al. High-energy extracorporeal shock wave treatment of nonunions[J].Clin Orthop Relat Res, 2001,(387):102-111.
[9] Haupt G. Use of extracorporeal shock waves in the treatment of pseudarthrosis, tendinopathy and other orthopedic diseases[J]. J Urol, 1997,158(1):4-11.
[10]李恩,李平,韩永斌,等.体外冲击波治疗骨不连临床研究[J].中国医学创新,2016,13(3):11-14.
[11]赵子星,李宏宇,席立成,等.体外冲击波联合仙桃草治疗骨不连对骨痂中BMP-2和VEGF mRNA表达的影响[J].中国临床新医学,2016,9(6):469-472.
[12]王璐,刘傥,张祥洪,等.骨形态发生蛋白2在人骨不连组织中的表达及其临床意义[J].中南大学学报(医学版),2014,39(10):1023-1028.
[13] Wang FS, Yang KD, Kuo YR, et al. Temporal and spatial expression of bone morphogenetic proteins in extracorporeal shock wave-promoted healing of segmental defect[J]. Bone, 2003,32(4):387-396.
[14] Chen YJ, Kuo YR, Yang KD, et al. Shock wave application enhances pertussis toxin protein-sensitive bone formation of segmental femoral defect in rats[J]. J Bone Miner Res, 2003,18(12):2169-2179.
[15]朱兵,胥少汀.冲击波在骨与软组织疾病中的应用[J].中华骨科杂志,2003,23(8):498-500.
[16] Mittermayr R, Antonic V, Hartinger J, et al. Extracorporeal shock wave therapy(ESWT)for wound healing:technology, mechanisms, and clinical efficacy[J]. Wound Repair Regen, 2012,20(4):456-465.
[17] Salas AE. Extracorporeal shock-wave therapy compared with surgery for hypertrophic long-bone nonunions[J]. J Bone Joint Surg Am, 2009,92(5):1316.
[18]张作君,王俊颀,成传德,等.针刺,艾灸促进骨折愈合的临床研究:附147例疗效分析[J].中国针灸,1992,12(2):7-10.
[19]张作君,王俊颀,成传德,等.针刺、艾灸促进骨折愈合的临床观察(附147例疗效分析)[J].中医正骨,1992,4(1):7-9.
[20]陈莉秋,苗荃,张娜.头针、腹针、康复训练和心理干预并用治疗中风后遗症30例[J].河北中医,2010,32(5):717-719.
[21]陈莉秋,刘立飞,汪雅茹,等.腹针结合动力灸法治疗腰椎间盘突出症33例临床观察[J].河北中医,2015,37(2):244-246.
[22]祁晓华,吕越,聂明,等.针刺对实验性骨折愈合的影响:血液流变学及组织学观察[J].中国针灸,1998,18(12):745-748.
[23]张俐,移平,吴炳煌.针灸对骨折家兔微量元素的影响[J].中国中医骨伤科,1999,7(5):1-4.
[24]林燕萍,王和鸣,周瑞祥,等.实验性骨折愈合过程中垂体─甲状腺轴变化的免疫细胞化学研究[J].中国中医骨伤科,1994,2(5):7-9.
[25] Shen M, Qi X, Huang Y, et al. Effects of acupuncture on the pituitary-thyroid axis in rabbits with fracture[J]. J Tradit Chin Med, 1999,19(4):300-303.
[26]李建萍,赵英侠,陈坚.针刺与应激免疫关系的实验研究[J].针刺研究,2000,25(2):104-105.
[27]余飞,吕威,黄怡然,等.针刺对骨骼肌钝挫伤模型大鼠肝细胞生长因子表达的影响[J].针刺研究,2015,40(1):50-55.
[28]毕美芬,张雪锋,沈立飚.针刺四缝穴合消积理脾法对30例矮小症患儿胰岛素样生长因子和身高的影响[J].新中医,2015,47(2):183-185.
[29]李钦潘,韩永升,韩咏竹,等.“醒脑开窍”针刺法对脑缺血再灌注大鼠模型早期脑内血管内皮生长因子与胶质纤维酸性蛋白表达的影响[J].中国康复医学杂志,2015,30(7):645-650.
[30]赵亮.针刺配合鼠神经生长因子穴位注射治疗脑瘫斜视[J].辽宁中医药大学学报,2014,16(1):186-188.
[31]张毅敏,程少冰,声鑫,等.针刺对颅脑损伤模型大鼠脑组织神经生长因子、脑源性神经营养因子表达的影响[J].中国老年学杂志,2014,34(21):6100-6102.
[32] Wang WB, Yang LF, He QS, et al. Mechanisms of electroacupuncture effects on acute cerebral ischemia/reperfusion injury:possible association with upregulation of transforming growth factor beta 1[J].Neural Regen Res, 2016,11(7):1099-1101.
[33]李心沁,王琳,单秋华.针刺对大鼠骨折愈合及骨痂TGF-?1表达的影响[J].山东中医杂志,2006,25(8):546-548.
[34]刘献祥,吴明霞,吴炳煌,等.针灸对实验性骨质疏松性骨折愈合影响的研究[J].中国骨伤,2001,14(2):81-82.
[2] Ogden JA, Alvarez RG, Levitt R, et al. Shock wave therapy(Orthotripsy)in musculoskeletal disorders[J].Clin Orthop Relat Res, 2001,(387):22-40.
[3]沈保磊,刘国浚,王耀生,等.体外冲击波治疗骨不连与骨折延迟愈合的应用进展[J].中国现代药物应用,2015,9(22):273-274.
[4]周伟,何明武,姚忠军.针药结合治疗骨折延迟愈合疗效观察[J].现代中西医结合杂志,2014,23(24):2701-2703.
[5] Saggini R, Di Stefano A, Saggini A, et al. Clinical application of shock wave therapy in musculoskeletal disorders:part I[J]. J Biol Regul Homeost Agents, 2015,29(3):533-545.
[6] Alkhawashki HM. Shock wave therapy of fracture nonunion[J]. Injury, 2015,46(11):2248-2252.
[7]杨军,史展,邢更彦.体外冲击波疗法治疗肌肉骨骼系统疾病研究的相关进展[J].中国医学前沿杂志(电子版),2014,6(1):34-39.
[8] Rompe JD, Rosendahl T, Sch?llner C, et al. High-energy extracorporeal shock wave treatment of nonunions[J].Clin Orthop Relat Res, 2001,(387):102-111.
[9] Haupt G. Use of extracorporeal shock waves in the treatment of pseudarthrosis, tendinopathy and other orthopedic diseases[J]. J Urol, 1997,158(1):4-11.
[10]李恩,李平,韩永斌,等.体外冲击波治疗骨不连临床研究[J].中国医学创新,2016,13(3):11-14.
[11]赵子星,李宏宇,席立成,等.体外冲击波联合仙桃草治疗骨不连对骨痂中BMP-2和VEGF mRNA表达的影响[J].中国临床新医学,2016,9(6):469-472.
[12]王璐,刘傥,张祥洪,等.骨形态发生蛋白2在人骨不连组织中的表达及其临床意义[J].中南大学学报(医学版),2014,39(10):1023-1028.
[13] Wang FS, Yang KD, Kuo YR, et al. Temporal and spatial expression of bone morphogenetic proteins in extracorporeal shock wave-promoted healing of segmental defect[J]. Bone, 2003,32(4):387-396.
[14] Chen YJ, Kuo YR, Yang KD, et al. Shock wave application enhances pertussis toxin protein-sensitive bone formation of segmental femoral defect in rats[J]. J Bone Miner Res, 2003,18(12):2169-2179.
[15]朱兵,胥少汀.冲击波在骨与软组织疾病中的应用[J].中华骨科杂志,2003,23(8):498-500.
[16] Mittermayr R, Antonic V, Hartinger J, et al. Extracorporeal shock wave therapy(ESWT)for wound healing:technology, mechanisms, and clinical efficacy[J]. Wound Repair Regen, 2012,20(4):456-465.
[17] Salas AE. Extracorporeal shock-wave therapy compared with surgery for hypertrophic long-bone nonunions[J]. J Bone Joint Surg Am, 2009,92(5):1316.
[18]张作君,王俊颀,成传德,等.针刺,艾灸促进骨折愈合的临床研究:附147例疗效分析[J].中国针灸,1992,12(2):7-10.
[19]张作君,王俊颀,成传德,等.针刺、艾灸促进骨折愈合的临床观察(附147例疗效分析)[J].中医正骨,1992,4(1):7-9.
[20]陈莉秋,苗荃,张娜.头针、腹针、康复训练和心理干预并用治疗中风后遗症30例[J].河北中医,2010,32(5):717-719.
[21]陈莉秋,刘立飞,汪雅茹,等.腹针结合动力灸法治疗腰椎间盘突出症33例临床观察[J].河北中医,2015,37(2):244-246.
[22]祁晓华,吕越,聂明,等.针刺对实验性骨折愈合的影响:血液流变学及组织学观察[J].中国针灸,1998,18(12):745-748.
[23]张俐,移平,吴炳煌.针灸对骨折家兔微量元素的影响[J].中国中医骨伤科,1999,7(5):1-4.
[24]林燕萍,王和鸣,周瑞祥,等.实验性骨折愈合过程中垂体─甲状腺轴变化的免疫细胞化学研究[J].中国中医骨伤科,1994,2(5):7-9.
[25] Shen M, Qi X, Huang Y, et al. Effects of acupuncture on the pituitary-thyroid axis in rabbits with fracture[J]. J Tradit Chin Med, 1999,19(4):300-303.
[26]李建萍,赵英侠,陈坚.针刺与应激免疫关系的实验研究[J].针刺研究,2000,25(2):104-105.
[27]余飞,吕威,黄怡然,等.针刺对骨骼肌钝挫伤模型大鼠肝细胞生长因子表达的影响[J].针刺研究,2015,40(1):50-55.
[28]毕美芬,张雪锋,沈立飚.针刺四缝穴合消积理脾法对30例矮小症患儿胰岛素样生长因子和身高的影响[J].新中医,2015,47(2):183-185.
[29]李钦潘,韩永升,韩咏竹,等.“醒脑开窍”针刺法对脑缺血再灌注大鼠模型早期脑内血管内皮生长因子与胶质纤维酸性蛋白表达的影响[J].中国康复医学杂志,2015,30(7):645-650.
[30]赵亮.针刺配合鼠神经生长因子穴位注射治疗脑瘫斜视[J].辽宁中医药大学学报,2014,16(1):186-188.
[31]张毅敏,程少冰,声鑫,等.针刺对颅脑损伤模型大鼠脑组织神经生长因子、脑源性神经营养因子表达的影响[J].中国老年学杂志,2014,34(21):6100-6102.
[32] Wang WB, Yang LF, He QS, et al. Mechanisms of electroacupuncture effects on acute cerebral ischemia/reperfusion injury:possible association with upregulation of transforming growth factor beta 1[J].Neural Regen Res, 2016,11(7):1099-1101.
[33]李心沁,王琳,单秋华.针刺对大鼠骨折愈合及骨痂TGF-?1表达的影响[J].山东中医杂志,2006,25(8):546-548.
[34]刘献祥,吴明霞,吴炳煌,等.针灸对实验性骨质疏松性骨折愈合影响的研究[J].中国骨伤,2001,14(2):81-82.