舒筋消肿方联合膝关节镜下关节清理术在中早期膝关节骨性关节炎中的疗效研究

发布时间：2018-06-26 09:54

本文选题：舒筋消肿方 + 膝　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:观察舒筋消肿方联合膝关节镜下关节清理术治疗中早期膝关节骨性关节炎的临床疗效,探讨舒筋消肿方联合膝关节镜下关节清理术治疗中早期膝关节骨性关节炎的机理。方法:将符合《中华人民共和国中医药行业标准·中医病症诊断疗效标准·骨伤科》的120例住院病人通过随机数字表法分为2组,每组60例,分别为对照组和联合清理术组。对照组60例中,男性25例,女性35例,平均年龄(x±S下同)45.0±5.1岁;联合清理术组60例中,男性18例,女性42例。平均年龄42.0±4.8岁。两组患者的一般情况无统计学差别。对照组入院第三日在腰硬联合麻醉下行“膝关节镜下关节清理术”;联合清理术组予膝关节镜下关节清理术,术后第一日服用舒筋消肿方:桃仁15 g、红花15 g、汉防己20 g、土茯苓30 g、酒大黄15 g、木瓜20 g、泽兰15 g、盐车前子30 g、川牛膝9 g、独活10 g、三七粉3 g、生薏苡仁30 g、茯苓15 g、生黄芩9 g、连翘12 g、泽泻15 g、桂枝6 g,水煎取汁400ml,分早晚两次口服。麻醉消退后即行股四头肌等长收缩练习,行直腿抬高训练,术后第1-3日再下地活动。舒筋消肿方服用14天,2组治疗后均进行相应的功能锻炼。观察指标包括反应手术疗效的指标:膝关节周径术后第一日和术后两周的差值(单位:cm),术后下地时间d(单位:天),VAS评分,HSS评分。分别统计治疗前后两组患者膝关节周径术后第一日和术后两周的差值,观察两组患者的术后最早下地的时间,及分别在术后2周、6周后对两组病人进行随访,统计两组患者的VAS疼痛评分及HSS膝关节评分,将两组数据进行统计学分析,术前术后膝关节压痛点,术后下地时间、术前术后的VAS评分,HSS评分进行组间及组内比较。结果:1两组治疗前膝关节周径变化情况比较差异无统计学意义(P0.05);对照组术后第一天、术后2周膝关节周径与术前比较有显著统计学意义(P0.05);联合清理术组患者术后第一天、术后2周膝关节周径明显变化,与术前比较有显著统计学意义(P0.05);联合清理术组术后第一天、术后2周膝关节周径,小于对照组,有显著统计学意义(P0.05);2两组患者术后最早下地时间无明显差异,无统计学意义(P0.05);3分别在术前、2周、6周后对两组病人以问卷调查的形式进行随访,得到VAS疼痛评分,两组患者在2周、6周后的VAS评分组内比较及组间比较均具有差异,具有统计学意义(P0.05);4分别在术前、2周、6周后对两组病人以问卷调查的形式进行随访,得到HSS评分,两组患者在2周、6周后的HSS评分组内比较及组间比较均具有差异,具有统计学意义(P0.05);5对照组治疗14d后临床疗效率为86.67%,联合清理术组为95.00%,两组临床疗效率比较差异有统计学意义(P0.05);6联合清理术组治疗14d后并发症发生率为5.00%,对照组为3.33%,两组治疗14d后并发症发生率差异无统计学意义(P0.05);结论:中早期膝关节骨性关节炎患者在舒筋消肿方基础上联合膝关节镜下关节清理术治疗效果理想,能改善患者关节功能,减轻患者疼痛,提高临床疗效,并且不同治疗方法的联合使用不会增加并发症发生率,值得推广应用。
[Abstract]:Objective: To observe the clinical effect of Shu Jin and knee arthroscopy combined with knee arthroscopy in the treatment of osteoarthritis of the knee joint, and to explore the mechanism of the treatment of osteoarthritis of the knee joint in the middle of the knee arthroscopy combined with the knee arthroscopy. Methods: it will be in accordance with the standard of Chinese medicine in People's Republic of China and the disease of traditional Chinese medicine. 120 patients in the orthopedics department of orthopedics were divided into 2 groups by random number table method, 60 cases in each group, the control group and the joint cleaning group. In the control group, 60 cases were male 25, female 35, the average age (x + S below) 45 + 5.1 years; in the joint cleaning group 60 cases, 18 males and 42 cases. Average age 42 + 4.8 years. There was no statistical difference in the general condition of the patients. The control group was treated with knee arthroscopy under combined spinal and hard anesthesia for third days. The joint cleaning group was given arthroscopic debridement of knee arthroscopy. The first day after the operation, it took Shu Jin to eliminate swelling: peach kernel 15 g, safflower 15 g, Han Fang 20 g, tuckahoe 30 g, wine rhubarb 15 g, papaya 20 g, jeresy 1 5 g, salt front son 30 g, kachyranthes 9 g, single live 10 g, 37 powder 3 G, raw coix seed 30 g, Poria cocos 15 g, raw Scutellaria 9 g, forsythia 12 g, Rhizoma rhizomata 15 g, cinnamon 6 g, decoct 400ml, before the anaesthesia, immediately leg elevation training, after the operation again next day after the operation. The 2 groups were treated with functional exercise after treatment. The observation index included the index of the response to the operation: the difference between the first day after the knee joint diameter and the two week after the operation (unit: cm), the D (unit: day), the VAS score, and the HSS score after the operation, and the difference between the first and the two weeks after the operation of the two groups of patients after the treatment, respectively. The two groups of patients were observed at the earliest post operation time, and the two groups were followed up at 2 weeks after the operation and 6 weeks after the operation. The VAS pain score and HSS knee score of the two groups were statistically analyzed. The two groups of data were statistically analyzed, the pain points of the knee joint before and after operation, the postoperative down time, the VAS score before and after the operation, and the HSS score were carried out. Results: 1 there was no significant difference in the change of the knee diameter of the two groups before treatment (P0.05); the knee diameter of the knee joint was statistically significant (P0.05) at the first day after operation and 2 weeks after the operation in the control group (P0.05). The knee joint diameter of the joint cleaning group Shu Houdi was obviously changed in one day after the operation, and compared with the preoperative comparison. There was significant statistical significance (P0.05); the first day after operation in the joint cleaning group and 2 weeks after the operation, the knee joint diameter was less than the control group (P0.05), and there was no significant difference between the 2 two groups at the earliest down time and no statistical significance (P0.05); 3 were followed up in the form of questionnaire survey in two groups of patients before, 2 weeks and 6 weeks after the operation. To get VAS pain score, two groups of patients in 2 weeks, 6 weeks after the VAS score group were compared and compared, with statistical significance (P0.05); 4 in pre operation, 2 weeks, 6 weeks after the two groups of patients in the form of questionnaire survey, the HSS score, two groups in the 2 week, 6 weeks after the HSS score group comparison and comparison between groups and comparison The difference was statistically significant (P0.05); the clinical therapeutic efficiency of the 5 control group was 86.67% after the treatment of 14d, the combined cleaning group was 95%, and the difference in the clinical therapeutic efficiency of the two groups was statistically significant (P0.05); the incidence of complications after the treatment of 14d in the 6 combined group was 5%, the control group was 3.33%, and the incidence of complications after the treatment of 14d was different in the two group. There is no statistical significance (P0.05). Conclusion: the effect of combined knee arthroscopy combined with knee arthroscopy for patients with osteoarthritis of the knee in the middle early stage is ideal, it can improve the function of the joints, relieve the pain and improve the clinical effect, and the combination of different treatment methods will not increase the incidence of complications, it is worth pushing. Wide application.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

【参考文献】