股骨前弓角在PFNA治疗股骨转子间骨折中的临床意义及桃红四物汤对其术后康复的影响

发布时间：2018-10-09 15:18

【摘要】：目的：观察股骨前弓角对股骨近端手术的影响及中药桃红四物汤对股骨近端手术后康复的作用。比较该方法与常规治疗的临床疗效，并对三组患者的术中、术后综合功能的临床观察指标进行分析。方法：自2012年6月至2014年1月手术治疗股骨转子间骨折患者100例。术前随机分三组，常规手术组（常规组）38例，取常规PFNA手术治疗。术前测量股骨前弓角手术组（测量组）30例，取术前测量股骨前弓角作为常规PFNA手术术前计划参数。术前测量股骨前弓角手术配合术后口服中药桃红四物汤组（测量加中药组）32例。所有病例均在硬膜外麻醉下，在骨科牵引床牵引下闭合复位，PFNA内固定，观察术中插入髓内钉的难易程度，术后骨科常规处理，加中药组术后第二天口服桃红四物汤，一日三次饭前口服，一周为一个疗程，，持续两个疗程。观察患者大腿疼痛、肿胀症状，一周后扶双拐下地行走。术后定期随访，术后第二天、3个月拍X线片复查，并行Harris评价患者术后功能。结果：100例患者均顺利完成手术。常规组8例患者在术中出现初次穿钉不顺利。测量组和测量中药组以股前弓角指导手术的患者，术中髓内钉插入过程顺利。术后第二天拍X线片示骨折复位满意，内固定置入位置良好，3个月复查X线片，病例已全部骨性愈合。术后Harris评分优良率，常规组、测量组与测量加中药组三组对比，差异有统计学意义（P＜0.05）。三组病例未出现螺旋刀片切割股骨头、下肢深静脉血栓、发热等手术并发症。常规手术组7例出现大腿疼痛现象，测量组和测量加中药组未出现大腿疼痛患者，常规组术后大腿肿胀现象较其他两组明显。结论：股骨前弓角随着患者年龄增加而增大，股骨前弓角可指导选择防旋型股骨近端髓内钉术中的使用，使手术进程顺利进行。说明术前测量股骨前弓角对手术顺利进行是有积极的作用。术后辅以中药桃红四物汤活血化瘀、养血补血，改善局部血氧和周围微循环，明显减少术后大腿肿胀疼痛及并发症的发生。试验说明中药桃红四物汤对骨折术后的康复有积极的作用。
[Abstract]:Objective: to observe the effect of anterior femur angle on proximal femur operation and the effect of Taohong Siwu decoction on rehabilitation of proximal femur. The clinical efficacy of this method was compared with that of routine treatment, and the clinical indexes of comprehensive function during and after operation in three groups were analyzed. Methods: from June 2012 to January 2014, 100 patients with intertrochanteric fracture of femur were operated. The patients were randomly divided into three groups before operation. 38 cases were treated with routine PFNA operation. Thirty patients in the group of preoperative measurement of the anterior femoral bow angle were taken as the preoperative planning parameters of routine PFNA operation for the measurement of the anterior angle of the femur. 32 cases were treated with Taohong Siwu decoction before operation and oral administration of Taohong Siwu decoction. All cases were under epidural anesthesia, closed reduction and PFNA fixation under traction in orthopedic traction bed. The degree of intraoperative insertion of intramedullary nail was observed, routine orthopedic treatment was performed after operation, and Taohong Siwu decoction was taken orally in the Chinese medicine group on the second day after operation. Take orally three times a day before meals, one week as a course of treatment, two courses of treatment. Observe symptoms of thigh pain and swelling and walk a week later. The patients were followed-up regularly, the second day and 3 months after operation. The postoperative function was evaluated by Harris. Results the operation was successfully completed in 100 cases. In the routine group, 8 patients suffered from primary nail puncture during operation. The procedure of intramedullary nail insertion was smooth in the measurement group and the traditional Chinese medicine group. On the second day after operation, X-ray film showed satisfactory reduction of fracture, good position of internal fixation, and 3 months reexamination of X-ray film, all the cases had healed. The excellent and good rate of Harris score in routine group, measurement group and measurement plus Chinese medicine group was significantly higher than that in control group (P < 0. 05). There were no complications such as cutting femoral head with spiral blade, deep vein thrombosis and fever in the three groups. There were 7 cases of thigh pain in the routine operation group, and no thigh pain was found in the measurement group and the measurement plus Chinese medicine group. The thigh swelling in the routine group was more obvious than that in the other two groups. Conclusion: the anterior angle of femur increases with the age of the patients. The anterior angle of femur can be used to guide the choice of anti-rotation intramedullary nail in proximal femur and make the operation progress smoothly. The results showed that preoperative measurement of the anterior femur angle had a positive effect on the successful operation. After the operation, Taohong Siwu decoction was used to promote blood circulation and blood stasis, to nourish blood and tonify blood, to improve local blood oxygen and peripheral microcirculation, and to reduce postoperative thigh swelling, pain and complications. The experiment shows that Taohong Siwu decoction has a positive effect on postoperative rehabilitation of fracture.
【学位授予单位】：山西中医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R687.3

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