骨伤洗剂对肘关节僵硬松解术后的临床疗效观察

发布时间：2018-02-01 22:35

本文关键词： 肘关节僵硬骨伤洗剂手术松解中药熏洗　出处：《广州中医药大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：探讨骨伤洗剂在肘关节僵硬松解术后应用的临床疗效,为临床上优化治疗方案提供建议,以进一步指导临床应用。方法：将2005年8月-2014年8月广东省中医院(除外珠海分院)符合纳入标准且无排除标准的肘关节僵硬的住院患者40例按照不同病例前后对照的研究方案分为A、B两组,其中A组-骨伤洗剂组(21例,2012年9月-2014年8月),B组-历史对照组(19例,2005年8月-2012年9月)。入院后行切开松解术,术后均予以吲哚美辛25mg tid,患肢冰敷24小时,术后48h拔引流,开始CPM机锻炼,2次/天,早晚各1次,每次30分钟,同时开始等长训练3次/天,每次持续约30分钟。术后2周伤口Ⅰ期愈合后,停止CPM, A组(骨伤洗剂组)开始用骨伤洗剂熏洗肘关节,在熏洗过程中患者主动作肘关节屈伸活动(每日3次,分早、中、晚,每次约30分钟)；B组(对照组)仅有作肘关节主动屈伸活动(每日3次,分早、中、晚,每次约30分钟)。收集各组术前临床资料,观察指标：1)消肿程度；2)疼痛强度；3)肘关节活动度；4)尺神经的症状；5)肘关节功能MAYO评分。测量术后第3天、术后4周患肘最大周径,并计算出消肿指数,评价其消肿程度；用VAS法记录术前,术后第2周、4周、6周和术后第6个月的疼痛强度；记录术前,术后第2周、4周、6周和术后第6个月患肘的活动度；分别于术前和术后2周、4周、6周和术后第6个月评定尺神经的症状；分别于术前和术后2周、4周、6周和术后第6个月A、B两组评定肘关节功能MAYO评分；术前及术后,术后1个月,3个月,6个月等复查X线影像进行安全性评定,得出两组术后半年的优良率。以上数据均用SPSS 17.0统计软件进行统计学处理,对比分析两组之间的差异性。结果：1.随访6个月,40例获得随访,其中：A组：21例,B组：19例；6例失访。所有患者均无药物过敏及其他不良反应；2.一般资料比较：两组术前各项数值比较均无统计学意义(P0.05),具有可比性；3.两组的比较结果：消肿疗效在术后4周两组比较有显著差异(P0.05)；疼痛强度和肘关节评分方面,两组患者分别在术后2周比较无统计学意义(P0.05),术后4周,6周,6个月两组相比有统计学意义(P0.01),两组数据有非常显著差异,肘关节功能评定优良率均大于对照组；肘关节活动度改善方面,A组-骨伤洗剂组的随时间增大的幅度大于B组,术后4周,6周,6个月两组相比较均有统计学意义(P0.01),有非常显著的差异；尺神经的症状改善方面,两组数据在术后各时间点比较均无统计学意义(P0.05)；术后6个月两组患者疗效判定的优良率：A组-骨伤洗剂组(85.72%)B组-治疗对照组(15.79%),两组比较有非常显著差异(P0.01),所有患者均无药物过敏及其它不良反应。结论：骨伤洗剂组较单纯的功能锻炼组对促进肘关节僵硬松解术后肘关节消肿、止痛、增加活动度方面及功能康复方面有疗效。
[Abstract]:Objective: to investigate the clinical effect of bone injury lotion in the treatment of elbow joint stiffness release, and to provide suggestions for clinical optimization of treatment. Methods: Guangdong Provincial Hospital of traditional Chinese Medicine (except Zhuhai Branch) from August 2005 to August 2014. Forty inpatients with stiff elbow joints who met the inclusion criteria and were not excluded were divided into two groups according to the pre-and post-contrast study. There were 21 cases in group A and 19 cases in group B from September 2012 to August 2014. From August 2005 to September 2012, the patients were treated with indomethacin 25mg tid, the affected limbs were frozen for 24 hours, and the drainage was removed 48 hours after operation. The CPM machine began to exercise twice a day, once in the morning and evening for 30 minutes each, and at the same time, 3 times a day for about 30 minutes each time. After 2 weeks of wound healing, CPM was stopped. In group A (bone injury lotion group), the elbow joint was fumigated with bone injury lotion, and the elbow flexion and extension activities were performed during the fumigation (3 times a day, early, middle, late, about 30 minutes each time). Group B (control group) had only active elbow flexion and extension (3 times a day, early, middle, late, about 30 minutes each time). 2) pain intensity; 3) elbow motion; 4) symptoms of ulnar nerve; 5) MAYO score of elbow joint function. The maximal circumference diameter of elbow was measured on the 3rd day and 4th week after operation, and the detumescence index was calculated to evaluate the degree of deswelling. The pain intensity was recorded by VAS method before operation, 2 weeks after operation, 4 weeks and 6 weeks and 6 months after operation. The movement of elbow was recorded before operation, 2 weeks after operation, 4 weeks, 6 weeks and 6 months after operation. The symptoms of ulnar nerve were evaluated before and 2 weeks and 6 weeks and 6 months after operation respectively. The MAYO score of elbow joint function was assessed in group A and B before and 2 weeks after operation and 6 weeks after operation and 6 months after operation. Before and after operation, the safety of X-ray images was evaluated 1 month, 3 months and 6 months after operation. All the above data were statistically processed by SPSS 17.0 statistical software, and the differences between the two groups were analyzed. Results: 1. Follow up for 6 months. 40 cases were followed up, including 21 cases in group A, 21 cases in group B, 19 cases in group B; No drug allergy and other adverse reactions were found in all the patients. 2. Comparison of general data: there was no statistical significance in comparison between the two groups before operation (P 0.05), which was comparable; 3.The results of comparison between the two groups: the effect of detumescence was significantly different between the two groups at 4 weeks after operation (P 0.05); In terms of pain intensity and elbow joint score, there was no significant difference between the two groups in 2 weeks after operation (P 0.05), 4 weeks after operation and 6 weeks after operation, and 6 months after operation, the two groups had statistical significance compared with the two groups (P 0.01). There was significant difference between the two groups, and the excellent and good rate of elbow joint function evaluation was higher than that of the control group. The improvement of elbow motion in group A and group B was larger than that in group B, 4 weeks after operation, 6 weeks after operation and 6 months after operation, there was significant difference between the two groups (P 0.01). There are very significant differences; For the improvement of ulnar nerve symptoms, there was no significant difference between the two groups at each time point after operation (P 0.05). 6 months after operation, the excellent and good rate of the curative effect of the two groups was determined by the bone injury lotion group (85.72B group) and the treatment control group (15.79g%). There was a very significant difference between the two groups (P 0.01). Conclusion: the bone injury lotion group is more effective than the simple functional exercise group in promoting elbow joint swelling and pain relief after elbow stiffness relaxation. [WT5HZ] [WT5 "HZ] [WT5BZ] [WT5" BZ] [WT5 "BZ] [WT5" BZ]. Increased activity and functional rehabilitation are effective.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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