丹参类制剂在胸腰段、跟骨骨折辅助治疗的作用

发布时间：2018-05-18 06:49

本文选题：丹参制剂 + 胸腰段压缩骨折脊髓损伤　；参考：《河北医科大学》2015年硕士论文

【摘要】：目的:随着我国建筑、交通等领域近年来的飞速发展,坠落伤、重物砸伤、车祸伤的发生率逐年增高,由此导致骨科疾患呈逐年增高的趋势。创伤骨科疾病的治疗常规上以切开复位固定的手术方式为主。由于骨折愈合需要6-8周甚至12周,伴随关节长时间限制活动及平卧引起的并发症随之增多。近年来,骨生物力学的研究和内固定技术的发展使得目前大多数骨折的复位可以达到另人满意的程度,但是术后制动引发的关节僵硬、肺部感染等一系列问题已经成为骨折预后的重要原因。因此,如何缩短骨科疾病的病程、缩短制动及卧床时间,从而减少并发症及后遗症的发生逐步成为国内外骨科研究的重点课题。丹参为祖国医学的传统药物,主要由丹参酮类和酚酸类物质组成其活性成分,目前临床已广泛应用丹参类制剂。有资料表明,丹参可有效促进骨折愈合,通过改善骨折断端的血供,增强骨折邻近部位的钙动员,促进成骨细胞、破骨细胞在骨基质形成、钙化及塑形中的功能增强等方面促进骨折断端的钙化。本研究通过观察丹参多酚酸盐注射液对胸腰段压缩骨折椎管减压术后脊髓损伤功能恢复的疗效、参芎葡萄糖预防跟骨骨折内固定术后切口皮缘坏死的临床应用,探究丹参制剂在骨科疾病术后恢复治疗中的作用,为丹参制剂在骨折多病种治理中的临床应用提供依据。方法:1丹参多酚酸盐对胸腰段压缩骨折椎管减压术后脊髓功能恢复的作用通过对临床260例不同治疗方法的外伤致胸腰段压缩骨折伴不同程度脊髓损伤术后患者疗效比较,观察丹参多酚酸盐在术后功能恢复中的疗效。1.1实验分组:胸腰段压缩骨折患者(病例来自于河北医科大学第三医院创伤急救中心和河北省辛集市第一医院骨科),随机分为2组,治疗组140例,对照组120例。治疗组患者男76例,女64例,年龄31~69岁,平均年龄为40.6岁。患者的主要损伤节段为:T11:37例,T12:41例,L1:50例,L2:12例。患者的主要损伤原因:交通事故60例,高空坠落57例,重物撞击23例。对照组患者男66例,女54例,年龄33~65岁,平均年龄为39.8岁。患者的主要损伤节段为:T11:32例,T12:41例,L1:40例,L2:7例。患者的主要损伤原因:交通事故46例,高空坠落47例,重物撞击27例。所有入组患者均伴不同程度脊髓损伤(所有患者均按ASIA残损分级确诊为脊髓损伤并记录评分,其中治疗组A级37例,B级41例,C级55例,D级7例,E级0例;对照组A级31例,B级32例,C级49例,D级8例,E级0例)。治疗组病例患者均伴有下肢肌力异常,其中下肢肌力完全丧失者72例,出现腹胀、大小便失禁者134例;对照组病例均出现下肢肌力异常,其中下肢肌力完全丧失者68例,伴腹胀、大小便失禁者112例。两组患者的性别、年龄、病程、损伤节段、损伤原因以及脊髓损伤分级等一般资料对比差异无统计学意义(P0.05),具有可比性。1.2治疗方法及药物:所有患者入院后给予甲泼尼龙冲击治疗,于受伤48h后常规行切开复位椎管减压椎弓根螺钉内固定术,术前术后24h内均常规应用抗生素预防感染,术后治疗组应用丹参多酚酸盐注射液。丹参多酚酸盐注射液的主要成分是丹参乙酸。用法与用量:静脉滴注。一次200mg,溶于0.9%氯化钠注射液250ml-500 ml后使用。一日1次。疗程10-14天。对照组应用0.9%氯化钠注射液250ml-500 ml。一日1次。疗程10-14天。1.3不良反应:所有病人中有4例病人用药后出现轻度过敏反应,抗过敏治疗后消退。2例出现胃肠道刺激症状,给予口服奥美拉唑后症状消失。1.4疗效评价:根据ASIA脊髓损伤神经学分类国际标准(ISNCSCI)对患者术前术后感觉/运动功能特点进行评分并分级。1.5统计学方法:所有数据均行描述性分析和正态性检验,符合正态性、方差齐性采用t检验,不符合采用秩和检验。统计治疗组和对照组术前术后评分差值,进行t检验,P0.05为有统计学意义。统计两组术前术后AISA残损分级等级(两样本方差不齐),进行秩检验,P0.05有统计学意义。2参芎葡萄糖预防跟骨骨折内固定术后切口皮缘坏死的临床作用观察60例新鲜跟骨骨折患者(病例来自于河北医科大学第三医院创伤急救中心和河北省辛集市第一医院骨科)内固定术后恢复过程中不同治疗方案伤口愈合情况,探讨参芎葡萄糖预防跟骨骨折术后切口皮缘坏死的应用。2.1实验分组60例新鲜跟骨骨折(受伤至入院手术时间7天)住院患者,随机分成2组(排除开放骨折、合并神经损伤、糖尿病等基础代谢疾病的患者)。所有患者根据Sanders分型确认为IV型。治疗组30例:男17例,女13例;年龄18~63岁,平均32.8岁;病程12d~14d,平均13d;受伤因素:高空坠落伤14例,车祸9例,重物撞击7例。对照组30例,男19例,女11例;年龄19~65岁,平均36.1岁;病程12d~15d,平均13.2d;受伤因素:高空坠落伤11例,车祸10例,重物撞击9例。2.2治疗方法及药物所有入选患者于入院后至手术前行患肢抬高、甘露醇消肿,于伤后48h采取切开复位跟骨钛板内固定术,术前术后24h内均常规应用抗生素预防感染,术后治疗组采用参芎葡萄糖注射液(吉林四长制药有限公司国药准字)100ml静脉滴注,每日2次。对照组应用100ml葡萄糖注射液静脉滴注,每日两次。2.3疗效标准伤口愈合分级参照《黄家驷外科学》相关诊断标准[2]:甲级愈合:用甲字代表,指愈合优良,没有不良反应的初期愈合;乙级愈合:用乙字代表,是指愈合欠佳,愈合处有炎症反应,如红肿,硬结,血肿,积液等,但未化脓;丙级愈合,用丙字代表,是指切口化脓,需要做切开引流,或者痂皮形成。疗效评价:甲级为显效,乙级为有效,丙级或伤口不愈合,皮缘坏死为无效。治疗组监测有无过敏、胃肠道反应等情况;患者术前均行血常规、凝血四项、生化全项检查,比较治疗组有无凝血机能异常及有无血糖异常。2.4统计学方法:所有数据均行描述性分析和正态性检验,符合正态性、方差齐性采用t检验,不符合采用秩和检验。应用SPSS13.0统计软件对数据进行t检验、秩和检验,治疗有效率的比较采用χ2检验。结果:1患者术前术后感觉/运动功能评分结果显示,应用丹参多酚酸盐后,患者术后评分较术前显著升高(22.51±4.12),而对照组评分改善不明显(15.35±4.89),P0.05。ASIA残损分级显示丹参多酚酸盐治疗组下肢神经功能改善相比对照组有统计学意义。结果提示,丹参多酚酸盐能促进外伤致胸腰段压缩骨折患者术后功能恢复,缩短患者制动时间。2伤口愈合分级结果显示,应用参芎葡萄糖注射液后,治疗组伤口血运改善有效率明显高于对照组。术前凝血四项检查、生化全项结果两组未见异常。结果提示参芎葡萄糖注射液能显著提高患者术后伤口的愈合速度,对预防切口皮缘坏死有积极作用。结论:通过对两种丹参制剂分别在两种不同骨科疾病中的应用疗效对比研究,均证实丹参制剂的应用有效的改善了患者的临床症状,缩短了住院及制动时间、减少了并发症,减轻了广大患者的病痛,并且副作用少,安全有效,具有良好的经济和社会效益,值得推广应用。
[Abstract]:Objective: with the rapid development of China's architecture, traffic and other fields in recent years, the incidence of falling injury, heavy weight injury, and accident injury is increasing year by year, which leads to an increasing trend in Department of orthopedics disease. The treatment of the disease in the traumatic Department of orthopedics is mainly by open reduction and fixed operation formula, which is accompanied by 6-8 weeks or even 12 weeks, accompanied by fracture healing. In recent years, the study of bone biomechanics and the development of internal fixation have made the reduction of most of the fractures satisfactory in recent years. However, a series of problems such as joint stiffness and lung infection caused by postoperative braking have become a serious prognosis. Therefore, how to shorten the course of the disease in the Department of orthopedics, shorten the time of braking and bed, and reduce the occurrence of complications and sequelae has gradually become the key topic in the study of the Department of orthopedics at home and abroad. Salvia miltiorrhiza is the traditional medicine of the motherland medicine, mainly composed of tanshinone and phenolic acids, which has been widely used in the clinic at present. It is suggested that Salvia miltiorrhiza can effectively promote fracture healing, improve the blood supply of fracture ends, enhance calcium mobilization in adjacent parts of the fracture, promote osteoblast, and promote calcification of fracture ends in the aspects of bone matrix formation, calcification and function enhancement. This study was conducted by observing the injection of Salvia salvianolic acid salt The therapeutic effect of liquid on the functional recovery of spinal cord injury after decompression of thoracolumbar compression fracture, and the clinical application of Shen Ligong glucose to prevent the necrosis of the incision skin after internal fixation of calcaneal fracture, to explore the role of Salvia miltiorrhiza preparation in the treatment of postoperative recovery in the Department of orthopedics. Method: 1 the effect of Salvia miltiorrhiza on the recovery of spinal cord function after decompression of thoracolumbar compression fractures with 260 different treatment methods for thoracolumbar compression fracture with different degree of spinal cord injury, the effect of Salvia miltiorrhiza on postoperative functional recovery of.1.1: thoracolumbar segment The patients were randomly divided into 2 groups, 140 cases in the treatment group and 120 in the control group. The patients were divided into 2 groups, 140 cases in the treatment group and 120 in the control group. The patients in the treatment group were 76 males and 64 women, aged 31~69 years and 40.6 years old. The main injury segments of the patients were T11:37, T12:41, L1:50. The main causes of injury were: 60 cases of traffic accidents: 60 cases of traffic accidents, 57 cases of high altitude falling, 23 cases of heavy weight impact. The control group was 66 men, 54 women, age 33~65, and the average age was 39.8 years old. The main injury segments of the patients were T11:32, T12:41, L1:40, and L2:7. The main causes of injury were 46 cases of traffic accidents and 47 cases falling in high altitude, There were 27 cases of heavy weight impact. All patients were accompanied with different degree of spinal cord injury (all patients were diagnosed as spinal cord injury according to ASIA damage classification, including 37 cases of class A, 41 cases of class B, 55 cases of C class, 7 cases of D class, 0 cases of E, 32 cases of class A, 49 C class, 8 cases of D, 0 cases of E). The patients in the treatment group were all accompanied with lower limbs muscle. There were 72 cases of complete loss of muscle strength in the lower extremities, 134 cases of abdominal distention and incontinence, and 134 cases of lower limb muscle strength in the control group, including 68 cases of complete loss of lower extremities, abdominal distension, and 112 cases of incontinence. The sex, age, course of disease, injury segment, cause of injury and classification of spinal cord injury in the two groups were general. There was no statistically significant difference (P0.05), with comparable.1.2 treatment methods and drugs: all patients were treated with methylprednisolone after admission to the hospital. After the injured 48h, open reduction and vertebral canal decompression and pedicle screw internal fixation were performed after injured 48h. All the patients were routinely used antibiotics to prevent infection in the preoperative and postoperative 24h, and the treatment group was treated with Salvia miltiorrhiza. Salvianolate injection. The main ingredient of Salvia salvianolate injection was Salvia miltiorrhiza acetic acid. Usage and dosage: intravenous drip. One 200mg, dissolved in 0.9% Sodium Chloride Injection 250ml-500 ml. 1 times a day for 10-14 days. The control group used 0.9% Sodium Chloride Injection 250ml-500 ml. a day 1 times. 10-14 days of adverse reaction: all patients 4 patients were treated with mild anaphylaxis after drug use. The symptoms of gastrointestinal irritation occurred in.2 cases after antiallergic treatment. The curative effect of.1.4 after oral omeprazole was given. According to the international standard of neurologic classification of ASIA spinal cord injury (ISNCSCI), the patients' sense of sensorless / motor function was graded and the.1.5 statistics were graded before and after operation. Methods: all data were analyzed by descriptive analysis and normality test, conforming to normality, t test was used for the homogeneity of variance, and the rank sum test was not used. The score difference between the treatment group and the control group was measured before and after the operation, and the t test was carried out. The statistical significance of the P0.05 was statistically significant in the two groups before and after the operation of AISA (the variance of the two samples was inhomogeneous). Line rank test, P0.05 has statistical significance for the prevention of calcaneal fracture after internal fixation of calcaneal fracture with.2. The clinical effect of 60 cases of fresh calcaneal fracture (cases from the third hospital trauma emergency center of Hebei Medical University and Department of orthopedics in the first hospital in Xinji, Hebei) 60 cases of fresh calcaneus fracture (injured to 7 days of hospitalization) were divided into 2 groups randomly (excluding open fracture, nerve injury, diabetes and other basic metabolic diseases). All patients were based on the.2.1 experiment. Sanders classification was confirmed as type IV. 30 cases in the treatment group: male 17, female 13; age 18~63 years, average 32.8 years old; course of disease 12d~14d, average 13D; injury factors: 14 cases of high altitude falling injury, 9 cases of car accident, 7 cases of heavy weight impact, 30 cases in the control group, 19 men, 11 cases; age 19~65 years, average average 13.2d; injury factors: high fall and injury 11 cases, injury factors, 12d~15d, average 13.2d; 10 cases of car accident, 9 cases of heavy material impact and.2.2 treatment methods and all the drugs were selected from the hospital after admission to the operation, the patient was raised, mannitol was swelling, after the injury, 48h adopted open reduction and titanium plate internal fixation, and the routine antibiotics were used to prevent infection in 24h before and after operation. The postoperative treatment group was treated with Salviae Miltiorrhizae Liguspyragine Hydrochloride and Glucose Injection (Jilin four length system). 100ml intravenous drip, 2 times a day. The control group was treated with 100ml Glucose Injection intravenous drip, and two times a daily.2.3 curative effect standard wound healing classification referred to < Huang Jia Si Surgery > related diagnostic criteria [2]: Grade a healing: a word with a word, finger healing excellent, no adverse reaction in the initial healing; second grade Union: use of grade B healing: Word representative, refers to the poor healing, healing where there is an inflammatory reaction, such as red and swelling, hard knot, hematoma, fluid and other, but not suppurative; C healing, the use of Chinese character, is the incision purulent, need to do incision drainage, or scab skin formation. Evaluation: the first class is effective, second class is effective, the third grade or wound nonunion, skin margin necrosis is invalid. Treatment group prison There were no anaphylaxis, gastrointestinal reaction, blood routine, four blood clotting items and biochemical whole examination before the operation. There were no coagulability and abnormal.2.4 statistics in the treatment group: all data were analyzed by descriptive analysis and normal test, conforming to normality, the homogeneity of variance was t test, and the rank sum test was not conformed to the test. SPSS13.0 statistical software was used to test the data with t test, rank sum test, and the comparison of treatment efficiency was compared with chi 2 test. Results: the results of sensory / motor function score of 1 patients before and after operation showed that after the application of Salvia salvianolic acid salt, the postoperative score of the patients was significantly higher than that before operation (22.51 + 4.12), while the improvement of the control group was not significantly improved (15.35 + 4.89), P 0.05.ASIA damage classification showed that the improvement of lower extremity nerve function in the treatment group of Salvia miltiorrhiza was statistically significant compared with the control group. The results suggest that salvianolic acid salt can promote the recovery of postoperative function of patients with thoracolumbar compression fractures, shorten the time of.2 wound healing of patients and use Salviae Miltiorrhizae Liguspyragine Hydrochloride and Glucose Injection, The effective rate of blood transport improvement in the treatment group was significantly higher than that of the control group. Four items of preoperative coagulation were examined, and the total biochemical results were not found in the two groups. The results suggested that Salviae Miltiorrhizae Liguspyragine Hydrochloride and Glucose Injection could significantly improve the healing speed of the wound after the operation, and had a positive effect on the prevention of the skin necrosis of the incision. Conclusion: two kinds of Salvia miltiorrhiza preparations were found in two kinds, respectively. The comparative study on the curative effect of different department of orthopedics diseases proved that the application of Salvia miltiorrhiza effectively improved the clinical symptoms of the patients, shortened the hospitalization and braking time, reduced the complications, reduced the pain of the majority of the patients, and had less side effects, safe and effective, and had good economic and social benefits. It was worth popularizing.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

【参考文献】