中医综合康复联合运动疗法对胫骨平台骨折术后膝关节僵硬临床观察

发布时间：2018-11-19 21:52

【摘要】：目的:通过临床研究观察中医综合康复疗法结合运动疗法对于胫骨平台骨折术后膝关节僵硬的疗效及可行性。同时尝试将中医综合康复疗法与运动疗法介入该病种的治疗操作进行规范。以期为进一步探索两疗法如何更好结合及其临床推广提供一些有益的帮助。方法:纳入2015年9月至2017年1月在四川省骨科医院康复科门诊及住院部因胫骨平台骨折术后膝关节僵硬就诊的患者共52例。采用随机、对照实验设计,将患者随机分为实验组及对照组,每组26例。实验组采用中医综合康复结合运动疗法,中医综合康复疗法主要包括电针、中药热奄包、传统关节粘连松解术结合关节松动术、冷疗,运动疗法主要包括关节松动训练、肌肉力量训练。除关节松动术隔日/1次,每周进行3次外,其余所有治疗每日/1次,一周五次为一个疗程,每个疗程间休息2日,共进行4个疗程(4周)。对照组只采用中医综合康复疗法治疗,具体治疗操作及治疗项目与疗程等与实验组无差别。观察时点及效应指标主要包括评分量表得分。在实验结束进行数据统计及处理后,使用SPSS22.0软件进行统计计算。结果:1.经4周治疗后,中医综合康复联合运动疗法(实验组)与单纯中医综合康复疗法(对照组)治疗胫骨平台骨折术后膝关节僵硬的综合临床疗效总有效率分别是88.46%与65.38%。(P0.05)。说明实验组疗效优于对照组。2.两组患者组内治疗前、后的疗效观察指标(膝关节屈伸角度,关节活动范围,疼痛、肌肉力量、ADL以及HSS评分)进行比较,治疗后均好于治疗前,差异有显著性(P0.05)。说明两组所用疗法对于各临床症状都有不同程度改善。3.两组组间比较治疗结束后各指标,其中实验组患者膝关节屈曲、伸直受限、活动范围角度、肌肉力量、ADL与HSS的评分均好于对照组,差异有显著性(P0.05);两组间VAS评分差异无显著性(P0.05)。表明实验组疗法在改善膝关节屈曲、伸直受限、活动范围角度、肌肉力量、ADL与HSS评分上优于对照组,在缓解VAS疼痛评分上与对照组的疗法差异无统计学意义。结论:1.两种疗法对胫骨平台骨折术后膝关节僵硬患者的关节活动范围、疼痛程度、日常生活能力、及全膝关节功能方面均有改善与提高。其中经中医综合康复疗法结合运动疗法治疗的患者,在改善膝关节的屈、伸活动受限、增加膝关节活动范围、提高日常生活能力(ADL)及全膝功能量表(HSS)评分方面,均优于单纯中医综合康复疗法组。在改善患者膝关节疼痛方面,两种疗法效果近似;2.临床综合疗效评中,中医综合康复疗法结合运动疗法治疗胫骨平台骨折术后膝关节僵硬的疗效且优于单纯中医综合康复疗法;3.中医综合康复疗法结合运动疗法治疗胫骨平台骨折术后膝关节僵硬是一种行之有效的治疗方案,其疗效良好、疗程短、安全可靠,可操作性较强,有一定的临床推广价值。
[Abstract]:Objective: to observe the curative effect and feasibility of comprehensive rehabilitation therapy combined with exercise therapy in the treatment of knee joint stiffness after tibial plateau fracture. At the same time, we try to regulate the operation of comprehensive rehabilitation therapy and exercise therapy. In order to further explore how to better the combination of the two therapies and its clinical promotion to provide some useful help. Methods: from September 2015 to January 2017, 52 patients with knee stiffness after tibial plateau fracture were enrolled in rehabilitation department of Sichuan Orthopaedic Hospital. Patients were randomly divided into experimental group and control group with 26 cases in each group. The experimental group was treated with comprehensive rehabilitation of TCM combined with exercise therapy. Comprehensive rehabilitation therapy of TCM mainly included electroacupuncture, traditional Chinese medicine hot election bag, traditional joint adhesion release combined with joint loosening, cold therapy, and exercise therapy mainly including joint loosening training. Muscle strength training. With the exception of joint loosening every other day / once, 3 times a week, all the other treatments were treated daily / once, five times a week as a course of treatment, with 2 days' rest between each course of treatment, with a total of 4 courses (4 weeks). The control group was only treated with TCM comprehensive rehabilitation therapy, and the treatment operation, treatment items and course of treatment were not different from those of the experimental group. The observation time point and the effect index mainly include the score scale score. At the end of the experiment for data statistics and processing, the use of SPSS22.0 software for statistical calculation. The result is 1: 1. After 4 weeks of treatment, The total effective rate of comprehensive rehabilitation combined with exercise therapy (experimental group) and traditional Chinese medicine combined rehabilitation therapy (control group) in the treatment of knee joint stiffness after tibial plateau fracture was 88.46% and 65.38%, respectively. % (P0.05). The results showed that the experimental group was superior to the control group. 2. Two groups of patients before and after the treatment of therapeutic indicators (knee flexion and extension angle, range of joint activity, pain, muscle strength, ADL and HSS score) were better than before treatment, the difference was significant (P0.05). It shows that the two groups of treatment for each of the clinical symptoms improved to varying degrees. 3. 3. The indexes after treatment were compared between the two groups. The knee flexion, extension limitation, range angle, muscle strength, ADL and HSS scores of the patients in the experimental group were better than those in the control group (P0.05). There was no significant difference in VAS score between the two groups (P0.05). The results showed that the experimental group was superior to the control group in improving knee flexion, extension limitation, range angle, muscle strength, ADL and HSS score, but there was no significant difference between the experimental group and the control group in relieving VAS pain score. Conclusion: 1. The two treatments can improve the range of knee joint motion, the degree of pain, the ability of daily living, and the function of total knee joint in patients with knee joint stiffness after tibial plateau fracture. Among them, the patients treated by comprehensive rehabilitation therapy of TCM combined with exercise therapy can improve the flexion and extension of the knee joint, increase the range of the knee joint activity, improve the ability of daily living (ADL) and the (HSS) score of the whole knee function scale. All of them were superior to the traditional Chinese medicine comprehensive rehabilitation therapy group. In the improvement of knee pain patients, the effect of the two treatments is similar; 2. In the clinical comprehensive curative effect evaluation, TCM comprehensive rehabilitation therapy combined with exercise therapy in the treatment of tibial plateau fracture postoperative knee stiffness curative effect and is superior to simple TCM comprehensive rehabilitation therapy; 3. Comprehensive rehabilitation therapy combined with exercise therapy in the treatment of knee joint stiffness after tibial plateau fracture is an effective treatment scheme with good curative effect, short course of treatment, safety and reliability, strong maneuverability, and has certain clinical promotion value.
【学位授予单位】：成都体育学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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