50例膝骨性关节炎膝关节表面置换术结合康复治疗的临床疗效观察

发布时间：2018-11-23 12:45

【摘要】：目的:将祖国传统医学与现代医学治疗手段相结合优势互补,合理选用中医康复治疗手段运用于膝关节表面置换术中。初步探讨其作用机理及其运用优势,为日后更为广泛的临床实践提供理论依据。方法:选择2013年1月—2014年12月间收入湖北省中医院骨伤科的严重膝骨性关节有手术适应症的患者作为研究对象。按照病例研究纳入及排除标准选择病例50例50膝,按照随机原则,根据患者入院顺序对应的统计学随机数字表,将患者分为实验组和对照组各25例。实验组对照组患者均进行人工膝关节表面置换术,并且手术由同一组医生完成。术前实验组患者接受辨证骨伤科手法治疗。术中采用个体化的软组织松解术。术后两组患者均按照术后常规处理流程规范化处理。术后第二天开始指导两组患者进行适度的功能锻炼,实验组患者辨证给予中药内服及骨伤科手法治疗。术后规范换药两周后视伤口愈合情况予以伤口拆线,实验组拆线后采用伤科熏洗汤熏洗患肢。实验组及对照组患者术前、术后2周,3周,1个月,3个月,半年和1年,运用美国膝关节协会膝关节综合评分标准(AKS)进行临床疗效评估。结果:1.实验组与对照组比较术前AKS评分,经检验差异无统计学意义(P0.05)。2.实验组与对照组比较术后2周、3周、1月AKS评分,经检验差异有统计学意义(P0.05)。3.实验组与对照组比较术后3个月、半年、1年AKS评分,经检验差异无统计学意义(P0.05)。4.实验组对照组手术时间比较差异无统计学意义(P0.05)。结论:1.膝骨关节炎膝关节表面置换结合中医康复治疗患者近期内改善膝关节功能,缓解肿胀、疼痛、畸形有效。2.膝骨关节炎膝关节表面置换的个体化软组织平衡过程中,精确有效地纠正了软组织失平衡状态。手术过程中创伤小、出血少、精度高获得了良好的临床疗效。3.膝骨关节炎膝关节表面置换结合康复治疗中手术过程中并没有明显延长手术时间。4.膝骨关节炎膝关节表面置换结合康复治疗时,并没有较多的增加医疗费用负担。5.膝骨关节炎膝关节表面置换结合康复治疗中缩短了患者康复期。6.膝骨关节炎膝关节表面置换结合康复治疗中副作用小无不良反应,安全性可靠性高、值得推广。7.为祖国传统医学现代化及中西医结合事业做了力所能及的贡献。
[Abstract]:Objective: to combine the advantages of traditional Chinese medicine with modern medical treatment, and to select the rehabilitation therapy of traditional Chinese medicine in knee arthroplasty. The mechanism and advantages of its application are discussed in order to provide theoretical basis for more extensive clinical practice in the future. Methods: from January 2013 to December 2014, patients with severe knee osteoarthrosis who were admitted to the Department of Orthopedics and Trauma of Hubei Provincial Hospital of traditional Chinese Medicine were selected as study objects. 50 cases (50 knees) were selected according to the criteria of inclusion and exclusion of case study. According to the random principle and the statistical random number table corresponding to the order of admission, the patients were divided into two groups: the experimental group (n = 25) and the control group (n = 25). The patients in the control group underwent artificial knee arthroplasty, and the operation was performed by the same group of doctors. The patients in the experimental group were treated with orthopedic and orthopedic manipulation before operation. Individualized soft tissue release was performed during the operation. The patients in both groups were treated according to the routine procedure. On the second day after operation, the patients in the two groups were given moderate functional exercise. The patients in the experimental group were treated with traditional Chinese medicine and orthopedic manipulation according to syndrome differentiation. Two weeks after the standard dressing change, the wound was removed according to the wound healing condition, and the injured limb was washed by fumigation and washing decoction after the thread removal in the experimental group. Before operation, 2 weeks, 3 weeks, 1 month, 3 months, 6 months and 1 year after operation, the patients in the experimental group and the control group were evaluated with the American knee Association knee Joint Comprehensive score (AKS). Results: 1. There was no significant difference in preoperative AKS score between the experimental group and the control group (P0.05). The AKS score of the experimental group was significantly higher than that of the control group at 2 weeks, 3 weeks and 1 month postoperatively (P0.05). There was no significant difference in AKS score between the experimental group and the control group in 3 months, 6 months and 1 year postoperatively (P0.05). There was no significant difference in operation time between the experimental group and the control group (P0.05). Conclusion: 1. Knee osteoarthritis knee surface replacement combined with traditional Chinese medicine rehabilitation treatment in the near future to improve the knee function, relieve swelling, pain, deformity effective. 2. In the process of individualized soft tissue balance of knee joint surface replacement, the misbalance of soft tissue is corrected accurately and effectively. In the process of operation, the trauma is small, the bleeding is less, and the accuracy is high. Knee osteoarthritis knee surface replacement combined with rehabilitation treatment did not significantly prolong the operation time. 4. Knee osteoarthritis knee surface replacement combined with rehabilitation treatment, and did not increase the burden of medical costs. 5. 5. Knee osteoarthritis knee surface replacement combined with rehabilitation treatment shortened the patient's recovery period. 6. 5%. Knee osteoarthritis knee surface replacement combined with rehabilitation in the treatment of small side effects no adverse reactions, high safety and reliability, worthy of promotion. For the modernization of traditional Chinese medicine and the cause of integrated Chinese and Western medicine to do what they can.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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