续骨活血汤结合PFNA内固定术治疗老年股骨粗隆间骨折的疗效观察
发布时间：2019-01-14 07:37
【摘要】：目的:观察研究续骨活血汤结合股骨近端防旋髓内针(Proximal Femoral Nail-A,PFNA)内固定术治疗老年人股骨粗隆间骨折的临床疗效,为中医药结合手术治疗老年人股骨粗隆间骨折的临床研究积累经验。方法:本项研究所选择的研究对象是60~89岁的股骨粗隆间骨折患者56名。将研究对象随机分成对照组和治疗组。对照组行PFNA手术治疗,术后第三天给予口服钙尔奇D片;治疗组行PFNA手术治疗,术后第三天给予续骨活血汤治疗。两组患者术前术后均给予常规处理。观察两组病人术后疼痛视觉模拟标尺法(Visual analogue scales,VAS)评分、骨折愈合率、患髋Harris评分及术后并发症发生情况等指标并记录数据。结果:1、将两组术后3周内的VAS评分做重复测量数据的方差分析,结果显示术后第1天、一周、两周、三周治疗组与对照组相比,F=4.23,P=0.040.05,说明VAS评分变化情况具有统计学意义。故认为治疗组在缓解股骨粗隆间骨折术后疼痛上较对照组疗效更明显。2、将两组术后骨折临床愈合率进行四格表卡方检验,比较结果显示,术后8周两组骨折愈合率差异有统计学意义(X2=4.37,P=0.040.05),术后3月两组骨折愈合率差异有统计学意义(X2=4.08,P=0.040.05),故可以认为治疗组术后8周、3月骨折愈合率均高于对照组。3、将两组术后3个月、6个月患侧髋关节功能评定情况作两独立样本T检验,结果显示术后3个月(P=0.060.05)、6个月(P=0.140.05)两组患髋功能评定差异无统计学意义。尚不能认为治疗组和对照组术后3个月、6个月Harris评分不相同,即两组术后均获得满意髋关节功能。4、两组并发症发生情况:两组术后在院期间及院外随访期间,均未出现髋内翻、压疮、内固定物松动断裂、股骨干股骨颈骨折、深静脉血栓形成、肺部感染等并发症。结论:本研究结果显示,与钙片加服组相比,续骨活血汤加服组疗效更加显著。在中医理论指导下,对患者整体辨证论治,临症加减,结合微创PFNA内固定术,中药加服组可明显缓解术后疼痛,提高骨折愈合率,改善髋关节功能活动,预防并发症发生。本方法体现了中西医结合优势互补,值得临床进一步推广与应用。
[Abstract]:Objective: to observe the clinical effect of Xuegu Huoxue decoction combined with (Proximal Femoral Nail-A,PFNA internal fixation in the treatment of femoral intertrochanteric fracture in the elderly. To accumulate experience in the clinical study of intertrochanteric fracture of femur in elderly patients with traditional Chinese medicine combined with surgery. Methods: 56 patients with intertrochanteric fracture of femur aged 60 ~ 89 years were enrolled in this study. The subjects were randomly divided into control group and treatment group. The control group was treated with PFNA, and the treatment group was treated with PFNA on the third day after operation, and the treatment group was treated with Xuegu Huoxue decoction on the third day after operation. The patients in both groups were given routine treatment before and after operation. The visual analogue scale (Visual analogue scales,VAS) score, fracture healing rate, hip Harris score and postoperative complications were observed and recorded in the two groups. Results: 1. The VAS scores of the two groups within 3 weeks after operation were analyzed by ANOVA. The results showed that on the first day, one week, two weeks and three weeks after operation, the treatment group was compared with the control group. It showed that the change of VAS score was statistically significant. It is considered that the treatment group is more effective than the control group in relieving postoperative pain of intertrochanteric fracture. 2. The clinical healing rate of fracture in the two groups was tested by four square chi-square test. There was a significant difference in fracture healing rate between the two groups at 8 weeks after operation (X2 + 4.37) and 3 months after operation (X2 + 4.08% PX 0.040.05), so the treatment group could be considered as 8 weeks after operation. The rate of fracture healing in 3 months was higher than that in control group. 3 months after operation, the evaluation of hip joint function in the two groups was tested by two independent samples. The results showed that there were 3 months after operation (P0. 060.05). There was no significant difference in hip function between the two groups at 6 months (P < 0. 140.05). The Harris scores of the treatment group and the control group were not the same at 3 and 6 months after operation, that is, the satisfactory hip function was obtained in both groups. 4. The complications occurred in the two groups: the two groups were in hospital and during the follow-up outside the hospital. There were no complications such as hip varus, pressure sore, loosening and breaking of internal fixator, femoral neck fracture, deep vein thrombosis, pulmonary infection and so on. Conclusion: the results of this study show that compared with calcium tablet plus oral group, the treatment group of contiguous bone and activating blood decoction is more effective. Under the guidance of traditional Chinese medicine theory, the patients were treated based on syndrome differentiation and treatment. Combined with minimally invasive PFNA internal fixation, the Chinese medicine plus administration group could obviously relieve postoperative pain, improve fracture healing rate, improve hip joint function, and prevent complications. This method reflects the complementary advantages of integrated Chinese and western medicine, and is worthy of further clinical promotion and application.
【学位授予单位】：山西中医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
本文编号：2408467
[Abstract]:Objective: to observe the clinical effect of Xuegu Huoxue decoction combined with (Proximal Femoral Nail-A,PFNA internal fixation in the treatment of femoral intertrochanteric fracture in the elderly. To accumulate experience in the clinical study of intertrochanteric fracture of femur in elderly patients with traditional Chinese medicine combined with surgery. Methods: 56 patients with intertrochanteric fracture of femur aged 60 ~ 89 years were enrolled in this study. The subjects were randomly divided into control group and treatment group. The control group was treated with PFNA, and the treatment group was treated with PFNA on the third day after operation, and the treatment group was treated with Xuegu Huoxue decoction on the third day after operation. The patients in both groups were given routine treatment before and after operation. The visual analogue scale (Visual analogue scales,VAS) score, fracture healing rate, hip Harris score and postoperative complications were observed and recorded in the two groups. Results: 1. The VAS scores of the two groups within 3 weeks after operation were analyzed by ANOVA. The results showed that on the first day, one week, two weeks and three weeks after operation, the treatment group was compared with the control group. It showed that the change of VAS score was statistically significant. It is considered that the treatment group is more effective than the control group in relieving postoperative pain of intertrochanteric fracture. 2. The clinical healing rate of fracture in the two groups was tested by four square chi-square test. There was a significant difference in fracture healing rate between the two groups at 8 weeks after operation (X2 + 4.37) and 3 months after operation (X2 + 4.08% PX 0.040.05), so the treatment group could be considered as 8 weeks after operation. The rate of fracture healing in 3 months was higher than that in control group. 3 months after operation, the evaluation of hip joint function in the two groups was tested by two independent samples. The results showed that there were 3 months after operation (P0. 060.05). There was no significant difference in hip function between the two groups at 6 months (P < 0. 140.05). The Harris scores of the treatment group and the control group were not the same at 3 and 6 months after operation, that is, the satisfactory hip function was obtained in both groups. 4. The complications occurred in the two groups: the two groups were in hospital and during the follow-up outside the hospital. There were no complications such as hip varus, pressure sore, loosening and breaking of internal fixator, femoral neck fracture, deep vein thrombosis, pulmonary infection and so on. Conclusion: the results of this study show that compared with calcium tablet plus oral group, the treatment group of contiguous bone and activating blood decoction is more effective. Under the guidance of traditional Chinese medicine theory, the patients were treated based on syndrome differentiation and treatment. Combined with minimally invasive PFNA internal fixation, the Chinese medicine plus administration group could obviously relieve postoperative pain, improve fracture healing rate, improve hip joint function, and prevent complications. This method reflects the complementary advantages of integrated Chinese and western medicine, and is worthy of further clinical promotion and application.
【学位授予单位】：山西中医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
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