手术配合活血续骨汤治疗腕舟状骨陈旧性骨折的临床研究

发布时间：2019-01-26 16:54

【摘要】：目的:探讨手术配合活血续骨汤治疗腕舟状骨陈旧性骨折的临床疗效。方法:收集2015年6月-2016年6月收治的腕舟状骨陈旧性骨折病例。符合入选标准的40例,随机分成2组,分别为手术+中药组和单纯手术组。手术组手术方法为腕舟状骨切开复位取自体桡骨茎突植骨螺纹钉加压内固定。手术+中药组在术后第2d开始口服活血续骨汤,疗程3月。两组患者均于术后第3d、7d、14d进行患侧腕关节疼痛评分,于手术后第1、3、6个月行血液流变学检测,术前及术后第3d、第1、3、6个月行PT、APTT、D-二聚体检测,术后1、3、6个月进行患侧腕关节功能评分,术后第3、6个月行腕关节CT,观察骨折愈合情况,并在术前、术后第3d、第3、6个月检测骨折端骨密度。所记录两组数据使用SPSS20.0进行统计学处理。结果:(1)两组患者在年龄、手术部位、术前腕功能评分比较,均未见显著性差异(P0.05),具有可比性。(2)术后疼痛程度比较:两组患者术后3d疼痛评分比较无明显差异(P0.05),术后7d、14d有显著差异(P0.05)。(3)腕关节活动功能比较:两组患者术前、术后第1个月无明显差异(P0.05),术后第3、6个月比较有显著差异(P0.05)。(4)血液流变学指标比较:两组患者血液流变学指标术后1月无明显差异(P0.05),术后3、6月有显著性差异(P0.05)。(5)PT、APTT比较:两组患者PT、APTT术前及术后第3d、第1、3、6个月比较无明显差异(P0.05)。(6)D-二聚体比较:两组患者D-二聚体术前及术后第3d无明显差异(p0.05),术后第1、3、6个月D-二聚体值有显著性差异(P0.05)。(7)总体临床疗效比较:两组患者术后3、6月复查腕关节CT,观察总体骨折愈合疗效上存在着明差异(p0.05)。(8)骨折端骨密度比较:两组患者骨折端骨密度在手术前、术后第3d骨折端骨密度无明显差异(P0.05),手术后第3、6个月骨折端骨密度有显著性差异(P0.05)。结论:腕舟状骨陈旧性骨折采用切开复位植骨螺纹钉加压内固定术,术后配合口服中药活血续骨汤,早期可明显减轻腕部疼痛症状。能够明显改善腕关节活动功能,促进骨折端骨密度增加,从而促进腕舟状骨陈旧性骨折术后骨折愈合。
[Abstract]:Objective: to investigate the clinical effect of operation combined with Huoxue Xiegu decoction in the treatment of old fracture of carpal scaphoid bone. Methods: old fracture of scaphoid bone was collected from June 2015 to June 2016. Forty patients who met the criteria were randomly divided into two groups: the traditional Chinese medicine group and the simple operation group. The operative method of operation group was open reduction of scaphoid bone and internal fixation with screw of styloid process of radius. The operation group began to take Huoxue Xiegu decoction on the 2nd day after operation, the course of treatment was 3 months. The patients in both groups were assessed for wrist pain on the 3rd and 7th day postoperatively, and hemorheology at the 1st day and the 6th month after the operation. The PT,APTT,D- dimer was detected at the 3rd day before operation and at the 3rd day after the operation, and the PT,APTT,D- dimer was measured at the 6th month after operation, and 1 day after operation, 3 days after the operation, the patients in the two groups received the PT,APTT,D- dimer test. The fracture healing was observed by CT, at the 3rd and 6th month after operation, and the bone mineral density of the fracture end was measured at the 3rd, 3rd and 6th month after operation before operation and at the 3rd, 3rd and 6th month after operation. Two groups of data were recorded using SPSS20.0 for statistical processing. Results: (1) there was no significant difference in age, site of operation and preoperative carpal function score between the two groups (P0.05). (2) comparison of postoperative pain degree: there was no significant difference in pain score between the two groups 3 days after operation (P0.05), 7 days after operation, There was significant difference (P0.05). (3) in wrist movement function between the two groups: there was no significant difference between the two groups before operation and at the first month after operation (P0.05). At the 3rd and 6th month after operation, there was significant difference (P0.05). (4) in hemorheological indexes: there was no significant difference in hemorheology indexes between the two groups at one month after operation (P0.05). There was significant difference in PT,APTT between 3 and 6 months after operation (P0.05). (5). The comparison of PT,APTT between the two groups: before and 3 days after PT,APTT, the 1st day, the 3rd day, the third day after PT,APTT in the two groups, There was no significant difference in 6-month (P0.05). (6) D- dimer: there was no significant difference between the two groups in D- dimer before and after operation (p0. 05), but there was no significant difference between the two groups (p0. 05), but there was no significant difference between the two groups (p0. 05). Comparison of the total clinical efficacy of 6-month D- dimer (P0.05). (7): CT, of wrist joint was reexamined 3 and 6 months after operation in the two groups. There was no significant difference in bone mineral density between the two groups (p0. 05). (8) before operation and 3 days after operation (P0.05). The bone mineral density (BMD) at the end of the fracture at the 3rd and 6th month after operation was significantly different (P0.05). Conclusion: open reduction and internal fixation with bone grafting screw and oral Chinese medicine Huoxue Xiegu decoction can obviously reduce wrist pain in the early stage of carpal scaphoid bone old fracture. It can obviously improve wrist movement function, promote bone mineral density increase at fracture end, thus promote fracture healing after carpal scaphoid bone old fracture.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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