叶伟洪教授脊柱疾病的学术经验总结及临床研究

发布时间：2018-01-06 12:26

  本文关键词：叶伟洪教授脊柱疾病的学术经验总结及临床研究　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

  更多相关文章： 叶伟洪 名医经验 骨质疏松症 壮骨强筋片 非手术椎体再骨折

【摘要】：目的：跟师目的：全面总结叶伟洪教授的治学思想、临床经验和学术思想,并结合自己的临床实践,在继承的基础上进行创新发展,开展壮骨强筋片为主综合治疗肝肾不足型骨质疏松症1年的科学研究,观察其疗效,并探讨作用机理,以期阐明导师的学术观点和临证思路,便于更好地在临床推广应用。研究目的：老年骨质疏松患者数量庞大,这类患者极容易发生椎体压缩性骨折,而术后发生非手术椎体再发骨折的风险亦较高。本文旨在探讨经皮椎体成形术后,采用壮骨强筋片防治非手术椎体再发骨折的疗效。方法：跟师方法：通过跟师学习、集中理论学习和独立临床实践,分析、归纳叶伟洪教授的治学思想、学术渊源,传承、体会、总结叶伟洪教授的学术思想和临床经验。科研方法：选择骨质疏松性椎体压缩骨折病例100例,随机分为A、B两组,每组各50例,均行经皮椎体成形术治疗,A组术后予常规抗骨质疏松药(鲑鱼降钙素、阿仑膦酸钠、骨化三醇和钙剂),B组术后予常规抗骨质疏松药联合中药制剂壮骨强筋片。记录两组患者术前和术后7天、1个月、3个月、6个月的视觉模拟评分(visual analogue scale, VAS)、Osweatry功能障碍指数(Osweatry disability index, ODI)、骨密度(bone mineral density,BMD) T值,以及术后6个月内非手术椎体再发骨折的例数。再使用SPSS22.0版软件对数据进行统计学分析。成果：跟师成果：1、叶伟洪教授治学思想总结：仁心仁术,淡泊名利,德者行医；博学精思,勤于实践,衷中参西。2、叶伟洪教授学术思想总结：包括方法学上倡导西学中用,中西并重；诊断上突出整体辨证,强调辨证求因；治疗上病证结合,标本兼顾、内外互补、筋骨并重,攻补合宜,善用攻下逐瘀、活血通络之法；调护上注重身心同治,道法自然,科学养生四方面。3、叶伟洪教授临床经验总结：通过对各型骨折、痛风性关节炎、膝关节骨性关节炎、腰椎间盘突出症、颈椎病、强直性脊柱炎、感染及烧伤创面等病因病机、辨证论治、临床心得的总结,阐明了导师西学中用,中西并重的理论观点,系统展现了导师整体辨证、标本兼顾、内外互补、筋骨并重、攻补合宜、身心同治的临证思路及用药特点。研究结果：所有患者手术成功,其中89例患者得到6个月以上随访,A组42例,B组47例。VAS评分和ODI指数均显示两组患者治疗后疼痛和活动功能均有明显改善(P0.05),A组术前VAS(6.48±1.19),术后7天(4.00±1.53)；术前ODI(78.33±7.28),术后7天(38.7±3.13)：B组术前VAS(6.40±0.92),术后7天(4.49±0.98)；术前ODI(76.45±6.52),术后7天(37.6±3.24)。A组与B组相比较,术后7天VAS评分和ODI指数差异均有统计学意义(P0.05)；A组与B组相比较,术后6个月骨密度T值差异有统计学意义(P0.05)。A组术前T值(-2.58±1.58),术后6个月(-2.09±1.22),B组术前T值(-2.41±1.92),术后6个月(-1.46±1.56)。随访期间,A组发生椎体再发骨折8例,B组2例,两组椎体骨折再发率差异有统计学意义(P0.05)。结论：跟师结论：叶伟洪教授学术思想不拘泥于古法,寻求与时俱进,既继承又创新,在丰富的中医临床经验和理论基础上,同时结合现代科学技术和诊疗手段,中西医融会贯通。对于现代中医的未来发展方向,他尤其倡导西学为中用,中西结合并重的医疗理念,这种模式极有可能成为中国新的医学发展模式；中医传统理念强调整体观和辨证论治的思维,叶伟洪教授在此基础上又结合自身临床经验,提出“辨证的整体观和辨证求因、审因论治”等诊断思维,进一步丰富了中医理论；对骨伤疑难病症的治疗,他又提出了“病证结合、标本兼顾、内外互补、筋骨并重”的治疗观点,这更加贴近现代临床实际。根据“攻补合宜”的治疗思想,以及“攻下逐瘀、活血通络”的治疗思路,叶伟洪教授创制了许多方药,经过临床反复验证以及实验研究的证明,疗效确切。他的“身心同治,道法自然,科学养生”的调护理念,对病人的全面康复,以及现代社会的科学发展和人类的身心健康均有重要的指导意义。以壮骨强筋片为主,配合壮骨强筋片、降钙素,结合饮食、劳逸调护等方法,综合治疗肝肾不足型骨质疏松症,在提高病人骨密度、缓解疼痛、改善生活质量及预防骨折等方面效果明显。其作用机制可能在于从多途径、多靶点干预和作用于骨质疏松症发病的各环节、各因素,调节人体的整体功能,恢复机体的生理状态和动态平衡,促进骨形成和抑制骨吸收,起到提高骨量的作用,最终达到使疾病痊愈的目的。该方法既融合了中西医的精华,又摒弃了中西医的缺陷,具有优势互补,标本兼治,远近期疗效确切,使用方便,不良反应少,费用低的特点,值得临床进一步推广应用。该研究为中西医结合防治骨质疏松症提供了理论依据和有效药物,为治疗骨质疏松症提供了新的思路、方法和途径,不仅具有一定的科学性和先进性,而且具有较高的学术价值和临床意义。科研结论：基于我们的试验分析,经皮椎体成形术后,相比单纯采用常规联合抗骨质疏松治疗,中药制剂壮骨强筋片联合常规抗骨质疏松治疗,可以更有效减轻术后患者疼痛,改善脊柱功能,增加骨密度,降低椎体压缩骨折再发率。
[Abstract]:Objective: to master Objective: comprehensive summary of Professor Ye Weihong's academic thought and clinical experience and academic thought, and combined with clinical practice, innovation and development on the basis of inheritance, carry out zhuangguqiangjin learning research of comprehensive treatment of liver and kidney deficiency type osteoporosis in 1 years, to observe the effect and explore the effect the mechanism of academic ideas and clinical thoughts to elucidate the tutor, which is better in clinical application. Objective: the elderly patients with osteoporosis in large quantities, these patients very prone to vertebral compression fractures, the risk of postoperative non-surgical vertebral fractures is higher. This paper aims to explore the percutaneous vertebroplasty after angioplasty, the effect of the prevention and treatment of non-surgical vertebral fractures zhuangguqiangjin tablets. Methods: with normal methods: learning with the teacher centered learning theory and independent clinical practice, analysis, induction of leaf Wei Hong academic thoughts, academic origin, inheritance, experience, academic thought and clinical experience of Professor Ye Weihong's research. Methods: 100 cases of osteoporotic vertebral compression fractures were randomly divided into A, B two groups, 50 cases in each group, were treated with percutaneous vertebroplasty in the treatment group, A after treated with anti osteoporosis drugs (salmon calcitonin, alendronate, ossification in three alcohol and calcium), treated with anti osteoporosis drugs combined with traditional Chinese medicine preparation zhuangguqiangjin B group after 7 days. Records of two groups of patients before and after surgery, 1 months, 3 months 6 months, the visual analogue scale (visual analogue scale, VAS), Osweatry disability index (Osweatry disability index, ODI), bone mineral density (bone mineral density, BMD) T, and 6 months after the operation of non surgical vertebral fractures. The number of cases using the SPSS22.0 software version of the data results: with the statistical analysis. Results: the 1 Division, Professor Ye Weihong thought summary: with both a benevolent mind and heart indifferent to fame and wealth, virtue, erudite practice; precise thinking, diligent practice, full participation in the west of.2, the academic thought of Professor Ye Weihong summary: including the methodology advocated by Western learning, both Chinese and Western medicine; diagnosis to highlight the overall differentiation, dialectical for combination; treatment of diseases of both inside and outside, complementary, bones, appropriate use of reinforcement, the capture of stasis, Huoxue Tongluo method; nursing focus on physical and mental Tongzhi, imitation of nature, four aspects of science and health.3, Professor Ye Weihong 's clinical experience: all types of fractures, gouty arthritis, osteoarthritis of the knee, lumbar disc herniation, cervical spondylosis, ankylosing spondylitis, burn wound infection and other etiology and pathogenesis, syndrome differentiation, clinical experience summary, the tutor of Western used western theories and heavy, show the guide system 甯堟暣浣撹鲸璇，

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