踝关节扭伤中药外敷疗法证据学疗效大样本调查研究

发布时间：2018-01-09 23:31

本文关键词：踝关节扭伤中药外敷疗法证据学疗效大样本调查研究　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：目前没有可信任或可引用的文献(比如核心期刊)证明中药外敷疗法对踝关节扭伤的有效性,且临床上对外踝扭伤诊断和治疗方法比较多样化。为证实临床研究更具有可靠性,通过对中药外敷治疗急性踝关节扭伤的文献质量评价,并进行大样本临床试验研究,为中药外敷疗法的有效性提供可靠的证据学支持。方法：采用大样本组间对照试验,于2015年4月-2015年10月分别在广东医学院第一附属医院、广东省第二中医院和广州中医药大学附属骨伤科医院,对急诊及门诊踝关节扭伤患者进行临床研究,共纳入294例急性踝关节扭伤患者,所有患者在签署知情同意书并参加本研究后,根据纳入和排除标准,按照分配方案分为3个组：对照组A 97例,观察组B 99例,观察组C 98例, A根据RICE原则进行保守治疗,B采用省第二中医院特制中药硬膏外敷治疗,C采用附属骨伤科医院特制祛瘀消肿膏外敷治疗。在治疗前、治疗后2天、治疗后8天、治疗后15天分别对患者采用局部压痛、肿胀度、瘀斑大小、踝关节功能活动度(ROM)及Kofoed踝关节评分标准为观察指标加以评分,根据以上几项积分变化结果,剖析其临床疗效。结果：经重复测定方差分析,与RICE组比较,中药硬膏组、祛瘀消肿膏组治疗后8天及15天VAS疼痛评分均明显降低(尸0.05)。说明中药硬膏组、祛瘀消肿膏组治疗后8天及15天止痛效果优于RICE组。经重复测定方差分析,与RICE组比较,中药硬膏组、祛瘀消肿膏组治疗后2天瘀斑大小评分均明显升高(p0.05),而治疗后8天及15天瘀斑大小评分均明显降低(p0.05),说明扭伤后冰敷使毛细血管收缩以减轻局部出血,故可见治疗后2天RICE组瘀斑评分较其他两组低；而治疗方面,中药硬膏组、祛瘀消肿膏组治疗后8天及15天活血化瘀效果优于RICE组。经重复测定方差分析,与RICE组比较,中药硬膏组、祛瘀消肿膏组治疗后2天、治疗后8天、治疗后15天关节活动度ROM评分均明显升高(p0.05),说明中药硬膏组、祛瘀消肿膏组治疗后2,8,15天恢复关节功能效果优于RICE组。经重复测定方差分析,与RICE组比较,中药硬膏组、祛瘀消肿膏组治疗后15天关节肿胀度评分均明显降低(p0.05),说明中药硬膏组、祛瘀消肿膏组治疗后15天消肿效果优于RICE组。经Ridit分析,三组组间总的临床疗效(kofoed评分)比较,均无统计学意义(p0.05),这说明中药硬膏组、祛瘀消肿膏组与RICE组在治疗急性踝关节扭伤的总疗效方面具有同等优势。结论：祛瘀消肿膏组与中药硬膏组比较RICE组,在抑制患踝炎性因子形成及加速炎性水肿消散方面更具优势,后期重建和调节创伤局部的血液循环,有助于受损软组织的恢复。祛瘀消肿膏与中药硬膏在治疗急性踝关节扭伤方面均有良好的效果,能明显减轻患踝疼痛,活血祛瘀,消退肿胀,促进关节功能恢复。
[Abstract]:Objective: at present, there is no reliable or citation literature (such as core journal) to prove the effectiveness of external application of traditional Chinese medicine in the treatment of ankle sprain. The clinical diagnosis and treatment of lateral ankle sprain is more diversified. In order to confirm the reliability of clinical research, the quality of literature on the treatment of acute ankle sprain by external application of traditional Chinese medicine was evaluated. A large sample of clinical trials were conducted to provide reliable evidential support for the effectiveness of external application of traditional Chinese medicine. Methods: a control trial was conducted among large sample groups. From April 2015 to October 2015, he was in the first affiliated Hospital of Guangdong Medical College, the second Chinese Medicine Hospital of Guangdong Province and the affiliated Orthopedic and Trauma Hospital of Guangzhou University of traditional Chinese Medicine. A total of 294 patients with acute ankle sprain were enrolled in the clinical study of emergency and outpatient ankle sprain. After signing the informed consent form and participating in this study, all the patients were included and excluded according to the criteria of inclusion and exclusion. According to the distribution scheme, the patients were divided into three groups: the control group (n = 97), the observation group (n = 99) and the observation group (C n = 98). According to the principle of RICE, A was treated conservatively. B was treated by external application of traditional Chinese medicine ointment specially made by the second Hospital of traditional Chinese Medicine. C was treated by special external application of Quyu Xiaoyong Ointment, affiliated Orthopedic and Trauma Hospital. Before treatment, 2 days after treatment, 8 days after treatment. 15 days after treatment, the patients were evaluated with local tenderness, swelling, size of ecchymosis, ankle function motion and Kofoed ankle scoring standard. Results: after repeated analysis of variance, compared with the RICE group, the traditional Chinese medicine ointment group. The pain score of VAS in QYXD group decreased significantly 8 and 15 days after treatment (P < 0.05). The analgesic effect of Quyu Xiaozhong ointment group was better than that of RICE group on the 8th and 15th day after treatment. After repeated analysis of variance, compared with RICE group, the traditional Chinese medicine ointment group was better than that of traditional Chinese medicine ointment group. The scores of ecchymosis in Quyu Xiaozhong ointment group were significantly increased at 2 days after treatment, but significantly decreased at 8 and 15 days after treatment (P 0.05). The results showed that ice compress after sprain caused capillaries constriction to reduce local bleeding, so the ecchymosis score of RICE group was lower than that of the other two groups 2 days after treatment. In the treatment aspect, the curative effect of traditional Chinese medicine ointment group and Quyu Xiaozhong ointment group was better than that of RICE group on the 8th and 15th day after treatment. After repeated analysis of variance, compared with the RICE group, the traditional Chinese medicine ointment group was better than the RICE group. The ROM scores of joint motion were significantly increased 2 days after treatment, 8 days after treatment and 15 days after treatment in Quyu Xiaozhong ointment group, indicating that the traditional Chinese medicine ointment group and Quyu Xiaozhong ointment group had 2 minutes 8 after treatment. After 15 days, the effect of restoring joint function was better than that of RICE group. After repeated analysis of variance, compared with RICE group, Chinese herbal ointment group was better than that of traditional Chinese medicine ointment group. 15 days after treatment, the scores of swelling degree of joints in the QYXD group were significantly lower than that in the control group, indicating that the Chinese medicine ointment group was treated with traditional Chinese medicine ointment. The effect of removing swelling 15 days after treatment in Quyu Xiaozhong paste group was better than that in RICE group. By Ridit analysis, the total clinical efficacy of the three groups was compared. There was no statistical significance between the two groups, which indicated that the traditional Chinese medicine ointment group. Quyu Xiaozhong ointment group and RICE group have the same advantages in the treatment of acute ankle sprain. Conclusion: Quyu Xiaozhong paste group and traditional Chinese medicine ointment group compared with RICE group. It has more advantages in inhibiting the formation of inflammatory factors in the ankle and accelerating the dissipation of inflammatory edema, and reconstructing and regulating the local blood circulation in the later stage. Quyu Xiaozhong ointment and traditional Chinese medicine ointment have good effect in the treatment of acute ankle sprain, can obviously reduce ankle pain, promote blood circulation and remove blood stasis, swelling fade. Promote joint function recovery.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R274.3

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