展筋活血方配合塔形垫自然牵引法治疗单纯性胸腰椎压缩性骨折的临床研究
发布时间：2018-09-04 05:55
【摘要】：目的:观察展筋活血方配合塔形垫自然牵引法治疗单纯性胸腰椎压缩性骨折的临床疗效,探讨展筋活血方配合塔形垫自然牵引法在治疗单纯性胸腰椎压缩性骨折的机理。方法:将符合《中华人民共和国中医药行业标准·中医病症诊断疗效标准·胸腰椎骨折》的80例住院病人通过随机数字表法分为两组,每组40例,分别为A组:对照组、B组:展筋活血方配合塔形垫自然牵引组,A组40例中,男性18例,女性22例,平均年龄((?)±S下同)67.0±5.1岁;B组40例中,男性14例,女性26例。平均年龄66.0±4.8岁。两组患者的一般情况无统计学差别。A组予骨康胶囊口服,入院1周后在医师指导下行“五点支撑”法功能锻炼;B组予塔形垫自然牵引,并服用展筋活血方:当归12g,川芎10g,怀牛膝9g,枳壳15g,姜黄15g,羌活15g,血竭10g,炒白术20g,茯苓15g,白芷15g,麝香0.1g(冲)。根据骨折分期调整,如前期消肿止痛加:汉防己20g,枳实9g,酒大黄15g;中期活血化瘀加:桃仁10g、红花10g、赤芍15g;后期补益肝肾加:骨碎补15g、续断20g、熟地15g,入院1周后在医师指导下行“五点支撑”法功能锻炼。12周为一疗程。观察指标包括反应压缩椎体压缩程度的楔变度数;反应患者愈合的时间t(单位:周);反应脊柱侧弯程度的Cobb角度数;反应患者对治疗效果的满意程度的胸腰椎压缩性骨折疗效评价PRO量表的积分。分别测量治疗前后两组的楔变度及Cobb角,观察两组患者的骨折愈合的时间,及分别在12周、24周后对两组病人进行随访,统计两组患者的PRO积分,将两组数据进行统计学分析,楔变度、Cobb角、PRO积分进行组间及组内比较,骨折愈合时间进行组间比较。结果:1两组患者治疗前Cobb角无明显差异,无统计学意义;A组患者治疗前、后Cobb角无明显变化,组内比较治疗前、后Cobb角变化无统计学意义(P0.05);B组患者治疗前、后Cobb角变化明显,组内比较治疗前、后Cobb角变化具有显著差异,有统计学意义(P0.05);两组患者治疗后的Cobb角比较具有显著差异,有统计学意义(P0.05);2两组患者治疗前楔变度无明显差异,无统计学意义;A组患者治疗前、后楔变度有变化,组内比较治疗前、后楔变度差异有统计学意义(P0.05);B组患者治疗前、后楔变度变化明显,组内比较治疗前、后楔变度变化具有显著差异,有统计学意义(P0.05);两组患者治疗后的Cobb角比较具有显著差异,有统计学意义(P0.05);3以X线片上显示的骨折愈合时间为标准,A组患者的骨折愈合时间平均值较B组患者的骨折愈合时间平均值大,且B组患者前期愈合病例数明显多于A组,两组数据具有显著差异,具有统计学意义(P0.05);4分别在12周、24周后对两组病人以问卷调查的形式进行随访,以百分制胸腰椎压缩性骨折疗效评价量表为尺度,得到PRO积分,两组患者在12周、24周后的PRO积分组内比较及组间比较均具有差异,具有统计学意义(P0.05)。结论:1对照组与展筋活血方配合塔形垫自然牵引组从影像学方面比较,展筋活血方配合塔形垫自然牵引治疗单纯性胸腰椎压缩性骨折在对伤椎椎体高度的恢复及脊柱生理曲度的恢复方面,明显优于常规保守治疗组A组。2对照组与展筋活血方配合塔形垫自然牵引组从椎体骨折愈合时间方面比较,展筋活血方配合塔形垫自然牵引治疗单纯性胸腰椎压缩性骨折在对伤椎椎体骨折愈合时间上,较常规保守治疗组A组明显缩短。3两组患者在采取两种不同的治疗方法治疗后,通过随访展筋活血方配合塔形垫自然牵引组的病人满意度明显高于常规保守治疗组A组。
[Abstract]:Objective:To observe the clinical effect of Zhanjin Huoxue Prescription combined with tower pad natural traction in the treatment of simple thoracolumbar vertebral compression fracture and explore the mechanism of Zhanjin Huoxue Prescription combined with tower pad natural traction in the treatment of simple thoracolumbar vertebral compression fracture. 80 patients with thoracolumbar fracture > were divided into two groups by random number table method, each group of 40 cases, respectively, group A: control group, group B: Zhanjin Huoxue Fang combined with natural traction tower pad group, group A 40 cases, 18 males, 22 females, the average age (?) + S below the same) 67.0 [5.1 years old; group B 40 cases, 14 males, 26 females. Group A was given Gukang Capsule orally for one week and then was given "five-point support" functional exercise under the guidance of doctors. Group B was given natural traction with tower pad and took Zhanjin Huoxue Recipe: Angelica sinensis 12g, Ligusticum Chuanxiong 10g, Achyranthes bidentata 9g, Fructus aurantii 15g, Curcuma Longae 15g, Qianghuo 15g, Dragon blood 10g, Fried Baizhu 20g, Poria Cocos 15g, etc. Radix Angelicae Dahuricae 15g, Musk 0.1g (Chong). Adjusted according to fracture stages, such as early swelling and pain relief plus: Hanfang-chi 20g, Fructus Aurantii 9g, Rhubarb 15g; mid-term Huoxue Huayu plus: peach kernel 10g, safflower 10g, red peony 15g; late tonifying liver and kidney plus: Gushubu 15g, intermittent 20g, ripe ground 15g, after one week in the hospital under the guidance of the "five-point support" method of functional exercise. Observational indices included the wedge degree of vertebral compression, the healing time t (unit: week), the Cobb angle of scoliosis, and the score of PRO scale for evaluating the curative effect of thoracolumbar vertebral compression fractures. Obb angle, observe the time of fracture healing of two groups of patients, and 12 weeks, 24 weeks after the follow-up of two groups of patients, statistical analysis of two groups of patients with PRO score, wedge change, Cobb angle, PRO score were compared between groups and within the group, fracture healing time was compared between the two groups before treatment. There was no significant difference in Cobb angle before and after treatment in group A. There was no significant change in Cobb angle before and after treatment in group A. There was no significant difference in Cobb angle before and after treatment in group B (P 0.05). Obb angle comparison has significant difference, with statistical significance (P 0.05); 2 groups of patients before treatment, wedge degree of no significant difference, no statistical significance; A group of patients before treatment, after the wedge degree of change, group comparison before treatment, after the wedge degree of difference was statistically significant (P 0.05); B group before treatment, after the wedge degree change significantly, group comparison before and after treatment, the difference was significant. Posterior wedge change had significant difference (P 0.05); there was significant difference in the Cobb angle between the two groups after treatment (P 0.05); 3 According to the fracture healing time on X-ray, the average fracture healing time in group A was larger than that in group B, and the average fracture healing time in group B was larger than that in group B before treatment. The number of patients with primary healing was significantly higher than that of group A, and there was significant difference between the two groups (P 0.05). 4 The patients in the two groups were followed up by questionnaires after 12 weeks and 24 weeks respectively. The score of PRO was obtained by using the 100% thoracolumbar vertebral compression fracture efficacy evaluation scale. There were significant differences between the two groups (P 0.05). Conclusion: 1 Compared with the control group and the Zhanjin Huoxue Fang combined with the tower pad natural traction group, Zhanjin Huoxue Fang combined with the tower pad natural traction treatment of simple thoracolumbar vertebral compression fractures in the recovery of vertebral height and spinal physiological curvature recovery. Comparing the healing time of vertebral body fracture between the control group and the traditional conservative treatment group A, the healing time of simple thoracolumbar vertebral body fracture treated by the combination of the two groups was shorter than that of the conventional conservative treatment group A. The patients in the two groups were significantly shortened. 3 After two different treatment methods, the patients'satisfaction in the group of Zhanjin Huoxue Fang combined with natural towering pad was significantly higher than that in the group of conventional conservative treatment A.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R274.1
本文编号：2221211
[Abstract]:Objective:To observe the clinical effect of Zhanjin Huoxue Prescription combined with tower pad natural traction in the treatment of simple thoracolumbar vertebral compression fracture and explore the mechanism of Zhanjin Huoxue Prescription combined with tower pad natural traction in the treatment of simple thoracolumbar vertebral compression fracture. 80 patients with thoracolumbar fracture > were divided into two groups by random number table method, each group of 40 cases, respectively, group A: control group, group B: Zhanjin Huoxue Fang combined with natural traction tower pad group, group A 40 cases, 18 males, 22 females, the average age (?) + S below the same) 67.0 [5.1 years old; group B 40 cases, 14 males, 26 females. Group A was given Gukang Capsule orally for one week and then was given "five-point support" functional exercise under the guidance of doctors. Group B was given natural traction with tower pad and took Zhanjin Huoxue Recipe: Angelica sinensis 12g, Ligusticum Chuanxiong 10g, Achyranthes bidentata 9g, Fructus aurantii 15g, Curcuma Longae 15g, Qianghuo 15g, Dragon blood 10g, Fried Baizhu 20g, Poria Cocos 15g, etc. Radix Angelicae Dahuricae 15g, Musk 0.1g (Chong). Adjusted according to fracture stages, such as early swelling and pain relief plus: Hanfang-chi 20g, Fructus Aurantii 9g, Rhubarb 15g; mid-term Huoxue Huayu plus: peach kernel 10g, safflower 10g, red peony 15g; late tonifying liver and kidney plus: Gushubu 15g, intermittent 20g, ripe ground 15g, after one week in the hospital under the guidance of the "five-point support" method of functional exercise. Observational indices included the wedge degree of vertebral compression, the healing time t (unit: week), the Cobb angle of scoliosis, and the score of PRO scale for evaluating the curative effect of thoracolumbar vertebral compression fractures. Obb angle, observe the time of fracture healing of two groups of patients, and 12 weeks, 24 weeks after the follow-up of two groups of patients, statistical analysis of two groups of patients with PRO score, wedge change, Cobb angle, PRO score were compared between groups and within the group, fracture healing time was compared between the two groups before treatment. There was no significant difference in Cobb angle before and after treatment in group A. There was no significant change in Cobb angle before and after treatment in group A. There was no significant difference in Cobb angle before and after treatment in group B (P 0.05). Obb angle comparison has significant difference, with statistical significance (P 0.05); 2 groups of patients before treatment, wedge degree of no significant difference, no statistical significance; A group of patients before treatment, after the wedge degree of change, group comparison before treatment, after the wedge degree of difference was statistically significant (P 0.05); B group before treatment, after the wedge degree change significantly, group comparison before and after treatment, the difference was significant. Posterior wedge change had significant difference (P 0.05); there was significant difference in the Cobb angle between the two groups after treatment (P 0.05); 3 According to the fracture healing time on X-ray, the average fracture healing time in group A was larger than that in group B, and the average fracture healing time in group B was larger than that in group B before treatment. The number of patients with primary healing was significantly higher than that of group A, and there was significant difference between the two groups (P 0.05). 4 The patients in the two groups were followed up by questionnaires after 12 weeks and 24 weeks respectively. The score of PRO was obtained by using the 100% thoracolumbar vertebral compression fracture efficacy evaluation scale. There were significant differences between the two groups (P 0.05). Conclusion: 1 Compared with the control group and the Zhanjin Huoxue Fang combined with the tower pad natural traction group, Zhanjin Huoxue Fang combined with the tower pad natural traction treatment of simple thoracolumbar vertebral compression fractures in the recovery of vertebral height and spinal physiological curvature recovery. Comparing the healing time of vertebral body fracture between the control group and the traditional conservative treatment group A, the healing time of simple thoracolumbar vertebral body fracture treated by the combination of the two groups was shorter than that of the conventional conservative treatment group A. The patients in the two groups were significantly shortened. 3 After two different treatment methods, the patients'satisfaction in the group of Zhanjin Huoxue Fang combined with natural towering pad was significantly higher than that in the group of conventional conservative treatment A.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R274.1
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