小腿开放性骨折游离骨块回植术后口服骨伤复元汤的临床疗效观察
发布时间：2018-11-06 10:57
【摘要】：目的：观察骨伤复元汤应用于小腿开放性骨折游离骨块回植术后的临床疗效。方法：30例符合诊断标准及纳入标准的小腿开放性骨折患者,采用随机对照试验的分组方法,根据入院顺序随机分为试验组15例,对照组15例。所有病例均对伤肢进行一期清创手术,内固定或外固定支架固定骨折后,将游离骨块颗粒化与富血小板血浆(PRP)混合回植于骨缺损处,再将抗生素骨水泥链珠置入骨折端周围,闭合伤口。试验组术后第1天开始服用骨伤复元汤,连续服用6周；对照组未服用。所有患者在术后第2周,第3周于骨块回植部位再次注射PRP。两组患者于术后第2天、第4天、第7天评估并记录术后疼痛评分；于术后第1天,第3天,第7天测量计算并记录患肢肢体肿胀度；于术后第1天,第7天抽取晨起空腹静脉血,测定并记录血液流变学指标；于术后第1天、第2周、第3周、第4周测定并记录血清中碱性磷酸酶(ALP)含量；于术后第6周、第10周、第16周、第24周拍摄X线片,评定并记录骨痂生长情况。随访记录两组患者骨愈合时间。结果：术后随访10个月,所有患者均完成随访。所有病例骨折端均愈合,愈合时间为4-8个月,平均6.1个月。3例在治疗过程中出现伤口红肿,血象升高,对症给予敏感抗生素治疗后症状消失。两组患者术后第2天,第4天疼痛评分无统计学差异,术后第7天试验组与对照组疼痛评分均降低,试验组明显低于对照组,具有统计学意义(P0.05)。两组患者术后第1天,第3天患肢肿胀度无统计学差异,术后第7天试验组患肢肿胀度明显低于对照组,‘具有统计学意义(P0.05)。术后第7天试验组血液流变学指标明显低于对照组,差异具有统计学意义(P0.05)。术后第2周,第3周,第4周试验组与对照组血清中碱性磷酸酶均升高,两组比较差异有统计学意义(P0.05)。术后第6周、第10周、第16周和第24周试验组的骨痂生长情况评分高于对照组；试验组的骨愈合时间平均值低于对照组,并且统计学上有显著性差异(P0.05)。结论：骨伤复元汤能减缓患者术后疼痛,减轻患者肢体肿胀,改善骨折端血液循环,促进回植骨块骨痂生长,缩短骨折的临床愈合时间,用于小腿开放性骨折游离骨块回植术后临床疗效确切。
[Abstract]:Objective: to observe the clinical effect of Fuyuan decoction on open fracture of lower leg after free bone mass replantation. Methods: thirty patients with open fracture of the leg who met the diagnostic criteria and included the criteria were randomly divided into trial group (n = 15) and control group (n = 15) according to the admission order. All the patients underwent primary debridement of the injured limb. After the fracture was fixed with internal or external fixator, the free bone granulation and platelet-rich plasma (PRP) were mixed back into the bone defect. Then the antibiotic bone cement chain beads were placed around the fracture end to close the wound. The experimental group took Gushangfuyuan decoction on the first day after operation for 6 weeks, while the control group did not. All patients were re-injected with PRP. at the site of bone graft replantation at week 2 and week 3 after operation. The pain scores were evaluated and recorded on the 2nd, 4th and 7th day after operation, and the swelling degree of the affected limbs was calculated and recorded on the 1st, 3rd and 7th day after operation. The serum alkaline phosphatase (ALP) levels were measured and recorded on the first day, the second week, the third week, the fourth week after the operation, and the fasting venous blood samples were taken from the first day, the seventh day after the operation, and the blood rheological indexes were measured and recorded. X-ray films were taken at 6 weeks, 10 weeks, 16 weeks and 24 weeks after operation to evaluate and record callus growth. Bone healing time was recorded in both groups. Results: all patients were followed up for 10 months. The healing time was 4-8 months with an average of 6.1 months. 3 cases showed redness and swelling in the wound and increased blood image. The symptoms disappeared after the treatment with sensitive antibiotics. There was no significant difference in pain score between the two groups on the second day and the fourth day after operation. On the 7th day after operation, the pain scores of the trial group and the control group were all decreased, which was significantly lower than that of the control group (P0.05). There was no statistical difference between the two groups on the first day and the third day after operation, but on the 7th day after operation, the swelling degree of the affected limb in the experimental group was significantly lower than that in the control group (P0.05). On the 7th day after operation, the hemorheological indexes in the experimental group were significantly lower than those in the control group (P0.05). After 2 weeks, 3 weeks, 4 weeks after operation, the serum alkaline phosphatase in the experimental group and the control group were increased, the difference between the two groups was statistically significant (P0.05). At the 6th week, 10th week, 16th week and 24th week after operation, the callus growth score in the experimental group was higher than that in the control group; the average bone healing time in the experimental group was lower than that in the control group, and there was statistically significant difference (P0.05). Conclusion: Fuyuan decoction can relieve postoperative pain, reduce limb swelling, improve blood circulation at fracture end, promote callus growth of bone graft, and shorten the healing time of fracture. The clinical effect of free bone mass replantation for open fracture of lower leg is definite.
【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】：2016
【分类号】：R274.1
本文编号：2314072
[Abstract]:Objective: to observe the clinical effect of Fuyuan decoction on open fracture of lower leg after free bone mass replantation. Methods: thirty patients with open fracture of the leg who met the diagnostic criteria and included the criteria were randomly divided into trial group (n = 15) and control group (n = 15) according to the admission order. All the patients underwent primary debridement of the injured limb. After the fracture was fixed with internal or external fixator, the free bone granulation and platelet-rich plasma (PRP) were mixed back into the bone defect. Then the antibiotic bone cement chain beads were placed around the fracture end to close the wound. The experimental group took Gushangfuyuan decoction on the first day after operation for 6 weeks, while the control group did not. All patients were re-injected with PRP. at the site of bone graft replantation at week 2 and week 3 after operation. The pain scores were evaluated and recorded on the 2nd, 4th and 7th day after operation, and the swelling degree of the affected limbs was calculated and recorded on the 1st, 3rd and 7th day after operation. The serum alkaline phosphatase (ALP) levels were measured and recorded on the first day, the second week, the third week, the fourth week after the operation, and the fasting venous blood samples were taken from the first day, the seventh day after the operation, and the blood rheological indexes were measured and recorded. X-ray films were taken at 6 weeks, 10 weeks, 16 weeks and 24 weeks after operation to evaluate and record callus growth. Bone healing time was recorded in both groups. Results: all patients were followed up for 10 months. The healing time was 4-8 months with an average of 6.1 months. 3 cases showed redness and swelling in the wound and increased blood image. The symptoms disappeared after the treatment with sensitive antibiotics. There was no significant difference in pain score between the two groups on the second day and the fourth day after operation. On the 7th day after operation, the pain scores of the trial group and the control group were all decreased, which was significantly lower than that of the control group (P0.05). There was no statistical difference between the two groups on the first day and the third day after operation, but on the 7th day after operation, the swelling degree of the affected limb in the experimental group was significantly lower than that in the control group (P0.05). On the 7th day after operation, the hemorheological indexes in the experimental group were significantly lower than those in the control group (P0.05). After 2 weeks, 3 weeks, 4 weeks after operation, the serum alkaline phosphatase in the experimental group and the control group were increased, the difference between the two groups was statistically significant (P0.05). At the 6th week, 10th week, 16th week and 24th week after operation, the callus growth score in the experimental group was higher than that in the control group; the average bone healing time in the experimental group was lower than that in the control group, and there was statistically significant difference (P0.05). Conclusion: Fuyuan decoction can relieve postoperative pain, reduce limb swelling, improve blood circulation at fracture end, promote callus growth of bone graft, and shorten the healing time of fracture. The clinical effect of free bone mass replantation for open fracture of lower leg is definite.
【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】：2016
【分类号】：R274.1
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