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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:

第26卷

期數(shù):

2014年01期

頁碼:

38-42

欄目:

臨床研究

出版日期:

2014-01-28

文章信息/Info

Title:

Observation on the curative effect of pelvic traction in prone position combined with manipulative reduction on thoracolumbar compression fracture

作者:

高宏文; 唐志榮; 陳景宇; 顧海洋; 張譯文

江蘇省射陽縣中醫(yī)院,江蘇 射陽 224300

Author(s):

Gao Hongwen^*; Tang Zhirong; Chen Jingyu; Gu Haiyang; Zhang Yiwen.

^*Traditional Chinese Medical Hospital of Sheyang county,Sheyang 224300,Jiangsu,China

關(guān)鍵詞:

脊柱骨折 骨折; 壓縮性 胸椎 腰椎 骨牽引復(fù)位法 正骨手法 治療; 臨床研究性

Keywords:

Spinal fractures;  Fractures;  compression;  Thoracic vertebrae;  Lumbar vertebrae;  Skeletal tracting reposition;  Bone setting manipulation;  Therapies; investigational

摘要:

目的:探討俯臥位骨盆牽引下手法復(fù)位治療胸腰椎單純壓縮骨折的臨床療效。方法:將符合要求的78例胸腰椎單純壓縮骨折患者隨機(jī)分為2組,治療組41例,采用俯臥位骨盆牽引下手法復(fù)位治療; 對(duì)照組37例,采用臥硬板床腰背部墊軟枕治療。2組患者均同時(shí)按照骨折三期辨證用藥原則服用中藥治療,并進(jìn)行腰背部功能鍛煉。分別于治療前、治療后2周、治療后1個(gè)月及治療后6個(gè)月,測定2組患者脊柱后凸Cobb's角和傷椎前緣高度,同時(shí)于治療后6個(gè)月采用口述分級(jí)評(píng)分法評(píng)定患者的腰部疼痛情況,參照《中醫(yī)病證診斷療效標(biāo)準(zhǔn)》中胸腰椎骨折的療效評(píng)定標(biāo)準(zhǔn)評(píng)定患者的總體療效。結(jié)果:①腰部疼痛。治療組0級(jí)32例、1級(jí)8例、2級(jí)1例,對(duì)照組0級(jí)22例、1級(jí)12例、2級(jí)2例、3級(jí)1例。2組患者的腰部疼痛程度比較,差異無統(tǒng)計(jì)學(xué)意義[R^-_治療組=0.454,95%CI(0.389,0.519); R^-_{對(duì)照組}=0.551,95%CI(0.466,0.636)]。②脊柱后凸Cobb's角。治療前后不同時(shí)間Cobb's角的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)[治療組:(18.40°±0.94°),(5.00°±0.92°),(4.30°±0.98°),(3.90°±0.45°),對(duì)照組:(18.10°±1.21°),(8.10°±1.02°),(7.80°±1.01°),(7.60°±0.82°),F=14.573,P=0.017]; 2組患者Cobb's角的組間差異總體上有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=22.350,P=0.008),除治療前外(t=0.973,P=0.139),其余各時(shí)點(diǎn)對(duì)照組的Cobb's角均大于治療組(t=20.573,P=0.007; t=22.840,P=0.005; t=22.350,P=0.003); 時(shí)間因素和分組因素之間存在交互效應(yīng)(F=11.567,P=0.012)。③傷椎前緣高度。治療前后不同時(shí)間傷椎前緣高度的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)[治療組:(11.70±0.78)mm,(18.90±0.22)mm,(18.90±0.26)mm,(18.90±0.36)mm,對(duì)照組:(11.70±0.68)mm,(13.10±1.02)mm,(13.90±0.23)mm,(13.90±0.24)mm,F=14.553,P=0.014]; 2組患者傷椎前緣高度的組間差異總體上有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=14.670,P=0.016),除治療前外(t=0.987,P=0.175),其余各時(shí)點(diǎn)對(duì)照組的傷椎前緣高度均小于治療組(t=13.654,P=0.018; t=13.986,P=0.017; t=18.535,P=0.014); 時(shí)間因素和分組因素之間存在交互效應(yīng)(F=12.597,P=0.011)。④總體療效。治療組治愈36例、好轉(zhuǎn)3例、未愈2例,對(duì)照組治愈29例、好轉(zhuǎn)4例、未愈4例。2組患者的總體療效比較,差異無統(tǒng)計(jì)學(xué)意義[R^-_治療組=0.477,95%CI(0.425,0.529); R^-_{對(duì)照組}=0.525,95%CI(0.455,0.596)]。結(jié)論:俯臥位骨盆牽引下手法復(fù)位可有效緩解胸腰椎單純壓縮骨折患者的腰背部疼痛癥狀,在糾正脊柱后凸畸形、恢復(fù)傷椎前緣高度方面療效優(yōu)于臥硬板床腰背部墊軟枕療法,是治療該病的有效方法。

Abstract:

Objective:To observe the clinical effects of pelvic traction in prone position combined with manipulative reduction on thoracolumbar compression fracture.Methods:Seventy-eight patients with thoracolumbar compression fracture who met the requirement were randomly divided into 2 groups,41 patients(treatment group)were treated with pelvic traction in prone position combined with manipulative reduction,while 37 patients(control group)were ordered to stay in hard bed with a soft pillow under the low back.Meanwhile,the patients in both of the 2 groups were treated with low back functional exercise and oral application of traditional Chinese medicine according to syndrome differentiation principles.The Cobb angle and the anterior border height of injured vertebrae were measured in both of the 2 groups before the treatment and at 2 weeks and 1 and 6 months after the treatment respectively.The low back pain were evaluated according to verbal rating scale,and the total curative effect were also evaluated according to Standard for diagnosis and therapeutic effectiveness evaluation of traditional Chinese medicine syndromes 6 months after the treatment.Results:Thirty-two patients were categorized as grade 0,8 patients as gradeⅠ,1 patients as gradeⅡin treatment group,while 22 patients were categorized as grade 0,12 patients as gradeⅠ,2 patients as gradeⅡand 1 patients as gradeⅢin control group.There was no statistical difference in the low back pain degree between the 2 groups(treatment group:(-overR)=0.454,95%CI 0.389 to 0.519; control group:(-overR)=0.551,95%CI 0.466 to 0.636).There was statistical difference in kyphosis Cobb angle between different time points,in other words,there was time effect(treatment group:18.40+/-0.94,5.00+/-0.92,4.30+/-0.98,3.90+/-0.45 degrees; control group:18.10+/-1.21,8.10+/-1.02,7.80+/-1.01,7.60+/-0.82 degrees; F=14.573,P=0.017).There was statistical difference in kyphosis Cobb angle between the 2 groups in general,in other words,there was grouping effect(F=22.350,P=0.008).The kyphosis Cobb angle of control group was higher than that of treatment group at posttreatment timepoints(t=20.573,P=0.007; t=22.840,P=0.005; t=22.350,P=0.003)except at pretreatment point(t=0.973,P=0.139).There was interaction between time factor and grouping factor(F=11.567,P=0.012).There was statistical difference in anterior border height of injured vertebrae between different time points,in other words,there was time effect(treatment group:11.70+/-0.78,18.90+/-0.22,18.90+/-0.26,18.90+/-0.36 mm; control group:11.70+/-0.68,13.10+/-1.02,13.90+/-0.23,13.90+/-0.24 mm; F=14.553,P=0.014).There was statistical difference in anterior border height of injured vertebrae between the 2 groups in general,in other words,there was grouping effect(F=14.670,P=0.016).The anterior border height of injured vertebrae of control group was less than that of treatment group at posttreatment timepoints(t=13.654,P=0.018; t=13.986,P=0.017; t=18.535,P=0.014)except at pretreatment point(t=0.987,P=0.175).There was interaction between time factor and grouping factor(F=12.597,P=0.011).Thirty-six patients obtained an excellent result,3 good and 2 poor in the treatment group; while 29 patients obtained an excellent result,4 good and 4 poor in the control group.There was no statistical difference in total curative effect between the 2 groups(treatment group:(-overR)=0.477,95%CI 0.425 to 0.529; control group:(-overR)=0.525,95%CI 0.455 to 0.596).Conclusion:The therapy of pelvic traction in prone position combined with manipulative reduction can relieve the low back pain effectively,and it surpassed the therapy of staying in hard bed with a soft pillow under the low back in kyphotic deformity correction and injured vertebral anterior border height restoration,so it is an effective method in the treatment of simplex thoracolumbar compression fracture.

備注/Memo

備注/Memo:

基金項(xiàng)目:江蘇省鹽城市科技計(jì)劃項(xiàng)目(YK2012087)

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更新日期/Last Update: 2014-01-20