84年鼠女哪年财运最旺,857comvvv色九欧美激情|85PO_87国产精品欲av国产av资源

[1]鄒光翼,陳佳琦,梁偉,等.畬藥活血通經(jīng)方外敷在旋后外旋型Ⅲ度、Ⅳ度踝關(guān)節(jié)骨折術(shù)后治療中的應(yīng)用及作用機(jī)制研究[J].中醫(yī)正骨,2020,32(12):31-37.
　ZOU Guangyi,CHEN Jiaqi,LIANG Wei,et al.A clinical study of external application of Huoxue Tongjing Fang(活血通經(jīng)方)to postoperative treatment of supination-extorsion-type gradeⅢandⅣankle fractures and its mechanism of action[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(12):31-37.
點(diǎn)擊復(fù)制

畬藥活血通經(jīng)方外敷在旋后外旋型Ⅲ度、Ⅳ度踝關(guān)節(jié)骨折術(shù)后治療中的應(yīng)用及作用機(jī)制研究()
分享到：

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

卷:
第32卷
期數(shù):
2020年12期
頁碼:
31-37
欄目:
臨床研究
出版日期:
2020-12-20

文章信息/Info

Title:
A clinical study of external application of Huoxue Tongjing Fang(活血通經(jīng)方)to postoperative treatment of supination-extorsion-type gradeⅢandⅣankle fractures and its mechanism of action
作者:
鄒光翼1; 陳佳琦1; 梁偉1; 鄢連和1; 朱美曉1; 魏永敏1; 王雙虎1; 耿培武1; 華愛蓮2; 葉靜1; 童培建3
(1.麗水市人民醫(yī)院,浙江 麗水 323000; 2.杭州市余杭區(qū)第一人民醫(yī)院,浙江 杭州 311100; 3.浙江省中醫(yī)院,浙江 杭州 310006)
Author(s):
ZOU Guangyi1; CHEN Jiaqi1; LIANG Wei1; YAN Lianhe1; ZHU Meixiao1; WEI Yongmin1; WANG Shuanghu1; GENG Peiwu1; HUA Ailian2; YE Jing1; TONG Peijian3
1.The People’s Hospital of Lishui City,Lishui 323000,Zhejiang,China
2.The First People’s Hospital of Yuhang,Hangzhou 311100,Zhejiang,China
3.Zhejiang Provincial Hospital of Traditional Chinese Medicine,Hangzhou 310006,Zhejiang,China
關(guān)鍵詞:
踝關(guān)節(jié);  骨折;  中藥外敷;  白細(xì)胞介素-6;  白細(xì)胞介素-10;  臨床試驗(yàn)
Keywords:
ankle joint;  fractures; bone;  external applications(TCD);  interleukin-6;  interleukin-10;  clinical trial
文獻(xiàn)標(biāo)志碼:
A
摘要:
目的:探討畬藥活血通經(jīng)方外敷在旋后外旋型Ⅲ度、Ⅳ度踝關(guān)節(jié)骨折術(shù)后治療中的應(yīng)用價(jià)值,并探討其作用機(jī)制。方法:將80例行切開復(fù)位鋼板內(nèi)固定術(shù)的旋后外旋型Ⅲ度、Ⅳ度踝關(guān)節(jié)骨折患者隨機(jī)分為2組,每組40例。常規(guī)治療組術(shù)后用支具固定并抬高患肢,給予常規(guī)抗感染治療; 術(shù)后第1天在手術(shù)切口周圍持續(xù)冰敷,每天4次,每次1 h; 并于術(shù)后第1天開始足趾屈伸功能鍛煉及踝關(guān)節(jié)功能鍛煉,每次15 min,每天4次,共4周。畬藥外敷組在常規(guī)治療的基礎(chǔ)上于術(shù)后第1天開始采用畬藥活血通經(jīng)方外敷患處,每日換藥1次,共4周。分別于術(shù)后第1天、第7天和第14天記錄并比較2組患者的足踝部疼痛視覺模擬量表(visual analogue scale,VAS)評(píng)分和足踝部周徑,分別于術(shù)后第1天、第90天和第180天記錄并比較2組患者的美國足與踝關(guān)節(jié)協(xié)會(huì)(American Orthopaedic Foot and Ankle Society,AOFAS)踝與后足功能評(píng)分,并分別于術(shù)后第1天、第7天和第14天記錄并比較2組患者的白細(xì)胞介素(interleukin,IL)-6、IL-10的血清含量。結(jié)果:①足踝部疼痛VAS評(píng)分。時(shí)間因素和分組因素存在交互效應(yīng)(F=1.430,P=0.000); 2組患者足踝部疼痛VAS評(píng)分總體比較,組間差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=2.144,P=0.033); 術(shù)后不同時(shí)間點(diǎn)足踝部疼痛VAS評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=215.900,P=0.000); 2組患者術(shù)后的足踝部疼痛VAS評(píng)分均呈降低趨勢(shì)[畬藥外敷組:(7.53&#177;1.58)分,(4.78&#177;1.17)分,(2.70&#177;1.24)分,F=129.700,P=0.000; 常規(guī)治療組:(7.45&#177;1.55)分,(5.65&#177;0.89)分,(3.70&#177;0.91)分,F=104.600,P=0.000],但2組的變化趨勢(shì)不完全一致; 術(shù)后第1天2組患者足踝部疼痛VAS評(píng)分的差異無統(tǒng)計(jì)學(xué)意義(t=0.214,P=0.831); 術(shù)后第7天、第14天畬藥外敷組足踝部疼痛VAS評(píng)分均低于常規(guī)治療組(t=3.769,P=0.000; t=4.100,P=0.000)。②足踝部周徑。時(shí)間因素和分組因素存在交互效應(yīng)(F=107.200,P=0.000); 2組患者足踝部周徑總體比較,組間差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=3.105,P=0.002); 術(shù)后不同時(shí)間點(diǎn)足踝部周徑的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=1.496,P=0.029); 2組患者術(shù)后的足踝部周徑均呈降低趨勢(shì)[畬藥外敷組:(28.39&#177;0.83)cm,(27.07&#177;0.81)cm,(25.78&#177;0.57)cm,F=108.800,P=0.000; 常規(guī)治療組:(28.31&#177;0.85)cm,(27.53&#177;0.90)cm,(26.84&#177;0.91)cm,F=27.520,P=0.000],但2組的變化趨勢(shì)不完全一致; 術(shù)后第1天2組患者足踝部周徑的差異無統(tǒng)計(jì)學(xué)意義(t=0.439,P=0.662); 術(shù)后第7天、第14天畬藥外敷組足踝部周徑均小于常規(guī)治療組(t=2.368,P=0.020; t=6.240,P=0.000)。③AOFAS踝與后足功能評(píng)分。時(shí)間因素和分組因素存在交互效應(yīng)(F=1.430,P=0.000); 2組患者AOFAS踝與后足功能評(píng)分總體比較,組間差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=4.913,P=0.000); 術(shù)后不同時(shí)間點(diǎn)AOFAS踝與后足功能評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=1.668,P=0.000); 2組患者術(shù)后的AOFAS踝與后足功能評(píng)分均呈上升趨勢(shì)[畬藥外敷組:(34.50&#177;3.24)分,(80.83&#177;3.61)分,(85.78&#177;3.53)分,F=2 669.000,P=0.000; 常規(guī)治療組:(34.48&#177;3.14)分,(74.13&#177;4.33)分,(83.88&#177;4.31)分,F=1 741.000,P=0.000],但2組的變化趨勢(shì)不完全一致; 術(shù)后第1天2組患者AOFAS踝與后足功能評(píng)分的差異無統(tǒng)計(jì)學(xué)意義(t=0.035,P=0.972); 術(shù)后第90天、第180天畬藥外敷組AOFAS踝與后足功能評(píng)分均高于常規(guī)治療組(t=7.514,P=0.000; t=4.100,P=0.034)。④IL-10血清含量。時(shí)間因素和分組因素存在交互效應(yīng)(F=1.373,P=0.006); 2組患者IL-10血清含量總體比較,組間差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=3.092,P=0.003); 術(shù)后不同時(shí)間點(diǎn)IL-10血清含量的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=22.080,P=0.000); 2組患者術(shù)后的IL-10血清含量均呈下降趨勢(shì)[畬藥外敷組:(73.07&#177;17.65)pg·mL<sup>-1</sup>,(54.60&#177;7.43)pg·mL<sup>-1</sup>,(46.68&#177;4.92)pg·mL<sup>-1</sup>,F=18.310,P=0.000; 常規(guī)治療組:(74.25&#177;13.41)pg·mL<sup>-1</sup>,(64.31&#177;13.08)pg·mL<sup>-1</sup>,(55.16&#177;11.79)pg·mL<sup>-1</sup>,F=7.260,P=0.002],但2組的變化趨勢(shì)不完全一致; 術(shù)后第1天2組患者IL-10血清含量的差異無統(tǒng)計(jì)學(xué)意義(t=0.192,P=0.849); 術(shù)后第7天、第14天畬藥外敷組IL-10血清含量均低于常規(guī)治療組(t=2.328,P=0.029; t=2.395,P=0.025)。⑤IL-6血清含量。時(shí)間因素和分組因素存在交互效應(yīng)(F=1.207,P=0.005); 2組患者IL-6血清含量總體比較,組間差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=2.797,P=0.007); 術(shù)后不同時(shí)間點(diǎn)IL-6血清含量的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=18.680,P=0.000); 2組患者術(shù)后的IL-6血清含量均呈下降趨勢(shì)[畬藥外敷組:(13.05&#177;3.50)pg·mL<sup>-1</sup>,(10.04&#177;2.24)pg·mL<sup>-1</sup>,(8.25&#177;1.91)pg·mL<sup>-1</sup>,F=10.960,P=0.000; 常規(guī)治療組:(13.83&#177;2.62)pg·mL<sup>-1</sup>,(11.90&#177;2.23)pg·mL<sup>-1</sup>,(9.96&#177;2.15)pg·mL<sup>-1</sup>,F=8.898,P=0.001],但2組的變化趨勢(shì)不完全一致; 術(shù)后第1天患者IL-6血清含量的差異無統(tǒng)計(jì)學(xué)意義(t=0.644,P=0.526); 術(shù)后第7天、第14天畬藥外敷組IL-6血清含量均低于常規(guī)治療組(t=2.124,P=0.044; t=2.138,P=0.043)。結(jié)論:對(duì)于旋后外旋型Ⅲ度、Ⅳ度踝關(guān)節(jié)骨折患者,術(shù)后應(yīng)用畬藥活血通經(jīng)方外敷治療,與單純常規(guī)治療相比,能更好地緩解足踝部疼痛,減輕足踝部腫脹,促進(jìn)踝關(guān)節(jié)功能的恢復(fù); 其作用機(jī)制可能是通過降低IL-10和IL-6血清含量,從而減輕了炎癥反應(yīng)。
Abstract:
To explore the applied values of external application of Huoxue Tongjing Fang(活血通經(jīng)方,HXTJF)to postoperative treatment of supination-extorsion-type gradeⅢandⅣankle fractures and to explore its mechanism of action.Methods:Eighty patients who received open reduction and plate internal fixation for treatment of supination-extorsion-type gradeⅢandⅣankle fractures were selected and randomly divided into conventional therapy group and HXTJF external application group,40 cases in each group.All patients in the 2 groups were treated with orthosis fixation,raising the injured limbs and anti-infection after the surgery,and the continuous ice compress was performed around the surgical incision on the postoperative day 1,four times a day,1 hour at a time.Meanwhile,all patients were instructed to perform toes flexion and extension functional exercises and ankle functional exercises since the postoperative day 1,four times a day,15 minutes at a time for consecutive 4 weeks.Moreover,the patients in HXTJF external application group were treated with external application of HXTJF at the fractured parts since the postoperative day 1,and the dressings chang were performed once a day for 4 weeks.The ankle pain visual analogue scale(VAS)scores,ankle circumferences and the serum contents of interleukin(IL)-6 and IL-10 were recorded and compared between the 2 groups on postoperative day 1,7 and 14 respectively.The American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot function scores were recorded and compared between the 2 groups on postoperative day 1,90 and 180 respectively.Results:There was interaction between time factor and group factor in ankle pain VAS scores(F=1.430,P=0.000).There was statistical difference in ankle pain VAS scores between the 2 groups in general,in other words,there was group effect(F=2.144,P=0.033).There was statistical difference in ankle pain VAS scores between different timepoints after the surgery,in other words,there was time effect(F=215.900,P=0.000).The postoperative ankle pain VAS scores presented a time-dependent decreasing trend in the 2 groups(HXTJF external application group:7.53+/-1.58,4.78+/-1.17,2.70+/-1.24 points,F=129.700,P=0.000; conventional therapy group:7.45+/-1.55,5.65+/-0.89,3.70+/-0.91 points,F=104.600,P=0.000),while the 2 groups were inconsistent with each other in the variation tendency.There was no statistical difference in ankle pain VAS scores between the 2 groups on postoperative day 1(t=0.214,P=0.831).The ankle pain VAS scores were lower in HXTJF external application group compared to conventional therapy group on postoperative day 7 and 14(t=3.769,P=0.000; t=4.100,P=0.000).There was interaction between time factor and group factor in ankle circumferences(F=107.200,P=0.000).There was statistical difference in ankle circumferences between the 2 groups in general,in other words,there was group effect(F=3.105,P=0.002).There was statistical difference in ankle circumferences between different timepoints after the surgery,in other words,there was time effect(F=1.496,P=0.029).The postoperative ankle circumferences presented a time-dependent decreasing trend in the 2 groups(HXTJF external application group:28.39+/-0.83,27.07+/-0.81,25.78+/-0.57 cm,F=108.800,P=0.000; conventional therapy group:28.31+/-0.85,27.53+/-0.90,26.84+/-0.91 cm,F=27.520,P=0.000),while the 2 groups were inconsistent with each other in the variation tendency.There was no statistical difference in ankle circumferences between the 2 groups on postoperative day 1(t=0.439,P=0.662).The ankle circumferences were smaller in HXTJF external application group compared to conventional therapy group on postoperative day 7 and 14(t=2.368,P=0.020; t=6.240,P=0.000).

參考文獻(xiàn)/References:

[1] THUR C K,EDGREN G,JANSSON K A,et al.Epidemiology of adult ankle fractures in Sweden between 1987 and 2004:a population-based study of 91,410 Swedish inpatients[J].Acta Orthop,2012,83(3):276-281.
[2] HARAGUCHI N,TOGA H,SHIBA N,et al.Avulsion of the lateral ankle ligament complex in severe inversion injury:incidence and clinical outcome[J].Am J Sports Med,2007,35(7):1144-1152.
[3] COURT-BROWN C M,CAESAR B.Epidemiology of adult fractures:A review[J].Injury,2006,37(8):691-697.
[4] 劉云鵬,劉沂.骨與關(guān)節(jié)損傷和疾病的診斷分類及功能評(píng)定標(biāo)準(zhǔn)[M].北京:清華大學(xué)出版社,2002:95-96.
[5] WOLFSTADT J I,PINCUS D,KREDER H J,et al.Association between socioeconomic deprivation and surgical complications in adults undergoing ankle fracture fixation:a population-based analysis[J].Can J Surg,2019,62(5):320-327.
[6] BOHL D D,IDARRAGA A J,HOLMES G B Jr,et al.Validated risk-stratification system for prediction of early adverse events following open reduction and internal fixation of closed ankle fractures[J].J Bone Joint Surg Am,2019,101(19):1768-1774.
[7] 胥少汀,葛寶豐,徐印坎.實(shí)用骨科學(xué)[M].4版.北京:人民軍醫(yī)出版社,2014:1064-1065.
[8] VAN LIESHOUT E M,DE BOER A S,MEUFFELS D E,et al.American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score:a study protocol for the translation and validation of the dutch language version[J].BMJ Open,2017,7(2):e012884.
[9] HAN S M,WU T H,WEN J X,et al.Radiographic analysis of adult ankle fractures using combined Danis-Weber and Lauge-Hansen classification systems[J].Sci Rep,2020,10(1):7655.
[10] BOSZCZYK A,FUDALEJ M,KWAPISZ S,et al.Ankle fracture-Correlation of Lauge-Hansen classification and patient reported fracture mechanism[J].Forensic Sci Int,2018,282:94-100.
[11] 王澤鴻,雷奶善.畬醫(yī)經(jīng)筋診療慢性軟組織損傷[J].中國民族民間醫(yī)藥雜志,2007,88(5):292-293.
[12] 雷后興,李水福.中國畬族醫(yī)藥學(xué)[M].北京:中國中醫(yī)藥出版社,2007:90-104.
[13] 鄭玉石.中藥外敷和薰洗治療第五跖骨基底部骨折[J].中醫(yī)正骨,2019,31(11):26-30.
[14] 蘭偉紅,魏嵐,陳麗麗.中藥外敷聯(lián)合功能鍛煉在髕骨骨折術(shù)后護(hù)理中的應(yīng)用[J].中醫(yī)正骨,2019,31(5):77-78.
[15] 孫京濤,劉宏建,魏瑄,等.電針聯(lián)合三七消腫止痛散外敷在全膝關(guān)節(jié)置換術(shù)后快速康復(fù)中的應(yīng)用[J].中醫(yī)正骨,2017,29(3):10-13.
[16] 彭玉蘭,周英,王英.分步手法復(fù)位肘關(guān)節(jié)外翻位固定聯(lián)合外用中藥治療嬰幼兒肱骨髁上骨折[J].中醫(yī)正骨,2015,27(4):56-58.
[17] 龔志兵,莊至坤,張煥堂,等.骨散外敷治療急性踝關(guān)節(jié)扭傷氣滯血瘀證的臨床研究[J].中醫(yī)正骨,2018,30(12):13-17.
[18] 孫洪林.手法聯(lián)合中藥外敷治療急性踝關(guān)節(jié)扭傷[J].中醫(yī)正骨,2017,29(6):65-66.
[19] ADAMS S B,SETTON L A,BELL R D,et al.Inflammatory cytokines and matrix metalloproteinases in the synovial fluid after intra-articular ankle fractures[J].Foot Ankle Int,2015,36(11):1264-1271.
[20] FURMAN B D,KIMMERLING K A,ZURA R D,et al.Articular ankle fracture results in increased synovitis, synovial macrophage infiltration, and synovial fluid concentrations of inflammatory cytokines and chemokines[J].Arthritis Rheumatol,2015,67(5):1234-1239.
[21] GODOY-SANTOS A L,RANZONI L,TEODORO W R,et al.Increased cytokine levels and histological changes in cartilage,synovial cells and synovial fluid after malleolar fractures[J].Injury,2017,48(Suppl 4):S27-S33.

相似文獻(xiàn)/References:

[1]許兵,葉小雨,王蕭楓,等.小管徑經(jīng)皮椎體后凸成形術(shù)治療 骨質(zhì)疏松性椎體重度壓縮骨折[J].中醫(yī)正骨,2015,27(11):29.
[2]方華宴,李興華,王愛國.手術(shù)治療踝關(guān)節(jié)骨折手術(shù)失敗導(dǎo)致的復(fù)雜陳舊性踝關(guān)節(jié)脫位[J].中醫(yī)正骨,2015,27(11):45.
[3]王 強(qiáng).脛腓下聯(lián)合骨牽引配合手法整復(fù)小夾板外固定治療 兒童閉合移位性股骨干骨折[J].中醫(yī)正骨,2015,27(10):15.
[4]田正強(qiáng).消腫止痛散外敷聯(lián)合繃帶固定治療急性踝關(guān)節(jié)扭傷[J].中醫(yī)正骨,2015,27(10):28.
[5]全先輝,萬春友,劉磊,等.Taylor空間支架外固定治療脛腓骨開放性骨折[J].中醫(yī)正骨,2015,27(10):30.
[6]袁偉,周曉莉.T形掌指骨微型鋼板內(nèi)固定治療鎖骨近端骨折[J].中醫(yī)正骨,2015,27(10):47.
[7]白晨平.微型鋼板內(nèi)固定治療掌指骨骨折[J].中醫(yī)正骨,2015,27(08):26.
[8]何 濤.帶尾孔髕骨針聯(lián)合纜索內(nèi)固定系統(tǒng)治療閉合性髕骨骨折[J].中醫(yī)正骨,2015,27(08):41.
[9]董正超,姚新苗.髕骨骨折的分型及內(nèi)固定治療進(jìn)展[J].中醫(yī)正骨,2015,27(08):58.
[10]李時(shí)軍,丁文軍,劉立春.恥骨下支應(yīng)力性骨折1例[J].中醫(yī)正骨,2015,27(08):74.
[11]江濤,江林,史俊德,等.動(dòng)氣針法在踝關(guān)節(jié)骨折術(shù)后中后期康復(fù)中的應(yīng)用[J].中醫(yī)正骨,2015,27(11):20.
　JIANG Tao,JIANG Lin,SHI Junde,et al.Application of Dongqi acupuncture(動(dòng)氣針法)to postoperative rehabilitation in the middle-late period in patients with ankle joint fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(12):20.
[12]朱彥昭,申成春,蔣麗娜,等.早期手術(shù)修復(fù)踝關(guān)節(jié)骨折合并的三角韌帶完全斷裂[J].中醫(yī)正骨,2015,27(08):46.
[13]劉 超.續(xù)骨活血湯和接骨紫金丹在三踝骨折治療中的應(yīng)用[J].中醫(yī)正骨,2015,27(06):57.
[14]李光陽,吳祥宗,陶志東,等.改良外側(cè)入路在三踝骨折切開復(fù)位內(nèi)固定術(shù)中的應(yīng)用[J].中醫(yī)正骨,2015,27(05):48.
[15]徐善強(qiáng),巫宗德,徐強(qiáng),等.經(jīng)皮微創(chuàng)內(nèi)固定術(shù)治療C型Danis-Weber踝關(guān)節(jié)骨折[J].中醫(yī)正骨,2016,28(02):49.
[16]趙洪濤.鎖定鋼板聯(lián)合拉力螺釘內(nèi)固定治療踝關(guān)節(jié)骨折合并下脛腓分離[J].中醫(yī)正骨,2017,29(03):67.
[17]王慧彪,塔依爾·牙合甫.切開復(fù)位內(nèi)固定治療旋后、旋前外旋型Ⅳ度踝關(guān)節(jié)骨折[J].中醫(yī)正骨,2017,29(10):78.
[18]尚林,王翔宇,王愛國,等.旋后內(nèi)收型Ⅱ度踝關(guān)節(jié)骨折術(shù)后內(nèi)踝固定失敗原因分析及對(duì)策[J].中醫(yī)正骨,2019,31(03):75.
[19]鄒光翼,梁偉,周崇斌,等.脛骨遠(yuǎn)端后側(cè)多向鎖定鋼板在旋后外旋型Ⅳ度踝關(guān)節(jié)骨折治療中的應(yīng)用[J].中醫(yī)正骨,2019,31(07):58.
[20]畢海亮,張起,古恩鵬,等.梯-塔墊在手法復(fù)位石膏托和夾板外固定治療旋后外旋型踝關(guān)節(jié)骨折中的應(yīng)用[J].中醫(yī)正骨,2019,31(07):62.

備注/Memo

備注/Memo:
基金項(xiàng)目:麗水市科技計(jì)劃項(xiàng)目(2016GYX45)
通訊作者:鄒光翼 E-mail:176019634@qq.com
更新日期/Last Update: 2021-06-17