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[1]王琪,郭磊,白平,等.益氣續(xù)骨合劑加蟲(chóng)類通絡(luò)方在踝關(guān)節(jié)骨折術(shù)后康復(fù)治療中的應(yīng)用[J].中醫(yī)正骨,2021,33(07):17-22.
　WANG Qi,GUO Lei,BAI Ping,et al.Application of Yiqi Xugu Heji(益氣續(xù)骨合劑)and Chonglei Tongluo Fang(蟲(chóng)類通絡(luò)方)to postoperative anke rehabilitation in patients with ankle fractures:a clinical study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(07):17-22.
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益氣續(xù)骨合劑加蟲(chóng)類通絡(luò)方在踝關(guān)節(jié)骨折術(shù)后康復(fù)治療中的應(yīng)用()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期數(shù):
2021年07期
頁(yè)碼:
17-22
欄目:
臨床研究
出版日期:
2021-07-20

文章信息/Info

Title:
Application of Yiqi Xugu Heji(益氣續(xù)骨合劑)and Chonglei Tongluo Fang(蟲(chóng)類通絡(luò)方)to postoperative anke rehabilitation in patients with ankle fractures:a clinical study
作者:
王琪; 郭磊; 白平; 王濤; 郭英; 李克鋒; 溫輝; 黃文澤
(昆明市中醫(yī)醫(yī)院,云南 昆明 650599)
Author(s):
WANG Qi; GUO Lei; BAI Ping; WANG Tao; GUO Ying; LI Kefeng; WEN Hui; HUANG Wenze
Kunming Municipal Hospital of Traditional Chinese Medicine,Kunming 650599,Yunnan,China
關(guān)鍵詞:
骨折;  踝關(guān)節(jié);  中醫(yī)康復(fù);  益氣續(xù)骨合劑;  蟲(chóng)類通絡(luò)方
Keywords:
fractures; bone;  ankle joint;  rehabilitation(TCM);  Yiqi Xugu Heji;  Chonglei Tongluo Fang
摘要:
目的:探討益氣續(xù)骨合劑加蟲(chóng)類通絡(luò)方在踝關(guān)節(jié)骨折術(shù)后康復(fù)治療中的應(yīng)用價(jià)值。方法:踝關(guān)節(jié)骨折患者60例,隨機(jī)分為2組,每組30例。2組患者均行切開(kāi)復(fù)位鋼板內(nèi)固定手術(shù)治療,術(shù)后均行常規(guī)踝關(guān)節(jié)功能康復(fù)鍛煉。術(shù)后第2天起,分別給予益氣續(xù)骨合劑加蟲(chóng)類通絡(luò)方顆粒口服(益氣續(xù)骨合劑加蟲(chóng)類通絡(luò)方組)和骨力膠囊口服(骨力膠囊組),均為每日早、中、晚餐后半小時(shí)各服1次,連續(xù)服用4周。分別于術(shù)前及服藥2周后、服藥4周后,采用疼痛視覺(jué)模擬量表(visual analogue scale,VAS)評(píng)分評(píng)價(jià)踝關(guān)節(jié)疼痛程度,根據(jù)關(guān)節(jié)腫脹度對(duì)踝關(guān)節(jié)腫脹情況進(jìn)行評(píng)分,測(cè)量踝關(guān)節(jié)屈伸活動(dòng)度。治療結(jié)束后第3天,采用美國(guó)足踝外科協(xié)會(huì)(American Orthopaedic Foot and Ankle Society,AOFAS)踝與后足評(píng)分評(píng)價(jià)踝關(guān)節(jié)功能。并分別于術(shù)前、治療結(jié)束后第3天,采用酶聯(lián)免疫吸附法檢測(cè)患者血清中白細(xì)胞介素-1β(interleukin-1β,IL-1β)、腫瘤壞死因子-α(tumor necrosis factor-α,TNF-α)、C反應(yīng)蛋白(C-reaction protein,CRP)水平。結(jié)果:①踝關(guān)節(jié)疼痛VAS評(píng)分及關(guān)節(jié)腫脹評(píng)分。治療前后不同時(shí)間點(diǎn)之間踝關(guān)節(jié)疼痛VAS評(píng)分、關(guān)節(jié)腫脹評(píng)分的差異均有統(tǒng)計(jì)學(xué)意義,即具有時(shí)間效應(yīng)(F=298.997,P=0.000; F=94.908,P=0.000); 2組患者踝關(guān)節(jié)疼痛VAS評(píng)分、關(guān)節(jié)腫脹評(píng)分均隨時(shí)間呈下降趨勢(shì),但2組的下降趨勢(shì)均不完全一致[疼痛VAS評(píng)分:(7.40±1.92)分,(4.21±1.24)分,(1.59±0.56)分,F=188.543,P=0.000;(7.27±1.72)分,(5.63±1.65)分,(3.03±0.89)分,F=116.301,P=0.000。關(guān)節(jié)腫脹評(píng)分:(1.99±0.53)分,(1.06±0.36)分,(0.33±0.21)分,F=71.504,P=0.000;(2.03±0.61)分,(1.37±0.49)分,(0.96±0.32)分,F=28.470,P=0.000]。2組患者踝關(guān)節(jié)疼痛VAS評(píng)分、關(guān)節(jié)腫脹評(píng)分組間總體比較,差異均有統(tǒng)計(jì)學(xué)意義,即具有分組效應(yīng)(F=16.142,P=0.000; F=25.274,P=0.000); 術(shù)前2組患者踝關(guān)節(jié)疼痛VAS評(píng)分、關(guān)節(jié)腫脹評(píng)分組間比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(t=0.283,P=0.778; t=0.226,P=0.822); 服藥2周后、服藥4周后,益氣續(xù)骨合劑加蟲(chóng)類通絡(luò)方組患者踝關(guān)節(jié)疼痛VAS評(píng)分、關(guān)節(jié)腫脹評(píng)分均低于骨力膠囊組(服藥2周后:t=3.800,P=0.000; t=2.688,P=0.009; 服藥4周后:t=7.454,P=0.000; t=6.019,P=0.000)。時(shí)間因素與分組因素存在交互效應(yīng)(F=5.847,P=0.005; F=5.066,P=0.009)。②踝關(guān)節(jié)屈伸活動(dòng)度。治療前后不同時(shí)間點(diǎn)之間踝關(guān)節(jié)屈伸活動(dòng)度的差異有統(tǒng)計(jì)學(xué)意義,即具有時(shí)間效應(yīng)(F=2 175.791,P=0.000); 2組患者踝關(guān)節(jié)屈伸活動(dòng)度均隨時(shí)間呈增加趨勢(shì),但2組的增加趨勢(shì)不完全一致[18.78°±0.84°,26.52°±0.96°,32.81°±1.15°,F=1 501.683,P=0.000; 19.05°±0.79°,23.47°±0.91°,28.37°±1.06°,F=639.580,P=0.000]。2組患者踝關(guān)節(jié)屈伸活動(dòng)度組間總體比較,差異有統(tǒng)計(jì)學(xué)意義,即具有分組效應(yīng)(F=295.236,P=0.000); 術(shù)前2組患者踝關(guān)節(jié)屈伸活動(dòng)度比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=1.281,P=0.205); 服藥2周后、服藥4周后,益氣續(xù)骨合劑加蟲(chóng)類通絡(luò)方組患者踝關(guān)節(jié)屈伸活動(dòng)度均大于骨力膠囊組(t=12.618,P=0.000; t=15.544,P=0.000)。時(shí)間因素與分組因素存在交互效應(yīng)(F=93.380,P=0.000)。③踝關(guān)節(jié)功能。治療結(jié)束后第3天,益氣續(xù)骨合劑加蟲(chóng)類通絡(luò)方組踝關(guān)節(jié)AOFAS踝與后足評(píng)分高于骨力膠囊組[(81.89±10.74)分,(75.04±11.23)分,t=2.415,P=0.019]; 益氣續(xù)骨合劑加蟲(chóng)類通絡(luò)方組踝關(guān)節(jié)功能優(yōu)10例、良16例、中3例、差1例,骨力膠囊組踝關(guān)節(jié)功能優(yōu)6例、良13例、中7例、差4例,益氣續(xù)骨合劑加蟲(chóng)類通絡(luò)方組患者踝關(guān)節(jié)功能優(yōu)于骨力膠囊組(Z=1.981,P=0.048)。④血清炎癥因子水平。術(shù)前,2組患者血清IL-1β、TNF-α、CRP水平比較,組間差異均無(wú)統(tǒng)計(jì)學(xué)意義[(29.65±7.14)pg·mL-1,(27.98±7.02)pg·mL-1,t=0.914,P=0.365;(34.25±7.35)pg·mL-1,(33.18±7.61)pg·mL-1,t=0.554,P=0.582;(38.94±10.26)mg·L-1,(37.15±9.68)mg·L-1,t=0.695,P=0.490]; 治療結(jié)束后第3天,2組患者血清IL-1β、TNF-α、CRP水平均低于術(shù)前(益氣續(xù)骨合劑加蟲(chóng)類通絡(luò)方組:t=6.283,P=0.000; t=7.328,P=0.000; t=16.419,P=0.000; 骨力膠囊組:t=3.141,P=0.003; t=4.215,P=0.000; t=14.942,P=0.000); 且益氣續(xù)骨合劑加蟲(chóng)類通絡(luò)方組均低于骨力膠囊組[(19.85±4.69)pg·mL-1,(23.08±4.87)pg·mL-1,t=2.617,P=0.011;(21.59±5.96)pg·mL-1,(25.94±5.53)pg·mL-1,t=2.930,P=0.005;(7.65±1.92)mg·L-1,(9.63±2.84)mg·L-1,t=3.164,P=0.002]。結(jié)論:對(duì)于踝關(guān)節(jié)骨折術(shù)后患者,在常規(guī)踝關(guān)節(jié)功能康復(fù)鍛煉的基礎(chǔ)上,采用益氣續(xù)骨合劑加蟲(chóng)類通絡(luò)方治療,可減輕炎癥反應(yīng),緩解踝關(guān)節(jié)疼痛和腫脹,改善踝關(guān)節(jié)屈伸活動(dòng)度,促進(jìn)踝關(guān)節(jié)功能恢復(fù)。
Abstract:
To explore the applied values of Yiqi Xugu Heji(益氣續(xù)骨合劑,YQXGHJ)and Chonglei Tongluo Fang(蟲(chóng)類通絡(luò)方,CLTLF)in postoperative anke rehabilitation in patients who undergoing surgery for treatment of ankle fractures.Methods:Sixty patients with ankle fractures were enrolled in the study and were randomly divided into 2 groups,30 cases in each group.All patients in the 2 groups were treated with open reduction and plate internal fixation,followed by conventional ankle functional rehabilitation exercises.Moreover,30 patients were further treated with oral application of YQXGHJ and CLTLF(YQXGHJ and CLTLF group),while the others with Guli(骨力,GL)capsules(GL capsule group)for consecutive 4 weeks,3 times a day at 30 minutes after breakfast,lunch and dinner respectively.The ankle pain degree was evaluated by using pain visual analogue scale(VAS)scores,the ankle swelling was scored according to the swelling degree of joints,and the ankle flexion-extension range of motion(ROM)was measured before the surgery and after 2- and 4-week medication respectively.The ankle function was evaluated by using American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot scores at the 3rd day after the end of the treatment,and the serum levels of interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α)and C-reaction protein(CRP)were detected by using enzyme linked immunosorbent assay(ELISA)before the surgery and at the 3rd day after the end of the treatment respectively.Results:There was statistical difference in ankle pain VAS scores and swelling scores between different timepoints before and after the treatment,in other words,there was time effect(F=298.997,P=0.000; F=94.908,P=0.000).The ankle pain VAS scores and swelling scores presented a time-dependent decreasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(pain VAS score:7.40±1.92,4.21±1.24,1.59±0.56 points,F=188.543,P=0.000; 7.27±1.72,5.63±1.65,3.03±0.89 points,F=116.301,P=0.000; swelling score:1.99±0.53,1.06±0.36,0.33±0.21 points,F=71.504,P=0.000; 2.03±0.61,1.37±0.49,0.96±0.32 points,F=28.470,P=0.000).There was statistical difference in ankle pain VAS scores and swelling scores between the 2 groups in general,in other words,there was group effect(F=16.142,P=0.000; F=25.274,P=0.000).There was no statistical difference in ankle pain VAS scores and swelling scores between the 2 groups before the surgery(t=0.283,P=0.778; t=0.226,P=0.822).The ankle pain VAS scores and swelling scores were lower in YQXGHJ and CLTLF group compared to GL capsule group after 2- and 4-week medication(after 2-week medication:t=3.800,P=0.000; t=2.688,P=0.009; after 4-week medication:t=7.454,P=0.000; t=6.019,P=0.000).There was interaction between time factor and group factor in ankle pain VAS scores and swelling scores(F=5.847,P=0.005; F=5.066,P=0.009).There was statistical difference in ankle flexion-extension ROM between different timepoints before and after the treatment,in other words,there was time effect(F=2 175.791,P=0.000).The ankle flexion-extension ROM presented a time-dependent increasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(18.78±0.84,26.52±0.96,32.81±1.15 degrees,F=1 501.683,P=0.000; 19.05±0.79,23.47±0.91,28.37±1.06 degrees,F=639.580,P=0.000)...

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備注/Memo

備注/Memo:
基金項(xiàng)目:昆明市科技計(jì)劃項(xiàng)目(2019-1-S-25318000001020)
通訊作者:郭磊 E-mail:[email protected]
更新日期/Last Update: 1900-01-01