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[1]王琪,郭磊,白平,等.益氣續(xù)骨合劑加蟲類通絡方在踝關節(jié)骨折術后康復治療中的應用[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(蟲類通絡方)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)骨合劑加蟲類通絡方在踝關節(jié)骨折術后康復治療中的應用()
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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(蟲類通絡方)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
關鍵詞:
骨折;  踝關節(jié);  中醫(yī)康復;  益氣續(xù)骨合劑;  蟲類通絡方
Keywords:
fractures; bone;  ankle joint;  rehabilitation(TCM);  Yiqi Xugu Heji;  Chonglei Tongluo Fang
摘要:
目的:探討益氣續(xù)骨合劑加蟲類通絡方在踝關節(jié)骨折術后康復治療中的應用價值。方法:踝關節(jié)骨折患者60例,隨機分為2組,每組30例。2組患者均行切開復位鋼板內(nèi)固定手術治療,術后均行常規(guī)踝關節(jié)功能康復鍛煉。術后第2天起,分別給予益氣續(xù)骨合劑加蟲類通絡方顆粒口服(益氣續(xù)骨合劑加蟲類通絡方組)和骨力膠囊口服(骨力膠囊組),均為每日早、中、晚餐后半小時各服1次,連續(xù)服用4周。分別于術前及服藥2周后、服藥4周后,采用疼痛視覺模擬量表(visual analogue scale,VAS)評分評價踝關節(jié)疼痛程度,根據(jù)關節(jié)腫脹度對踝關節(jié)腫脹情況進行評分,測量踝關節(jié)屈伸活動度。治療結(jié)束后第3天,采用美國足踝外科協(xié)會(American Orthopaedic Foot and Ankle Society,AOFAS)踝與后足評分評價踝關節(jié)功能。并分別于術前、治療結(jié)束后第3天,采用酶聯(lián)免疫吸附法檢測患者血清中白細胞介素-1β(interleukin-1β,IL-1β)、腫瘤壞死因子-α(tumor necrosis factor-α,TNF-α)、C反應蛋白(C-reaction protein,CRP)水平。結(jié)果:①踝關節(jié)疼痛VAS評分及關節(jié)腫脹評分。治療前后不同時間點之間踝關節(jié)疼痛VAS評分、關節(jié)腫脹評分的差異均有統(tǒng)計學意義,即具有時間效應(F=298.997,P=0.000; F=94.908,P=0.000); 2組患者踝關節(jié)疼痛VAS評分、關節(jié)腫脹評分均隨時間呈下降趨勢,但2組的下降趨勢均不完全一致[疼痛VAS評分:(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。關節(jié)腫脹評分:(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組患者踝關節(jié)疼痛VAS評分、關節(jié)腫脹評分組間總體比較,差異均有統(tǒng)計學意義,即具有分組效應(F=16.142,P=0.000; F=25.274,P=0.000); 術前2組患者踝關節(jié)疼痛VAS評分、關節(jié)腫脹評分組間比較,差異均無統(tǒng)計學意義(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)骨合劑加蟲類通絡方組患者踝關節(jié)疼痛VAS評分、關節(jié)腫脹評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)。時間因素與分組因素存在交互效應(F=5.847,P=0.005; F=5.066,P=0.009)。②踝關節(jié)屈伸活動度。治療前后不同時間點之間踝關節(jié)屈伸活動度的差異有統(tǒng)計學意義,即具有時間效應(F=2 175.791,P=0.000); 2組患者踝關節(jié)屈伸活動度均隨時間呈增加趨勢,但2組的增加趨勢不完全一致[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組患者踝關節(jié)屈伸活動度組間總體比較,差異有統(tǒng)計學意義,即具有分組效應(F=295.236,P=0.000); 術前2組患者踝關節(jié)屈伸活動度比較,差異無統(tǒng)計學意義(t=1.281,P=0.205); 服藥2周后、服藥4周后,益氣續(xù)骨合劑加蟲類通絡方組患者踝關節(jié)屈伸活動度均大于骨力膠囊組(t=12.618,P=0.000; t=15.544,P=0.000)。時間因素與分組因素存在交互效應(F=93.380,P=0.000)。③踝關節(jié)功能。治療結(jié)束后第3天,益氣續(xù)骨合劑加蟲類通絡方組踝關節(jié)AOFAS踝與后足評分高于骨力膠囊組[(81.89±10.74)分,(75.04±11.23)分,t=2.415,P=0.019]; 益氣續(xù)骨合劑加蟲類通絡方組踝關節(jié)功能優(yōu)10例、良16例、中3例、差1例,骨力膠囊組踝關節(jié)功能優(yōu)6例、良13例、中7例、差4例,益氣續(xù)骨合劑加蟲類通絡方組患者踝關節(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。術前,2組患者血清IL-1β、TNF-α、CRP水平比較,組間差異均無統(tǒng)計學意義[(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水平均低于術前(益氣續(xù)骨合劑加蟲類通絡方組: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)骨合劑加蟲類通絡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:對于踝關節(jié)骨折術后患者,在常規(guī)踝關節(jié)功能康復鍛煉的基礎上,采用益氣續(xù)骨合劑加蟲類通絡方治療,可減輕炎癥反應,緩解踝關節(jié)疼痛和腫脹,改善踝關節(jié)屈伸活動度,促進踝關節(jié)功能恢復。
Abstract:
To explore the applied values of Yiqi Xugu Heji(益氣續(xù)骨合劑,YQXGHJ)and Chonglei Tongluo Fang(蟲類通絡方,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:
基金項目:昆明市科技計劃項目(2019-1-S-25318000001020)
通訊作者:郭磊 E-mail:[email protected]
更新日期/Last Update: 1900-01-01