摘要
目的：探讨在胫骨平台骨折的术后治疗中应用中药内服和薰洗的临床疗效和安全性。方法：接受切开复位锁定钢板内固定手术治疗的单侧胫骨平台骨折患者78例，随机分为2组。中药联合功能锻炼组36例，术后采用中药内服（每日1剂，水煎，早晚各1次饭后半小时口服，共服60 d）和薰洗（每次20 min，每日2次，15 d 为1个疗程，共治疗2个疗程）联合功能锻炼治疗。功能锻炼组42例，术后单纯采用功能锻炼治疗。按照《外科学》中的骨折临床愈合标准评估骨折愈合情况，记录骨折愈合时间，并观察并发症发生情况。术后6个月，分别参照 Rasmussen 膝关节功能评分标准和美国特种外科医院（hospital for special surgery， HSS）膝关节评分标准对患膝功能进行评价。结果：78例患者均获随访，随访时间7～31个月，中位数13个月。2组患者骨折均愈合，中药联合功能锻炼组骨折愈合时间较功能锻炼组短[（98．44±9．96）d，（109．78±10．13）d；t ＝4．967，P ＝0．001]。术后6个月，中药联合功能锻炼组 Rasmussen 评分和 HSS 评分均高于功能锻炼组[（27．42±3．18）分，（19．24±2．96）分，t ＝11．757，P ＝0．000；（91．16±4．98）分，（77．35±6．69）分，t ＝10．195，P ＝0．000]。中药联合功能锻炼组术后并发切口感染1例、下肢深静脉血栓形成1例、膝关节创伤性关节炎2例；功能锻炼组术后并发切口感染1例、下肢深静脉血栓形成2例、膝关节创伤性关节炎3例；2组患者并发症发生率比较，差异无统计学意义（χ2＝0．006，P ＝0．938）。结论：对于接受切开复位锁定钢板内固定手术治疗的胫骨平台骨折患者，术后在功能锻炼的基础上采用中药内服和薰洗，有利于骨折愈合和患膝功能恢复，疗效优于单纯功能锻炼，而在安全性方面与后者相当。
Objective：To explore the clinical curative effects and safety of oral application of traditional Chinese medicine（TCM）and Chinese herbal steaming washing therapy in the postoperative treatment of tibial plateau fractures.Methods：Seventy -eight patients with unilateral tibial plateau fractures who received open reduction and locking plate internal fixation were randomly divided into 2 groups. Thirty -six patients（combination treatment group）were treated with oral application of TCM（one dose a day,at half an hour after breakfast and supper respectively for 60 consecutive days）combined with Chinese herbal steaming washing therapy（twice a day,20 minutes at a time for consecutive two course of treatment,1 5 days for each course）and functional exercise after surgery.Forty -two patients（functional exer-cise group）were treated with monotherapy of functional exercise.Fracture healing were evaluated according to clinical healing standard of fracture which was extracted from surgery.The fracture healing time and the complication incidences were recorded.The knee function were evaluated according to Rasmussen knee function scoring standard and hospital for special surgery（HSS）knee scoring standard respectively at 6 months after surgery.Results：All of the patients were followed up for 7 -31 months with a median of 1 3 months.All fractures healed in the 2 groups,and the fracture healing time was shorter in combination treatment group compared to functional exercise group（98.44 ＋/-9.96 vs 1 09.78 ＋/-1 0.1 3 days;t =4.967,P =0.001 ）.The Rasmussen scores and HSS scores were higher in combination treatment group compared to functional exercise group at 6 months after surgery（27.42 ＋/-3.1 8 vs 1 9.24 ＋/-2.96 points,t =1 1 .757,P =0.000;91 .1 6 ＋/-4.98 vs 77.35 ＋/-6.69 points,t =1 0.1 95,P =0.000）.After the surgery,incision infection（1 ）,lower extremity deep venous thrombosis（1 ）and traumatic knee arthritis（2）were found in combination treatment group;while incision infection（1 ）,lower extremity deep venous thrombosis（2）and traumatic knee arthritis（3）were found in functional exercise group.There was no statistical difference in complication incidences between the two groups（χ2 =0.006,P =0.938）.Conclusion：For patients with unilateral tibial plateau fractures who received open reduction and locking plate internal fixation,combination of functional exercise with oral application of TCMand Chinese herbal steaming washing therapy is conducive to fracture healing and knee function recovery,and its curative effect is better than that of monothera-py of functional exercise,and it is similar to the latter in the safety.
出处
《中医正骨》
2016年第11期17-20,共4页
The Journal of Traditional Chinese Orthopedics and Traumatology
关键词
胫骨骨折
膝损伤
手术后期间
中草药
薰洗
tibial fractures
knee injuries
fracture fixation, internal
postoperative period
drugs, Chinese herbal
steaming washing therapy
