【摘要】：目的：觀察股骨前弓角對(duì)股骨近端手術(shù)的影響及中藥桃紅四物湯對(duì)股骨近端手術(shù)后康復(fù)的作用。比較該方法與常規(guī)治療的臨床療效，并對(duì)三組患者的術(shù)中、術(shù)后綜合功能的臨床觀察指標(biāo)進(jìn)行分析。 方法：自2012年6月至2014年1月手術(shù)治療股骨轉(zhuǎn)子間骨折患者100例。術(shù)前隨機(jī)分三組，常規(guī)手術(shù)組（常規(guī)組）38例，取常規(guī)PFNA手術(shù)治療。術(shù)前測(cè)量股骨前弓角手術(shù)組（測(cè)量組）30例，取術(shù)前測(cè)量股骨前弓角作為常規(guī)PFNA手術(shù)術(shù)前計(jì)劃參數(shù)。術(shù)前測(cè)量股骨前弓角手術(shù)配合術(shù)后口服中藥桃紅四物湯組（測(cè)量加中藥組）32例。所有病例均在硬膜外麻醉下，在骨科牽引床牽引下閉合復(fù)位，PFNA內(nèi)固定，觀察術(shù)中插入髓內(nèi)釘?shù)碾y易程度，術(shù)后骨科常規(guī)處理，加中藥組術(shù)后第二天口服桃紅四物湯，一日三次飯前口服，一周為一個(gè)療程，，持續(xù)兩個(gè)療程。觀察患者大腿疼痛、腫脹癥狀，一周后扶雙拐下地行走。術(shù)后定期隨訪，術(shù)后第二天、3個(gè)月拍X線片復(fù)查，并行Harris評(píng)價(jià)患者術(shù)后功能。 結(jié)果：100例患者均順利完成手術(shù)。常規(guī)組8例患者在術(shù)中出現(xiàn)初次穿釘不順利。測(cè)量組和測(cè)量中藥組以股前弓角指導(dǎo)手術(shù)的患者，術(shù)中髓內(nèi)釘插入過程順利。術(shù)后第二天拍X線片示骨折復(fù)位滿意，內(nèi)固定置入位置良好，3個(gè)月復(fù)查X線片，病例已全部骨性愈合。術(shù)后Harris評(píng)分優(yōu)良率，常規(guī)組、測(cè)量組與測(cè)量加中藥組三組對(duì)比，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。三組病例未出現(xiàn)螺旋刀片切割股骨頭、下肢深靜脈血栓、發(fā)熱等手術(shù)并發(fā)癥。常規(guī)手術(shù)組7例出現(xiàn)大腿疼痛現(xiàn)象，測(cè)量組和測(cè)量加中藥組未出現(xiàn)大腿疼痛患者，常規(guī)組術(shù)后大腿腫脹現(xiàn)象較其他兩組明顯。 結(jié)論：股骨前弓角隨著患者年齡增加而增大，股骨前弓角可指導(dǎo)選擇防旋型股骨近端髓內(nèi)釘術(shù)中的使用，使手術(shù)進(jìn)程順利進(jìn)行。說明術(shù)前測(cè)量股骨前弓角對(duì)手術(shù)順利進(jìn)行是有積極的作用。術(shù)后輔以中藥桃紅四物湯活血化瘀、養(yǎng)血補(bǔ)血，改善局部血氧和周圍微循環(huán)，明顯減少術(shù)后大腿腫脹疼痛及并發(fā)癥的發(fā)生。試驗(yàn)說明中藥桃紅四物湯對(duì)骨折術(shù)后的康復(fù)有積極的作用。
[Abstract]:Objective: to observe the effect of anterior femur angle on proximal femur operation and the effect of Taohong Siwu decoction on rehabilitation of proximal femur. The clinical efficacy of this method was compared with that of routine treatment, and the clinical indexes of comprehensive function during and after operation in three groups were analyzed. Methods: from June 2012 to January 2014, 100 patients with intertrochanteric fracture of femur were operated. The patients were randomly divided into three groups before operation. 38 cases were treated with routine PFNA operation. Thirty patients in the group of preoperative measurement of the anterior femoral bow angle were taken as the preoperative planning parameters of routine PFNA operation for the measurement of the anterior angle of the femur. 32 cases were treated with Taohong Siwu decoction before operation and oral administration of Taohong Siwu decoction. All cases were under epidural anesthesia, closed reduction and PFNA fixation under traction in orthopedic traction bed. The degree of intraoperative insertion of intramedullary nail was observed, routine orthopedic treatment was performed after operation, and Taohong Siwu decoction was taken orally in the Chinese medicine group on the second day after operation. Take orally three times a day before meals, one week as a course of treatment, two courses of treatment. Observe symptoms of thigh pain and swelling and walk a week later. The patients were followed-up regularly, the second day and 3 months after operation. The postoperative function was evaluated by Harris. Results the operation was successfully completed in 100 cases. In the routine group, 8 patients suffered from primary nail puncture during operation. The procedure of intramedullary nail insertion was smooth in the measurement group and the traditional Chinese medicine group. On the second day after operation, X-ray film showed satisfactory reduction of fracture, good position of internal fixation, and 3 months reexamination of X-ray film, all the cases had healed. The excellent and good rate of Harris score in routine group, measurement group and measurement plus Chinese medicine group was significantly higher than that in control group (P < 0. 05). There were no complications such as cutting femoral head with spiral blade, deep vein thrombosis and fever in the three groups. There were 7 cases of thigh pain in the routine operation group, and no thigh pain was found in the measurement group and the measurement plus Chinese medicine group. The thigh swelling in the routine group was more obvious than that in the other two groups. Conclusion: the anterior angle of femur increases with the age of the patients. The anterior angle of femur can be used to guide the choice of anti-rotation intramedullary nail in proximal femur and make the operation progress smoothly. The results showed that preoperative measurement of the anterior femur angle had a positive effect on the successful operation. After the operation, Taohong Siwu decoction was used to promote blood circulation and blood stasis, to nourish blood and tonify blood, to improve local blood oxygen and peripheral microcirculation, and to reduce postoperative thigh swelling, pain and complications. The experiment shows that Taohong Siwu decoction has a positive effect on postoperative rehabilitation of fracture.
【學(xué)位授予單位】：山西中醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R687.3

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