本文關鍵詞： 肘關節(jié)僵硬 骨傷洗劑 手術松解 中藥熏洗　出處：《廣州中醫(yī)藥大學》2015年碩士論文　論文類型：學位論文

【摘要】：目的：探討骨傷洗劑在肘關節(jié)僵硬松解術后應用的臨床療效,為臨床上優(yōu)化治療方案提供建議,以進一步指導臨床應用。方法：將2005年8月-2014年8月廣東省中醫(yī)院(除外珠海分院)符合納入標準且無排除標準的肘關節(jié)僵硬的住院患者40例按照不同病例前后對照的研究方案分為A、B兩組,其中A組-骨傷洗劑組(21例,2012年9月-2014年8月),B組-歷史對照組(19例,2005年8月-2012年9月)。入院后行切開松解術,術后均予以吲哚美辛25mg tid,患肢冰敷24小時,術后48h拔引流,開始CPM機鍛煉,2次/天,早晚各1次,每次30分鐘,同時開始等長訓練3次/天,每次持續(xù)約30分鐘。術后2周傷口Ⅰ期愈合后,停止CPM, A組(骨傷洗劑組)開始用骨傷洗劑熏洗肘關節(jié),在熏洗過程中患者主動作肘關節(jié)屈伸活動(每日3次,分早、中、晚,每次約30分鐘)；B組(對照組)僅有作肘關節(jié)主動屈伸活動(每日3次,分早、中、晚,每次約30分鐘)。收集各組術前臨床資料,觀察指標：1)消腫程度；2)疼痛強度；3)肘關節(jié)活動度；4)尺神經的癥狀；5)肘關節(jié)功能MAYO評分。測量術后第3天、術后4周患肘最大周徑,并計算出消腫指數,評價其消腫程度；用VAS法記錄術前,術后第2周、4周、6周和術后第6個月的疼痛強度；記錄術前,術后第2周、4周、6周和術后第6個月患肘的活動度；分別于術前和術后2周、4周、6周和術后第6個月評定尺神經的癥狀；分別于術前和術后2周、4周、6周和術后第6個月A、B兩組評定肘關節(jié)功能MAYO評分；術前及術后,術后1個月,3個月,6個月等復查X線影像進行安全性評定,得出兩組術后半年的優(yōu)良率。以上數據均用SPSS 17.0統(tǒng)計軟件進行統(tǒng)計學處理,對比分析兩組之間的差異性。結果：1.隨訪6個月,40例獲得隨訪,其中：A組：21例,B組：19例；6例失訪。所有患者均無藥物過敏及其他不良反應；2.一般資料比較：兩組術前各項數值比較均無統(tǒng)計學意義(P0.05),具有可比性；3.兩組的比較結果：消腫療效在術后4周兩組比較有顯著差異(P0.05)；疼痛強度和肘關節(jié)評分方面,兩組患者分別在術后2周比較無統(tǒng)計學意義(P0.05),術后4周,6周,6個月兩組相比有統(tǒng)計學意義(P0.01),兩組數據有非常顯著差異,肘關節(jié)功能評定優(yōu)良率均大于對照組；肘關節(jié)活動度改善方面,A組-骨傷洗劑組的隨時間增大的幅度大于B組,術后4周,6周,6個月兩組相比較均有統(tǒng)計學意義(P0.01),有非常顯著的差異；尺神經的癥狀改善方面,兩組數據在術后各時間點比較均無統(tǒng)計學意義(P0.05)；術后6個月兩組患者療效判定的優(yōu)良率：A組-骨傷洗劑組(85.72%)B組-治療對照組(15.79%),兩組比較有非常顯著差異(P0.01),所有患者均無藥物過敏及其它不良反應。結論：骨傷洗劑組較單純的功能鍛煉組對促進肘關節(jié)僵硬松解術后肘關節(jié)消腫、止痛、增加活動度方面及功能康復方面有療效。
[Abstract]:Objective: to investigate the clinical effect of bone injury lotion in the treatment of elbow joint stiffness release, and to provide suggestions for clinical optimization of treatment. Methods: Guangdong Provincial Hospital of traditional Chinese Medicine (except Zhuhai Branch) from August 2005 to August 2014. Forty inpatients with stiff elbow joints who met the inclusion criteria and were not excluded were divided into two groups according to the pre-and post-contrast study. There were 21 cases in group A and 19 cases in group B from September 2012 to August 2014. From August 2005 to September 2012, the patients were treated with indomethacin 25mg tid, the affected limbs were frozen for 24 hours, and the drainage was removed 48 hours after operation. The CPM machine began to exercise twice a day, once in the morning and evening for 30 minutes each, and at the same time, 3 times a day for about 30 minutes each time. After 2 weeks of wound healing, CPM was stopped. In group A (bone injury lotion group), the elbow joint was fumigated with bone injury lotion, and the elbow flexion and extension activities were performed during the fumigation (3 times a day, early, middle, late, about 30 minutes each time). Group B (control group) had only active elbow flexion and extension (3 times a day, early, middle, late, about 30 minutes each time). 2) pain intensity; 3) elbow motion; 4) symptoms of ulnar nerve; 5) MAYO score of elbow joint function. The maximal circumference diameter of elbow was measured on the 3rd day and 4th week after operation, and the detumescence index was calculated to evaluate the degree of deswelling. The pain intensity was recorded by VAS method before operation, 2 weeks after operation, 4 weeks and 6 weeks and 6 months after operation. The movement of elbow was recorded before operation, 2 weeks after operation, 4 weeks, 6 weeks and 6 months after operation. The symptoms of ulnar nerve were evaluated before and 2 weeks and 6 weeks and 6 months after operation respectively. The MAYO score of elbow joint function was assessed in group A and B before and 2 weeks after operation and 6 weeks after operation and 6 months after operation. Before and after operation, the safety of X-ray images was evaluated 1 month, 3 months and 6 months after operation. All the above data were statistically processed by SPSS 17.0 statistical software, and the differences between the two groups were analyzed. Results: 1. Follow up for 6 months. 40 cases were followed up, including 21 cases in group A, 21 cases in group B, 19 cases in group B; No drug allergy and other adverse reactions were found in all the patients. 2. Comparison of general data: there was no statistical significance in comparison between the two groups before operation (P 0.05), which was comparable; 3.The results of comparison between the two groups: the effect of detumescence was significantly different between the two groups at 4 weeks after operation (P 0.05); In terms of pain intensity and elbow joint score, there was no significant difference between the two groups in 2 weeks after operation (P 0.05), 4 weeks after operation and 6 weeks after operation, and 6 months after operation, the two groups had statistical significance compared with the two groups (P 0.01). There was significant difference between the two groups, and the excellent and good rate of elbow joint function evaluation was higher than that of the control group. The improvement of elbow motion in group A and group B was larger than that in group B, 4 weeks after operation, 6 weeks after operation and 6 months after operation, there was significant difference between the two groups (P 0.01). There are very significant differences; For the improvement of ulnar nerve symptoms, there was no significant difference between the two groups at each time point after operation (P 0.05). 6 months after operation, the excellent and good rate of the curative effect of the two groups was determined by the bone injury lotion group (85.72B group) and the treatment control group (15.79g%). There was a very significant difference between the two groups (P 0.01). Conclusion: the bone injury lotion group is more effective than the simple functional exercise group in promoting elbow joint swelling and pain relief after elbow stiffness relaxation. [WT5HZ] [WT5 "HZ] [WT5BZ] [WT5" BZ] [WT5 "BZ] [WT5" BZ]. Increased activity and functional rehabilitation are effective.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.4

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