本文選題：丹參制劑 + 胸腰段壓縮骨折脊髓損傷��； 參考：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:隨著我國建筑、交通等領(lǐng)域近年來的飛速發(fā)展,墜落傷、重物砸傷、車禍傷的發(fā)生率逐年增高,由此導(dǎo)致骨科疾患呈逐年增高的趨勢。創(chuàng)傷骨科疾病的治療常規(guī)上以切開復(fù)位固定的手術(shù)方式為主。由于骨折愈合需要6-8周甚至12周,伴隨關(guān)節(jié)長時間限制活動及平臥引起的并發(fā)癥隨之增多。近年來,骨生物力學(xué)的研究和內(nèi)固定技術(shù)的發(fā)展使得目前大多數(shù)骨折的復(fù)位可以達(dá)到另人滿意的程度,但是術(shù)后制動引發(fā)的關(guān)節(jié)僵硬、肺部感染等一系列問題已經(jīng)成為骨折預(yù)后的重要原因。因此,如何縮短骨科疾病的病程、縮短制動及臥床時間,從而減少并發(fā)癥及后遺癥的發(fā)生逐步成為國內(nèi)外骨科研究的重點課題。丹參為祖國醫(yī)學(xué)的傳統(tǒng)藥物,主要由丹參酮類和酚酸類物質(zhì)組成其活性成分,目前臨床已廣泛應(yīng)用丹參類制劑。有資料表明,丹參可有效促進(jìn)骨折愈合,通過改善骨折斷端的血供,增強骨折鄰近部位的鈣動員,促進(jìn)成骨細(xì)胞、破骨細(xì)胞在骨基質(zhì)形成、鈣化及塑形中的功能增強等方面促進(jìn)骨折斷端的鈣化。本研究通過觀察丹參多酚酸鹽注射液對胸腰段壓縮骨折椎管減壓術(shù)后脊髓損傷功能恢復(fù)的療效、參芎葡萄糖預(yù)防跟骨骨折內(nèi)固定術(shù)后切口皮緣壞死的臨床應(yīng)用,探究丹參制劑在骨科疾病術(shù)后恢復(fù)治療中的作用,為丹參制劑在骨折多病種治理中的臨床應(yīng)用提供依據(jù)。方法:1丹參多酚酸鹽對胸腰段壓縮骨折椎管減壓術(shù)后脊髓功能恢復(fù)的作用通過對臨床260例不同治療方法的外傷致胸腰段壓縮骨折伴不同程度脊髓損傷術(shù)后患者療效比較,觀察丹參多酚酸鹽在術(shù)后功能恢復(fù)中的療效。1.1實驗分組:胸腰段壓縮骨折患者(病例來自于河北醫(yī)科大學(xué)第三醫(yī)院創(chuàng)傷急救中心和河北省辛集市第一醫(yī)院骨科),隨機分為2組,治療組140例,對照組120例。治療組患者男76例,女64例,年齡31~69歲,平均年齡為40.6歲�；颊叩闹饕獡p傷節(jié)段為:T11:37例,T12:41例,L1:50例,L2:12例�；颊叩闹饕獡p傷原因:交通事故60例,高空墜落57例,重物撞擊23例。對照組患者男66例,女54例,年齡33~65歲,平均年齡為39.8歲�；颊叩闹饕獡p傷節(jié)段為:T11:32例,T12:41例,L1:40例,L2:7例�；颊叩闹饕獡p傷原因:交通事故46例,高空墜落47例,重物撞擊27例。所有入組患者均伴不同程度脊髓損傷(所有患者均按ASIA殘損分級確診為脊髓損傷并記錄評分,其中治療組A級37例,B級41例,C級55例,D級7例,E級0例;對照組A級31例,B級32例,C級49例,D級8例,E級0例)。治療組病例患者均伴有下肢肌力異常,其中下肢肌力完全喪失者72例,出現(xiàn)腹脹、大小便失禁者134例;對照組病例均出現(xiàn)下肢肌力異常,其中下肢肌力完全喪失者68例,伴腹脹、大小便失禁者112例。兩組患者的性別、年齡、病程、損傷節(jié)段、損傷原因以及脊髓損傷分級等一般資料對比差異無統(tǒng)計學(xué)意義(P0.05),具有可比性。1.2治療方法及藥物:所有患者入院后給予甲潑尼龍沖擊治療,于受傷48h后常規(guī)行切開復(fù)位椎管減壓椎弓根螺釘內(nèi)固定術(shù),術(shù)前術(shù)后24h內(nèi)均常規(guī)應(yīng)用抗生素預(yù)防感染,術(shù)后治療組應(yīng)用丹參多酚酸鹽注射液。丹參多酚酸鹽注射液的主要成分是丹參乙酸。用法與用量:靜脈滴注。一次200mg,溶于0.9%氯化鈉注射液250ml-500 ml后使用。一日1次。療程10-14天。對照組應(yīng)用0.9%氯化鈉注射液250ml-500 ml。一日1次。療程10-14天。1.3不良反應(yīng):所有病人中有4例病人用藥后出現(xiàn)輕度過敏反應(yīng),抗過敏治療后消退。2例出現(xiàn)胃腸道刺激癥狀,給予口服奧美拉唑后癥狀消失。1.4療效評價:根據(jù)ASIA脊髓損傷神經(jīng)學(xué)分類國際標(biāo)準(zhǔn)(ISNCSCI)對患者術(shù)前術(shù)后感覺/運動功能特點進(jìn)行評分并分級。1.5統(tǒng)計學(xué)方法:所有數(shù)據(jù)均行描述性分析和正態(tài)性檢驗,符合正態(tài)性、方差齊性采用t檢驗,不符合采用秩和檢驗。統(tǒng)計治療組和對照組術(shù)前術(shù)后評分差值,進(jìn)行t檢驗,P0.05為有統(tǒng)計學(xué)意義。統(tǒng)計兩組術(shù)前術(shù)后AISA殘損分級等級(兩樣本方差不齊),進(jìn)行秩檢驗,P0.05有統(tǒng)計學(xué)意義。2參芎葡萄糖預(yù)防跟骨骨折內(nèi)固定術(shù)后切口皮緣壞死的臨床作用觀察60例新鮮跟骨骨折患者(病例來自于河北醫(yī)科大學(xué)第三醫(yī)院創(chuàng)傷急救中心和河北省辛集市第一醫(yī)院骨科)內(nèi)固定術(shù)后恢復(fù)過程中不同治療方案傷口愈合情況,探討參芎葡萄糖預(yù)防跟骨骨折術(shù)后切口皮緣壞死的應(yīng)用。2.1實驗分組60例新鮮跟骨骨折(受傷至入院手術(shù)時間7天)住院患者,隨機分成2組(排除開放骨折、合并神經(jīng)損傷、糖尿病等基礎(chǔ)代謝疾病的患者)。所有患者根據(jù)Sanders分型確認(rèn)為IV型。治療組30例:男17例,女13例;年齡18~63歲,平均32.8歲;病程12d~14d,平均13d;受傷因素:高空墜落傷14例,車禍9例,重物撞擊7例。對照組30例,男19例,女11例;年齡19~65歲,平均36.1歲;病程12d~15d,平均13.2d;受傷因素:高空墜落傷11例,車禍10例,重物撞擊9例。2.2治療方法及藥物所有入選患者于入院后至手術(shù)前行患肢抬高、甘露醇消腫,于傷后48h采取切開復(fù)位跟骨鈦板內(nèi)固定術(shù),術(shù)前術(shù)后24h內(nèi)均常規(guī)應(yīng)用抗生素預(yù)防感染,術(shù)后治療組采用參芎葡萄糖注射液(吉林四長制藥有限公司國藥準(zhǔn)字)100ml靜脈滴注,每日2次。對照組應(yīng)用100ml葡萄糖注射液靜脈滴注,每日兩次。2.3療效標(biāo)準(zhǔn)傷口愈合分級參照《黃家駟外科學(xué)》相關(guān)診斷標(biāo)準(zhǔn)[2]:甲級愈合:用甲字代表,指愈合優(yōu)良,沒有不良反應(yīng)的初期愈合;乙級愈合:用乙字代表,是指愈合欠佳,愈合處有炎癥反應(yīng),如紅腫,硬結(jié),血腫,積液等,但未化膿;丙級愈合,用丙字代表,是指切口化膿,需要做切開引流,或者痂皮形成。療效評價:甲級為顯效,乙級為有效,丙級或傷口不愈合,皮緣壞死為無效。治療組監(jiān)測有無過敏、胃腸道反應(yīng)等情況;患者術(shù)前均行血常規(guī)、凝血四項、生化全項檢查,比較治療組有無凝血機能異常及有無血糖異常。2.4統(tǒng)計學(xué)方法:所有數(shù)據(jù)均行描述性分析和正態(tài)性檢驗,符合正態(tài)性、方差齊性采用t檢驗,不符合采用秩和檢驗。應(yīng)用SPSS13.0統(tǒng)計軟件對數(shù)據(jù)進(jìn)行t檢驗、秩和檢驗,治療有效率的比較采用χ2檢驗。結(jié)果:1患者術(shù)前術(shù)后感覺/運動功能評分結(jié)果顯示,應(yīng)用丹參多酚酸鹽后,患者術(shù)后評分較術(shù)前顯著升高(22.51±4.12),而對照組評分改善不明顯(15.35±4.89),P0.05。ASIA殘損分級顯示丹參多酚酸鹽治療組下肢神經(jīng)功能改善相比對照組有統(tǒng)計學(xué)意義。結(jié)果提示,丹參多酚酸鹽能促進(jìn)外傷致胸腰段壓縮骨折患者術(shù)后功能恢復(fù),縮短患者制動時間。2傷口愈合分級結(jié)果顯示,應(yīng)用參芎葡萄糖注射液后,治療組傷口血運改善有效率明顯高于對照組。術(shù)前凝血四項檢查、生化全項結(jié)果兩組未見異常。結(jié)果提示參芎葡萄糖注射液能顯著提高患者術(shù)后傷口的愈合速度,對預(yù)防切口皮緣壞死有積極作用。結(jié)論:通過對兩種丹參制劑分別在兩種不同骨科疾病中的應(yīng)用療效對比研究,均證實丹參制劑的應(yīng)用有效的改善了患者的臨床癥狀,縮短了住院及制動時間、減少了并發(fā)癥,減輕了廣大患者的病痛,并且副作用少,安全有效,具有良好的經(jīng)濟和社會效益,值得推廣應(yīng)用。
[Abstract]:Objective: with the rapid development of China's architecture, traffic and other fields in recent years, the incidence of falling injury, heavy weight injury, and accident injury is increasing year by year, which leads to an increasing trend in Department of orthopedics disease. The treatment of the disease in the traumatic Department of orthopedics is mainly by open reduction and fixed operation formula, which is accompanied by 6-8 weeks or even 12 weeks, accompanied by fracture healing. In recent years, the study of bone biomechanics and the development of internal fixation have made the reduction of most of the fractures satisfactory in recent years. However, a series of problems such as joint stiffness and lung infection caused by postoperative braking have become a serious prognosis. Therefore, how to shorten the course of the disease in the Department of orthopedics, shorten the time of braking and bed, and reduce the occurrence of complications and sequelae has gradually become the key topic in the study of the Department of orthopedics at home and abroad. Salvia miltiorrhiza is the traditional medicine of the motherland medicine, mainly composed of tanshinone and phenolic acids, which has been widely used in the clinic at present. It is suggested that Salvia miltiorrhiza can effectively promote fracture healing, improve the blood supply of fracture ends, enhance calcium mobilization in adjacent parts of the fracture, promote osteoblast, and promote calcification of fracture ends in the aspects of bone matrix formation, calcification and function enhancement. This study was conducted by observing the injection of Salvia salvianolic acid salt The therapeutic effect of liquid on the functional recovery of spinal cord injury after decompression of thoracolumbar compression fracture, and the clinical application of Shen Ligong glucose to prevent the necrosis of the incision skin after internal fixation of calcaneal fracture, to explore the role of Salvia miltiorrhiza preparation in the treatment of postoperative recovery in the Department of orthopedics. Method: 1 the effect of Salvia miltiorrhiza on the recovery of spinal cord function after decompression of thoracolumbar compression fractures with 260 different treatment methods for thoracolumbar compression fracture with different degree of spinal cord injury, the effect of Salvia miltiorrhiza on postoperative functional recovery of.1.1: thoracolumbar segment The patients were randomly divided into 2 groups, 140 cases in the treatment group and 120 in the control group. The patients were divided into 2 groups, 140 cases in the treatment group and 120 in the control group. The patients in the treatment group were 76 males and 64 women, aged 31~69 years and 40.6 years old. The main injury segments of the patients were T11:37, T12:41, L1:50. The main causes of injury were: 60 cases of traffic accidents: 60 cases of traffic accidents, 57 cases of high altitude falling, 23 cases of heavy weight impact. The control group was 66 men, 54 women, age 33~65, and the average age was 39.8 years old. The main injury segments of the patients were T11:32, T12:41, L1:40, and L2:7. The main causes of injury were 46 cases of traffic accidents and 47 cases falling in high altitude, There were 27 cases of heavy weight impact. All patients were accompanied with different degree of spinal cord injury (all patients were diagnosed as spinal cord injury according to ASIA damage classification, including 37 cases of class A, 41 cases of class B, 55 cases of C class, 7 cases of D class, 0 cases of E, 32 cases of class A, 49 C class, 8 cases of D, 0 cases of E). The patients in the treatment group were all accompanied with lower limbs muscle. There were 72 cases of complete loss of muscle strength in the lower extremities, 134 cases of abdominal distention and incontinence, and 134 cases of lower limb muscle strength in the control group, including 68 cases of complete loss of lower extremities, abdominal distension, and 112 cases of incontinence. The sex, age, course of disease, injury segment, cause of injury and classification of spinal cord injury in the two groups were general. There was no statistically significant difference (P0.05), with comparable.1.2 treatment methods and drugs: all patients were treated with methylprednisolone after admission to the hospital. After the injured 48h, open reduction and vertebral canal decompression and pedicle screw internal fixation were performed after injured 48h. All the patients were routinely used antibiotics to prevent infection in the preoperative and postoperative 24h, and the treatment group was treated with Salvia miltiorrhiza. Salvianolate injection. The main ingredient of Salvia salvianolate injection was Salvia miltiorrhiza acetic acid. Usage and dosage: intravenous drip. One 200mg, dissolved in 0.9% Sodium Chloride Injection 250ml-500 ml. 1 times a day for 10-14 days. The control group used 0.9% Sodium Chloride Injection 250ml-500 ml. a day 1 times. 10-14 days of adverse reaction: all patients 4 patients were treated with mild anaphylaxis after drug use. The symptoms of gastrointestinal irritation occurred in.2 cases after antiallergic treatment. The curative effect of.1.4 after oral omeprazole was given. According to the international standard of neurologic classification of ASIA spinal cord injury (ISNCSCI), the patients' sense of sensorless / motor function was graded and the.1.5 statistics were graded before and after operation. Methods: all data were analyzed by descriptive analysis and normality test, conforming to normality, t test was used for the homogeneity of variance, and the rank sum test was not used. The score difference between the treatment group and the control group was measured before and after the operation, and the t test was carried out. The statistical significance of the P0.05 was statistically significant in the two groups before and after the operation of AISA (the variance of the two samples was inhomogeneous). Line rank test, P0.05 has statistical significance for the prevention of calcaneal fracture after internal fixation of calcaneal fracture with.2. The clinical effect of 60 cases of fresh calcaneal fracture (cases from the third hospital trauma emergency center of Hebei Medical University and Department of orthopedics in the first hospital in Xinji, Hebei) 60 cases of fresh calcaneus fracture (injured to 7 days of hospitalization) were divided into 2 groups randomly (excluding open fracture, nerve injury, diabetes and other basic metabolic diseases). All patients were based on the.2.1 experiment. Sanders classification was confirmed as type IV. 30 cases in the treatment group: male 17, female 13; age 18~63 years, average 32.8 years old; course of disease 12d~14d, average 13D; injury factors: 14 cases of high altitude falling injury, 9 cases of car accident, 7 cases of heavy weight impact, 30 cases in the control group, 19 men, 11 cases; age 19~65 years, average average 13.2d; injury factors: high fall and injury 11 cases, injury factors, 12d~15d, average 13.2d; 10 cases of car accident, 9 cases of heavy material impact and.2.2 treatment methods and all the drugs were selected from the hospital after admission to the operation, the patient was raised, mannitol was swelling, after the injury, 48h adopted open reduction and titanium plate internal fixation, and the routine antibiotics were used to prevent infection in 24h before and after operation. The postoperative treatment group was treated with Salviae Miltiorrhizae Liguspyragine Hydrochloride and Glucose Injection (Jilin four length system). 100ml intravenous drip, 2 times a day. The control group was treated with 100ml Glucose Injection intravenous drip, and two times a daily.2.3 curative effect standard wound healing classification referred to < Huang Jia Si Surgery > related diagnostic criteria [2]: Grade a healing: a word with a word, finger healing excellent, no adverse reaction in the initial healing; second grade Union: use of grade B healing: Word representative, refers to the poor healing, healing where there is an inflammatory reaction, such as red and swelling, hard knot, hematoma, fluid and other, but not suppurative; C healing, the use of Chinese character, is the incision purulent, need to do incision drainage, or scab skin formation. Evaluation: the first class is effective, second class is effective, the third grade or wound nonunion, skin margin necrosis is invalid. Treatment group prison There were no anaphylaxis, gastrointestinal reaction, blood routine, four blood clotting items and biochemical whole examination before the operation. There were no coagulability and abnormal.2.4 statistics in the treatment group: all data were analyzed by descriptive analysis and normal test, conforming to normality, the homogeneity of variance was t test, and the rank sum test was not conformed to the test. SPSS13.0 statistical software was used to test the data with t test, rank sum test, and the comparison of treatment efficiency was compared with chi 2 test. Results: the results of sensory / motor function score of 1 patients before and after operation showed that after the application of Salvia salvianolic acid salt, the postoperative score of the patients was significantly higher than that before operation (22.51 + 4.12), while the improvement of the control group was not significantly improved (15.35 + 4.89), P 0.05.ASIA damage classification showed that the improvement of lower extremity nerve function in the treatment group of Salvia miltiorrhiza was statistically significant compared with the control group. The results suggest that salvianolic acid salt can promote the recovery of postoperative function of patients with thoracolumbar compression fractures, shorten the time of.2 wound healing of patients and use Salviae Miltiorrhizae Liguspyragine Hydrochloride and Glucose Injection, The effective rate of blood transport improvement in the treatment group was significantly higher than that of the control group. Four items of preoperative coagulation were examined, and the total biochemical results were not found in the two groups. The results suggested that Salviae Miltiorrhizae Liguspyragine Hydrochloride and Glucose Injection could significantly improve the healing speed of the wound after the operation, and had a positive effect on the prevention of the skin necrosis of the incision. Conclusion: two kinds of Salvia miltiorrhiza preparations were found in two kinds, respectively. The comparative study on the curative effect of different department of orthopedics diseases proved that the application of Salvia miltiorrhiza effectively improved the clinical symptoms of the patients, shortened the hospitalization and braking time, reduced the complications, reduced the pain of the majority of the patients, and had less side effects, safe and effective, and had good economic and social benefits. It was worth popularizing.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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本文編號：1904851