【摘要】：目的:通過(guò)臨床研究觀察中醫(yī)綜合康復(fù)療法結(jié)合運(yùn)動(dòng)療法對(duì)于脛骨平臺(tái)骨折術(shù)后膝關(guān)節(jié)僵硬的療效及可行性。同時(shí)嘗試將中醫(yī)綜合康復(fù)療法與運(yùn)動(dòng)療法介入該病種的治療操作進(jìn)行規(guī)范。以期為進(jìn)一步探索兩療法如何更好結(jié)合及其臨床推廣提供一些有益的幫助。方法:納入2015年9月至2017年1月在四川省骨科醫(yī)院康復(fù)科門(mén)診及住院部因脛骨平臺(tái)骨折術(shù)后膝關(guān)節(jié)僵硬就診的患者共52例。采用隨機(jī)、對(duì)照實(shí)驗(yàn)設(shè)計(jì),將患者隨機(jī)分為實(shí)驗(yàn)組及對(duì)照組,每組26例。實(shí)驗(yàn)組采用中醫(yī)綜合康復(fù)結(jié)合運(yùn)動(dòng)療法,中醫(yī)綜合康復(fù)療法主要包括電針、中藥熱奄包、傳統(tǒng)關(guān)節(jié)粘連松解術(shù)結(jié)合關(guān)節(jié)松動(dòng)術(shù)、冷療,運(yùn)動(dòng)療法主要包括關(guān)節(jié)松動(dòng)訓(xùn)練、肌肉力量訓(xùn)練。除關(guān)節(jié)松動(dòng)術(shù)隔日/1次,每周進(jìn)行3次外,其余所有治療每日/1次,一周五次為一個(gè)療程,每個(gè)療程間休息2日,共進(jìn)行4個(gè)療程(4周)。對(duì)照組只采用中醫(yī)綜合康復(fù)療法治療,具體治療操作及治療項(xiàng)目與療程等與實(shí)驗(yàn)組無(wú)差別。觀察時(shí)點(diǎn)及效應(yīng)指標(biāo)主要包括評(píng)分量表得分。在實(shí)驗(yàn)結(jié)束進(jìn)行數(shù)據(jù)統(tǒng)計(jì)及處理后,使用SPSS22.0軟件進(jìn)行統(tǒng)計(jì)計(jì)算。結(jié)果:1.經(jīng)4周治療后,中醫(yī)綜合康復(fù)聯(lián)合運(yùn)動(dòng)療法(實(shí)驗(yàn)組)與單純中醫(yī)綜合康復(fù)療法(對(duì)照組)治療脛骨平臺(tái)骨折術(shù)后膝關(guān)節(jié)僵硬的綜合臨床療效總有效率分別是88.46%與65.38%。(P0.05)。說(shuō)明實(shí)驗(yàn)組療效優(yōu)于對(duì)照組。2.兩組患者組內(nèi)治療前、后的療效觀察指標(biāo)(膝關(guān)節(jié)屈伸角度,關(guān)節(jié)活動(dòng)范圍,疼痛、肌肉力量、ADL以及HSS評(píng)分)進(jìn)行比較,治療后均好于治療前,差異有顯著性(P0.05)。說(shuō)明兩組所用療法對(duì)于各臨床癥狀都有不同程度改善。3.兩組組間比較治療結(jié)束后各指標(biāo),其中實(shí)驗(yàn)組患者膝關(guān)節(jié)屈曲、伸直受限、活動(dòng)范圍角度、肌肉力量、ADL與HSS的評(píng)分均好于對(duì)照組,差異有顯著性(P0.05);兩組間VAS評(píng)分差異無(wú)顯著性(P0.05)。表明實(shí)驗(yàn)組療法在改善膝關(guān)節(jié)屈曲、伸直受限、活動(dòng)范圍角度、肌肉力量、ADL與HSS評(píng)分上優(yōu)于對(duì)照組,在緩解VAS疼痛評(píng)分上與對(duì)照組的療法差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:1.兩種療法對(duì)脛骨平臺(tái)骨折術(shù)后膝關(guān)節(jié)僵硬患者的關(guān)節(jié)活動(dòng)范圍、疼痛程度、日常生活能力、及全膝關(guān)節(jié)功能方面均有改善與提高。其中經(jīng)中醫(yī)綜合康復(fù)療法結(jié)合運(yùn)動(dòng)療法治療的患者,在改善膝關(guān)節(jié)的屈、伸活動(dòng)受限、增加膝關(guān)節(jié)活動(dòng)范圍、提高日常生活能力(ADL)及全膝功能量表(HSS)評(píng)分方面,均優(yōu)于單純中醫(yī)綜合康復(fù)療法組。在改善患者膝關(guān)節(jié)疼痛方面,兩種療法效果近似;2.臨床綜合療效評(píng)中,中醫(yī)綜合康復(fù)療法結(jié)合運(yùn)動(dòng)療法治療脛骨平臺(tái)骨折術(shù)后膝關(guān)節(jié)僵硬的療效且優(yōu)于單純中醫(yī)綜合康復(fù)療法;3.中醫(yī)綜合康復(fù)療法結(jié)合運(yùn)動(dòng)療法治療脛骨平臺(tái)骨折術(shù)后膝關(guān)節(jié)僵硬是一種行之有效的治療方案,其療效良好、療程短、安全可靠,可操作性較強(qiáng),有一定的臨床推廣價(jià)值。
[Abstract]:Objective: to observe the curative effect and feasibility of comprehensive rehabilitation therapy combined with exercise therapy in the treatment of knee joint stiffness after tibial plateau fracture. At the same time, we try to regulate the operation of comprehensive rehabilitation therapy and exercise therapy. In order to further explore how to better the combination of the two therapies and its clinical promotion to provide some useful help. Methods: from September 2015 to January 2017, 52 patients with knee stiffness after tibial plateau fracture were enrolled in rehabilitation department of Sichuan Orthopaedic Hospital. Patients were randomly divided into experimental group and control group with 26 cases in each group. The experimental group was treated with comprehensive rehabilitation of TCM combined with exercise therapy. Comprehensive rehabilitation therapy of TCM mainly included electroacupuncture, traditional Chinese medicine hot election bag, traditional joint adhesion release combined with joint loosening, cold therapy, and exercise therapy mainly including joint loosening training. Muscle strength training. With the exception of joint loosening every other day / once, 3 times a week, all the other treatments were treated daily / once, five times a week as a course of treatment, with 2 days' rest between each course of treatment, with a total of 4 courses (4 weeks). The control group was only treated with TCM comprehensive rehabilitation therapy, and the treatment operation, treatment items and course of treatment were not different from those of the experimental group. The observation time point and the effect index mainly include the score scale score. At the end of the experiment for data statistics and processing, the use of SPSS22.0 software for statistical calculation. The result is 1: 1. After 4 weeks of treatment, The total effective rate of comprehensive rehabilitation combined with exercise therapy (experimental group) and traditional Chinese medicine combined rehabilitation therapy (control group) in the treatment of knee joint stiffness after tibial plateau fracture was 88.46% and 65.38%, respectively. % (P0.05). The results showed that the experimental group was superior to the control group. 2. Two groups of patients before and after the treatment of therapeutic indicators (knee flexion and extension angle, range of joint activity, pain, muscle strength, ADL and HSS score) were better than before treatment, the difference was significant (P0.05). It shows that the two groups of treatment for each of the clinical symptoms improved to varying degrees. 3. 3. The indexes after treatment were compared between the two groups. The knee flexion, extension limitation, range angle, muscle strength, ADL and HSS scores of the patients in the experimental group were better than those in the control group (P0.05). There was no significant difference in VAS score between the two groups (P0.05). The results showed that the experimental group was superior to the control group in improving knee flexion, extension limitation, range angle, muscle strength, ADL and HSS score, but there was no significant difference between the experimental group and the control group in relieving VAS pain score. Conclusion: 1. The two treatments can improve the range of knee joint motion, the degree of pain, the ability of daily living, and the function of total knee joint in patients with knee joint stiffness after tibial plateau fracture. Among them, the patients treated by comprehensive rehabilitation therapy of TCM combined with exercise therapy can improve the flexion and extension of the knee joint, increase the range of the knee joint activity, improve the ability of daily living (ADL) and the (HSS) score of the whole knee function scale. All of them were superior to the traditional Chinese medicine comprehensive rehabilitation therapy group. In the improvement of knee pain patients, the effect of the two treatments is similar; 2. In the clinical comprehensive curative effect evaluation, TCM comprehensive rehabilitation therapy combined with exercise therapy in the treatment of tibial plateau fracture postoperative knee stiffness curative effect and is superior to simple TCM comprehensive rehabilitation therapy; 3. Comprehensive rehabilitation therapy combined with exercise therapy in the treatment of knee joint stiffness after tibial plateau fracture is an effective treatment scheme with good curative effect, short course of treatment, safety and reliability, strong maneuverability, and has certain clinical promotion value.
【學(xué)位授予單位】：成都體育學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3

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本文編號(hào)：2343526