【摘要】：目的:觀察新傷續(xù)斷湯聯(lián)合短節(jié)段傷椎置術(shù)治療單節(jié)段胸腰段骨折的臨床療效,初步探討新傷續(xù)斷湯對(duì)胸腰段骨折愈合的作用機(jī)制。方法:收集本院2015年11月至2016年8月單節(jié)段胸腰段骨折患者60例,按照入院順序以隨機(jī)數(shù)字表法分為中藥組、對(duì)照組各30例。2組患者均由同組手術(shù)組醫(yī)師行短節(jié)段傷椎置釘術(shù)治療,對(duì)照組術(shù)后常規(guī)止痛、抗感染、功能鍛煉等,不予其他可影響骨質(zhì)代謝的藥物治療。中藥組在對(duì)照組的基礎(chǔ)上,術(shù)后第三天開始服用新傷續(xù)斷湯,連續(xù)4周,觀察隨訪6個(gè)月,記錄術(shù)前及術(shù)后VAS評(píng)分、ODI評(píng)分、BALP,以CT檢查觀察骨折愈合的情況,并在術(shù)后6個(gè)月對(duì)2組患者進(jìn)行療效評(píng)價(jià),數(shù)據(jù)用SPSS22.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:2組最終完成57例,其中中藥組完成28例,對(duì)照組完成29例。比較2組患者術(shù)前基線特征(年齡、性別、損傷節(jié)段、術(shù)前VAS評(píng)分、ODI評(píng)分、BALP),均未見顯著性差異(P0.05),具有可比性。2組VAS評(píng)分、ODI評(píng)分隨著時(shí)間的延長(zhǎng)而降低,中藥組下降更為明顯,同一時(shí)間點(diǎn)組間比較,中藥組在術(shù)后1、3、6個(gè)月均低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2組患者術(shù)后BALP隨著時(shí)間延長(zhǎng)而呈上升的趨勢(shì),且中藥組上升的幅度大于對(duì)照,術(shù)后中藥組各時(shí)間點(diǎn)BALP值均高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。經(jīng)CT檢查,2組術(shù)后3、6個(gè)月均有骨小梁通過骨折端,中藥組骨折斷端CT值在術(shù)后3、6個(gè)月高于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后6個(gè)月中藥組治愈率高于對(duì)照組(P0.05)。結(jié)論:1、新傷續(xù)斷湯聯(lián)合短節(jié)段傷椎置釘術(shù)能有效緩解胸腰段骨折患者疼痛癥狀,促進(jìn)骨折愈合,改善脊柱活動(dòng)功能,臨床療效確切;2、新傷續(xù)斷湯能明顯提高胸腰段骨折患者行短節(jié)段傷椎置釘術(shù)后骨特異性堿性磷酸酶的活性,從而促進(jìn)骨折椎體的愈合。
[Abstract]:Objective: to observe the clinical effect of Xinshangdianshu decoction (XSCD) combined with short segmental injury vertebra insertion in treating single segment thoracolumbar fracture, and to explore the mechanism of Xinshangdianling decoction (XSWD) on the healing of thoracolumbar fracture. Methods: sixty patients with single segment thoracolumbar fracture from November 2015 to August 2016 were collected and randomly divided into two groups according to the order of admission. The patients in the control group were treated by short segmental spinal screw insertion. The patients in the control group were treated with routine analgesic, anti-infection, functional exercise, and no other drugs could affect the bone metabolism. On the basis of the control group, the traditional Chinese medicine group began to take Xinshanglianling decoction on the third day after operation for 4 weeks. The patients were followed up for 6 months. The VAS score, ODI score before and after operation were recorded, and the fracture healing was observed by BALP, with CT examination. 6 months after operation, two groups of patients were evaluated, and the data were statistically analyzed by SPSS22.0 software. Results: 57 cases were finished in group 2, 28 cases in Chinese medicine group and 29 cases in control group. The baseline features (age, sex, injury segment, preoperative VAS score and ODI score, BALP),) were not significantly different between the two groups (P0.05). The VAS score and ODI score of the two groups decreased with time. Compared with the control group at the same time point, the BALP of the traditional Chinese medicine group was significantly lower than that of the control group at 1 and 6 months after operation (P0.05). The BALP of the two groups increased with the prolongation of time. And the increase of the Chinese medicine group is larger than that of the control group, the BALP value of the traditional Chinese medicine group is higher than that of the control group at each time point after operation, the difference is statistically significant (P0.05). CT examination showed that the trabeculae of the two groups passed through the fracture end 3 and 6 months after operation, and the CT value of the broken end of the fracture in the Chinese medicine group was higher than that in the control group at 3 and 6 months after operation, the difference was statistically significant (P0.05). 6 months after operation, the cure rate of TCM group was higher than that of control group (P0.05). Conclusion: 1. Xinshangdianshu decoction combined with short segment spinal screw insertion can effectively relieve pain symptoms of patients with thoracolumbar fracture, promote fracture healing, improve spinal movement function, and the clinical curative effect is accurate. 2. Xinshangdiaxian decoction can obviously improve the activity of bone specific alkaline phosphatase after short segmental spinal screw insertion in patients with thoracolumbar fracture, and thus promote the healing of fracture vertebral body.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【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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