【摘要】：目的:將祖國傳統(tǒng)醫(yī)學(xué)與現(xiàn)代醫(yī)學(xué)治療手段相結(jié)合優(yōu)勢(shì)互補(bǔ),合理選用中醫(yī)康復(fù)治療手段運(yùn)用于膝關(guān)節(jié)表面置換術(shù)中。初步探討其作用機(jī)理及其運(yùn)用優(yōu)勢(shì),為日后更為廣泛的臨床實(shí)踐提供理論依據(jù)。方法:選擇2013年1月—2014年12月間收入湖北省中醫(yī)院骨傷科的嚴(yán)重膝骨性關(guān)節(jié)有手術(shù)適應(yīng)癥的患者作為研究對(duì)象。按照病例研究納入及排除標(biāo)準(zhǔn)選擇病例50例50膝,按照隨機(jī)原則,根據(jù)患者入院順序?qū)?yīng)的統(tǒng)計(jì)學(xué)隨機(jī)數(shù)字表,將患者分為實(shí)驗(yàn)組和對(duì)照組各25例。實(shí)驗(yàn)組對(duì)照組患者均進(jìn)行人工膝關(guān)節(jié)表面置換術(shù),并且手術(shù)由同一組醫(yī)生完成。術(shù)前實(shí)驗(yàn)組患者接受辨證骨傷科手法治療。術(shù)中采用個(gè)體化的軟組織松解術(shù)。術(shù)后兩組患者均按照術(shù)后常規(guī)處理流程規(guī)范化處理。術(shù)后第二天開始指導(dǎo)兩組患者進(jìn)行適度的功能鍛煉,實(shí)驗(yàn)組患者辨證給予中藥內(nèi)服及骨傷科手法治療。術(shù)后規(guī)范換藥兩周后視傷口愈合情況予以傷口拆線,實(shí)驗(yàn)組拆線后采用傷科熏洗湯熏洗患肢。實(shí)驗(yàn)組及對(duì)照組患者術(shù)前、術(shù)后2周,3周,1個(gè)月,3個(gè)月,半年和1年,運(yùn)用美國膝關(guān)節(jié)協(xié)會(huì)膝關(guān)節(jié)綜合評(píng)分標(biāo)準(zhǔn)(AKS)進(jìn)行臨床療效評(píng)估。結(jié)果:1.實(shí)驗(yàn)組與對(duì)照組比較術(shù)前AKS評(píng)分,經(jīng)檢驗(yàn)差異無統(tǒng)計(jì)學(xué)意義(P0.05)。2.實(shí)驗(yàn)組與對(duì)照組比較術(shù)后2周、3周、1月AKS評(píng)分,經(jīng)檢驗(yàn)差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3.實(shí)驗(yàn)組與對(duì)照組比較術(shù)后3個(gè)月、半年、1年AKS評(píng)分,經(jīng)檢驗(yàn)差異無統(tǒng)計(jì)學(xué)意義(P0.05)。4.實(shí)驗(yàn)組對(duì)照組手術(shù)時(shí)間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.膝骨關(guān)節(jié)炎膝關(guān)節(jié)表面置換結(jié)合中醫(yī)康復(fù)治療患者近期內(nèi)改善膝關(guān)節(jié)功能,緩解腫脹、疼痛、畸形有效。2.膝骨關(guān)節(jié)炎膝關(guān)節(jié)表面置換的個(gè)體化軟組織平衡過程中,精確有效地糾正了軟組織失平衡狀態(tài)。手術(shù)過程中創(chuàng)傷小、出血少、精度高獲得了良好的臨床療效。3.膝骨關(guān)節(jié)炎膝關(guān)節(jié)表面置換結(jié)合康復(fù)治療中手術(shù)過程中并沒有明顯延長手術(shù)時(shí)間。4.膝骨關(guān)節(jié)炎膝關(guān)節(jié)表面置換結(jié)合康復(fù)治療時(shí),并沒有較多的增加醫(yī)療費(fèi)用負(fù)擔(dān)。5.膝骨關(guān)節(jié)炎膝關(guān)節(jié)表面置換結(jié)合康復(fù)治療中縮短了患者康復(fù)期。6.膝骨關(guān)節(jié)炎膝關(guān)節(jié)表面置換結(jié)合康復(fù)治療中副作用小無不良反應(yīng),安全性可靠性高、值得推廣。7.為祖國傳統(tǒng)醫(yī)學(xué)現(xiàn)代化及中西醫(yī)結(jié)合事業(yè)做了力所能及的貢獻(xiàn)。
[Abstract]:Objective: to combine the advantages of traditional Chinese medicine with modern medical treatment, and to select the rehabilitation therapy of traditional Chinese medicine in knee arthroplasty. The mechanism and advantages of its application are discussed in order to provide theoretical basis for more extensive clinical practice in the future. Methods: from January 2013 to December 2014, patients with severe knee osteoarthrosis who were admitted to the Department of Orthopedics and Trauma of Hubei Provincial Hospital of traditional Chinese Medicine were selected as study objects. 50 cases (50 knees) were selected according to the criteria of inclusion and exclusion of case study. According to the random principle and the statistical random number table corresponding to the order of admission, the patients were divided into two groups: the experimental group (n = 25) and the control group (n = 25). The patients in the control group underwent artificial knee arthroplasty, and the operation was performed by the same group of doctors. The patients in the experimental group were treated with orthopedic and orthopedic manipulation before operation. Individualized soft tissue release was performed during the operation. The patients in both groups were treated according to the routine procedure. On the second day after operation, the patients in the two groups were given moderate functional exercise. The patients in the experimental group were treated with traditional Chinese medicine and orthopedic manipulation according to syndrome differentiation. Two weeks after the standard dressing change, the wound was removed according to the wound healing condition, and the injured limb was washed by fumigation and washing decoction after the thread removal in the experimental group. Before operation, 2 weeks, 3 weeks, 1 month, 3 months, 6 months and 1 year after operation, the patients in the experimental group and the control group were evaluated with the American knee Association knee Joint Comprehensive score (AKS). Results: 1. There was no significant difference in preoperative AKS score between the experimental group and the control group (P0.05). The AKS score of the experimental group was significantly higher than that of the control group at 2 weeks, 3 weeks and 1 month postoperatively (P0.05). There was no significant difference in AKS score between the experimental group and the control group in 3 months, 6 months and 1 year postoperatively (P0.05). There was no significant difference in operation time between the experimental group and the control group (P0.05). Conclusion: 1. Knee osteoarthritis knee surface replacement combined with traditional Chinese medicine rehabilitation treatment in the near future to improve the knee function, relieve swelling, pain, deformity effective. 2. In the process of individualized soft tissue balance of knee joint surface replacement, the misbalance of soft tissue is corrected accurately and effectively. In the process of operation, the trauma is small, the bleeding is less, and the accuracy is high. Knee osteoarthritis knee surface replacement combined with rehabilitation treatment did not significantly prolong the operation time. 4. Knee osteoarthritis knee surface replacement combined with rehabilitation treatment, and did not increase the burden of medical costs. 5. 5. Knee osteoarthritis knee surface replacement combined with rehabilitation treatment shortened the patient's recovery period. 6. 5%. Knee osteoarthritis knee surface replacement combined with rehabilitation in the treatment of small side effects no adverse reactions, high safety and reliability, worthy of promotion. For the modernization of traditional Chinese medicine and the cause of integrated Chinese and Western medicine to do what they can.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.4

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