關(guān)節(jié)鏡清理術(shù)聯(lián)合痛風(fēng)顆粒治療膝痛風(fēng)性關(guān)節(jié)炎的臨床觀察
發(fā)布時(shí)間：2018-11-25 11:11
【摘要】：目的通過(guò)觀察比較關(guān)節(jié)鏡清理術(shù)后患者的主觀滿意度,疼痛程度,血沉、C反應(yīng)蛋白、血尿酸的變化,臨床療效,膝關(guān)節(jié)功能Lysholm評(píng)分,術(shù)后并發(fā)癥等,探討關(guān)節(jié)鏡清理術(shù)聯(lián)合痛風(fēng)顆粒治療膝痛風(fēng)性關(guān)節(jié)炎的臨床療效,為膝痛風(fēng)性關(guān)節(jié)炎尋求安全、有效的治療方法。方法本次研究對(duì)象選取自2013年3月至2014年9月在湖北省十堰市太和醫(yī)院骨關(guān)節(jié)科病房住院治療的60例反復(fù)發(fā)作的膝痛風(fēng)性關(guān)節(jié)炎病人。所有就診患者按入院的先后順序采用隨機(jī)化對(duì)照方法(拋硬幣法)分為治療組和對(duì)照組兩組,治療組30例,對(duì)照組30例,行膝關(guān)節(jié)清理術(shù)及術(shù)后的常規(guī)處理相同。60例膝痛風(fēng)性關(guān)節(jié)炎患者,男性55例,女性5例;年齡34-65歲,病程7天至15年。中醫(yī)辨證均為濕熱蘊(yùn)結(jié)證。入院后完善術(shù)前常規(guī)檢查及術(shù)前手術(shù)評(píng)估,無(wú)手術(shù)絕對(duì)禁忌癥。治療組30例,行關(guān)節(jié)鏡清理術(shù),術(shù)后第一天起開(kāi)始口服痛風(fēng)顆粒,一袋10克,每日三次,每次一袋,連續(xù)14天;對(duì)照組30例,行關(guān)節(jié)鏡清理術(shù),術(shù)后口服秋水仙堿片、碳酸氫鈉片;1周后改服別嘌醇片、丙磺舒片,連續(xù)治療14天。觀察術(shù)后各組患者主觀滿意度;術(shù)后1周、2周疼痛程度進(jìn)行視覺(jué)模擬評(píng)分(VAS評(píng)分);術(shù)后1周、2周血沉、C反應(yīng)蛋白、血尿酸的變化;臨床療效;術(shù)后1個(gè)月、3個(gè)月的膝關(guān)節(jié)功能Lysholm評(píng)分;術(shù)后并發(fā)癥。并進(jìn)行統(tǒng)計(jì)學(xué)分析結(jié)果(SPSSl9.0統(tǒng)計(jì)軟件)。結(jié)果1.兩組主觀滿意度比較治療組病例評(píng)估時(shí)滿意26例(86.7%),一般3例(10%),不滿意1例(3.3%)。對(duì)照組病例評(píng)估時(shí)滿意20例(66.7%),一般6例(20%),不滿意4例(13.3%)。主觀滿意度治療組明顯優(yōu)于對(duì)照組(見(jiàn)表2)。2.兩組術(shù)前及術(shù)后1周、2周疼痛程度進(jìn)行視覺(jué)模擬評(píng)分比較對(duì)兩組患者治療前、治療后1周以及治療后2周進(jìn)行VAS評(píng)分,結(jié)果如表3所示。結(jié)果顯示:治療組患者在治療1周、2周后其評(píng)分分值明顯低于對(duì)照組(P0.05),治療組術(shù)后疼痛緩解明顯優(yōu)于對(duì)照組(見(jiàn)表3)。3.術(shù)后1周、2周兩組的血沉、C反應(yīng)蛋白及血尿酸比較治療組治療后血沉、C反應(yīng)蛋白及血尿酸水平明顯降低,且降低程度優(yōu)于對(duì)照組,具有統(tǒng)計(jì)學(xué)差異(P0.01)(見(jiàn)表4)。痛風(fēng)顆粒降血尿酸、降低血沉以及C反應(yīng)蛋白,減輕關(guān)節(jié)炎癥優(yōu)于西藥。4.術(shù)后3個(gè)月兩組臨床療效比較術(shù)后隨訪3個(gè)月,治療組總有效率為96.7%,對(duì)照組總有效率為73.3%,經(jīng)統(tǒng)計(jì)學(xué)比較,差異有統(tǒng)計(jì)學(xué)意義(PO.05)(見(jiàn)表5)。兩組患者臨床療效比較,治療組明顯優(yōu)于對(duì)照組。5.兩組術(shù)前、術(shù)后1個(gè)月及3個(gè)月的膝關(guān)節(jié)功能Lysholm評(píng)分比較術(shù)后1個(gè)月隨訪膝關(guān)節(jié)功能評(píng)分,治療組為68.15±10.04,對(duì)照組為51.80±16.90,治療組優(yōu)于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(PO.05)(見(jiàn)表6)。術(shù)后3個(gè)月隨訪膝關(guān)節(jié)功能評(píng)分,治療組為85.85±8.08,對(duì)照組為63.28±10.02,治療組明顯優(yōu)于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(PO.05)(見(jiàn)表6)。結(jié)論通過(guò)對(duì)關(guān)節(jié)鏡清理術(shù)聯(lián)合痛風(fēng)顆粒治療膝痛風(fēng)性關(guān)節(jié)炎的臨床療效觀察比較,研究結(jié)果表明:關(guān)節(jié)鏡清理術(shù)聯(lián)合痛風(fēng)顆粒治療膝痛風(fēng)性關(guān)節(jié)炎療效顯著,相比關(guān)節(jié)鏡下清理術(shù)配合西藥治療療效更佳,是治療膝痛風(fēng)性關(guān)節(jié)炎的一種安全、有效、微創(chuàng)、迅速的方法。關(guān)節(jié)鏡下清理術(shù)聯(lián)合痛風(fēng)顆粒治療膝痛風(fēng)性關(guān)節(jié)炎,術(shù)后養(yǎng)成良好的生活方式以及飲食習(xí)慣,可最大限度減輕關(guān)節(jié)內(nèi)損害,阻止病程進(jìn)展,保護(hù)膝關(guān)節(jié)功能。
[Abstract]:Objective To compare the subjective degree of satisfaction, the degree of pain, the erythrocyte sedimentation rate, the C-reactive protein, the change of the blood uric acid, the clinical curative effect, the Lysholm score of the knee joint function, the postoperative complications and so on by comparing the subjective satisfaction degree, the pain degree, the erythrocyte sedimentation rate, the C-reactive protein, the blood uric acid, the clinical curative effect, the function of the knee joint, the Lysholm score, the postoperative complications, etc. of the patients after the arthroscopy. To explore the clinical effect of arthroscopy combined with gout in the treatment of gouty arthritis, and to find a safe and effective method for the treatment of gouty arthritis of the knee. Methods 60 cases of knee-gouty arthritis were selected from March, 2013 to September, 2014 in the hospital of Taihe Hospital of Taihe Hospital in Shiyan City, Hubei Province. All the patients in the treatment group were divided into the treatment group and the control group according to the sequence of admission, 30 cases of the treatment group, 30 cases of the control group, the operation of the knee joint cleaning and the routine treatment after the operation. 5 female; aged 34-65, course of course 7-15 years. The syndrome differentiation of TCM is the syndrome of damp-heat. The pre-operative routine examination before and after admission and the pre-operative assessment and no absolute contraindication for the operation were performed. In the treatment group, 30 cases were treated with arthroscopy, and the first day after the operation, the oral gout particles were taken, a bag of 10 g, three times a day, one bag for 14 days, 30 cases in the control group, an arthroscopic debridement procedure, an oral colchicine tablet and a sodium bicarbonate tablet after operation, and the alcohol tablet was changed after 1 week. The probenecid tablets were treated for 14 consecutive days. The subjective satisfaction of the patients after operation was observed, and the visual analogue score (VAS score) was performed at 1 week and 2 weeks after the operation; the changes of the erythrocyte sedimentation rate, the C-reactive protein and the blood uric acid were measured at 1 week, 2 weeks after the operation, and the Lysholm score of the knee joint function of 3 months after the operation was 1 month and 3 months after the operation; and the postoperative complications. Statistical analysis was performed (SPSSl92.0 statistical software). Results 1. The subjective satisfaction of the two groups was satisfactory in 26 cases (86.7%) in the treatment group, 3 (10%) and 1 (3.3%). In the control group, 20 cases (66. 7%), 6 (20%) and 4 (13. 3%) were satisfied. The subjective satisfaction treatment group was significantly superior to the control group (see Table 2). The VAS scores were compared between the two groups before and after 1 and 2 weeks after treatment, 1 week after treatment, and 2 weeks after treatment, as shown in Table 3. The results showed that the score of the treatment group was significantly lower than that in the control group after 1 week and 2 weeks (P0.05). The pain relief after the treatment group was better than that of the control group (see Table 3). The levels of erythrocyte sedimentation, C-reactive protein and serum uric acid in the treatment group were significantly lower after 1 week and 2 weeks after the operation, and the degree of reduction was better than that of the control group (P0.01) (see Table 4). The gout granule has the advantages of reducing blood uric acid, lowering the erythrocyte sedimentation rate and C-reactive protein, and relieving the inflammation of the joint to the western medicine. The total effective rate of the treatment group was 96.7%, the total effective rate of the control group was 73.3%, and the difference was statistically significant (PO. 05) (see Table 5). The curative effect of the two groups was better than that of the control group. The function score of the knee joint was followed for 1 month and 3 months before and after the operation. The treatment group was 68. 15-10.04, the control group was 51. 80-16. 90, the treatment group was better than the control group, and the difference was statistically significant (PO. 05) (see Table 6). The functional scores of the knee joint were followed up 3 months after the operation. The treatment group was 85. 85 to 8.08, and the control group was 63.28 to 10.02, and the treatment group was significantly superior to the control group, and the difference was statistically significant (PO. 05) (see Table 6). Conclusion The clinical effect of arthroscopy combined with gout in the treatment of gouty arthritis of the knee was compared, and the results showed that the combination of arthroscopy combined with the treatment of gout was a significant effect on the treatment of the gouty arthritis of the knee. is a safe, effective, minimally invasive and rapid method for treating the gouty arthritis of the knee. under the arthroscope, the combined gout particles can be used for the treatment of the gouty arthritis of the knee, the good living mode and the eating habits are formed after the operation, the damage in the joint can be reduced to the maximum extent, the course of the disease is prevented, and the function of the knee joint is protected.
【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
本文編號(hào)：2355896
[Abstract]:Objective To compare the subjective degree of satisfaction, the degree of pain, the erythrocyte sedimentation rate, the C-reactive protein, the change of the blood uric acid, the clinical curative effect, the Lysholm score of the knee joint function, the postoperative complications and so on by comparing the subjective satisfaction degree, the pain degree, the erythrocyte sedimentation rate, the C-reactive protein, the blood uric acid, the clinical curative effect, the function of the knee joint, the Lysholm score, the postoperative complications, etc. of the patients after the arthroscopy. To explore the clinical effect of arthroscopy combined with gout in the treatment of gouty arthritis, and to find a safe and effective method for the treatment of gouty arthritis of the knee. Methods 60 cases of knee-gouty arthritis were selected from March, 2013 to September, 2014 in the hospital of Taihe Hospital of Taihe Hospital in Shiyan City, Hubei Province. All the patients in the treatment group were divided into the treatment group and the control group according to the sequence of admission, 30 cases of the treatment group, 30 cases of the control group, the operation of the knee joint cleaning and the routine treatment after the operation. 5 female; aged 34-65, course of course 7-15 years. The syndrome differentiation of TCM is the syndrome of damp-heat. The pre-operative routine examination before and after admission and the pre-operative assessment and no absolute contraindication for the operation were performed. In the treatment group, 30 cases were treated with arthroscopy, and the first day after the operation, the oral gout particles were taken, a bag of 10 g, three times a day, one bag for 14 days, 30 cases in the control group, an arthroscopic debridement procedure, an oral colchicine tablet and a sodium bicarbonate tablet after operation, and the alcohol tablet was changed after 1 week. The probenecid tablets were treated for 14 consecutive days. The subjective satisfaction of the patients after operation was observed, and the visual analogue score (VAS score) was performed at 1 week and 2 weeks after the operation; the changes of the erythrocyte sedimentation rate, the C-reactive protein and the blood uric acid were measured at 1 week, 2 weeks after the operation, and the Lysholm score of the knee joint function of 3 months after the operation was 1 month and 3 months after the operation; and the postoperative complications. Statistical analysis was performed (SPSSl92.0 statistical software). Results 1. The subjective satisfaction of the two groups was satisfactory in 26 cases (86.7%) in the treatment group, 3 (10%) and 1 (3.3%). In the control group, 20 cases (66. 7%), 6 (20%) and 4 (13. 3%) were satisfied. The subjective satisfaction treatment group was significantly superior to the control group (see Table 2). The VAS scores were compared between the two groups before and after 1 and 2 weeks after treatment, 1 week after treatment, and 2 weeks after treatment, as shown in Table 3. The results showed that the score of the treatment group was significantly lower than that in the control group after 1 week and 2 weeks (P0.05). The pain relief after the treatment group was better than that of the control group (see Table 3). The levels of erythrocyte sedimentation, C-reactive protein and serum uric acid in the treatment group were significantly lower after 1 week and 2 weeks after the operation, and the degree of reduction was better than that of the control group (P0.01) (see Table 4). The gout granule has the advantages of reducing blood uric acid, lowering the erythrocyte sedimentation rate and C-reactive protein, and relieving the inflammation of the joint to the western medicine. The total effective rate of the treatment group was 96.7%, the total effective rate of the control group was 73.3%, and the difference was statistically significant (PO. 05) (see Table 5). The curative effect of the two groups was better than that of the control group. The function score of the knee joint was followed for 1 month and 3 months before and after the operation. The treatment group was 68. 15-10.04, the control group was 51. 80-16. 90, the treatment group was better than the control group, and the difference was statistically significant (PO. 05) (see Table 6). The functional scores of the knee joint were followed up 3 months after the operation. The treatment group was 85. 85 to 8.08, and the control group was 63.28 to 10.02, and the treatment group was significantly superior to the control group, and the difference was statistically significant (PO. 05) (see Table 6). Conclusion The clinical effect of arthroscopy combined with gout in the treatment of gouty arthritis of the knee was compared, and the results showed that the combination of arthroscopy combined with the treatment of gout was a significant effect on the treatment of the gouty arthritis of the knee. is a safe, effective, minimally invasive and rapid method for treating the gouty arthritis of the knee. under the arthroscope, the combined gout particles can be used for the treatment of the gouty arthritis of the knee, the good living mode and the eating habits are formed after the operation, the damage in the joint can be reduced to the maximum extent, the course of the disease is prevented, and the function of the knee joint is protected.
【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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