本文關(guān)鍵詞：葉偉洪教授脊柱疾病的學(xué)術(shù)經(jīng)驗總結(jié)及臨床研究　出處：《廣州中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 葉偉洪 名醫(yī)經(jīng)驗 骨質(zhì)疏松癥 壯骨強筋片 非手術(shù)椎體再骨折

【摘要】：目的：跟師目的：全面總結(jié)葉偉洪教授的治學(xué)思想、臨床經(jīng)驗和學(xué)術(shù)思想,并結(jié)合自己的臨床實踐,在繼承的基礎(chǔ)上進行創(chuàng)新發(fā)展,開展壯骨強筋片為主綜合治療肝腎不足型骨質(zhì)疏松癥1年的科學(xué)研究,觀察其療效,并探討作用機理,以期闡明導(dǎo)師的學(xué)術(shù)觀點和臨證思路,便于更好地在臨床推廣應(yīng)用。研究目的：老年骨質(zhì)疏松患者數(shù)量龐大,這類患者極容易發(fā)生椎體壓縮性骨折,而術(shù)后發(fā)生非手術(shù)椎體再發(fā)骨折的風(fēng)險亦較高。本文旨在探討經(jīng)皮椎體成形術(shù)后,采用壯骨強筋片防治非手術(shù)椎體再發(fā)骨折的療效。方法：跟師方法：通過跟師學(xué)習(xí)、集中理論學(xué)習(xí)和獨立臨床實踐,分析、歸納葉偉洪教授的治學(xué)思想、學(xué)術(shù)淵源,傳承、體會、總結(jié)葉偉洪教授的學(xué)術(shù)思想和臨床經(jīng)驗�？蒲蟹椒ǎ哼x擇骨質(zhì)疏松性椎體壓縮骨折病例100例,隨機分為A、B兩組,每組各50例,均行經(jīng)皮椎體成形術(shù)治療,A組術(shù)后予常規(guī)抗骨質(zhì)疏松藥(鮭魚降鈣素、阿侖膦酸鈉、骨化三醇和鈣劑),B組術(shù)后予常規(guī)抗骨質(zhì)疏松藥聯(lián)合中藥制劑壯骨強筋片。記錄兩組患者術(shù)前和術(shù)后7天、1個月、3個月、6個月的視覺模擬評分(visual analogue scale, VAS)、Osweatry功能障礙指數(shù)(Osweatry disability index, ODI)、骨密度(bone mineral density,BMD) T值,以及術(shù)后6個月內(nèi)非手術(shù)椎體再發(fā)骨折的例數(shù)。再使用SPSS22.0版軟件對數(shù)據(jù)進行統(tǒng)計學(xué)分析。成果：跟師成果：1、葉偉洪教授治學(xué)思想總結(jié)：仁心仁術(shù),淡泊名利,德者行醫(yī)；博學(xué)精思,勤于實踐,衷中參西。2、葉偉洪教授學(xué)術(shù)思想總結(jié)：包括方法學(xué)上倡導(dǎo)西學(xué)中用,中西并重；診斷上突出整體辨證,強調(diào)辨證求因；治療上病證結(jié)合,標(biāo)本兼顧、內(nèi)外互補、筋骨并重,攻補合宜,善用攻下逐瘀、活血通絡(luò)之法；調(diào)護上注重身心同治,道法自然,科學(xué)養(yǎng)生四方面。3、葉偉洪教授臨床經(jīng)驗總結(jié)：通過對各型骨折、痛風(fēng)性關(guān)節(jié)炎、膝關(guān)節(jié)骨性關(guān)節(jié)炎、腰椎間盤突出癥、頸椎病、強直性脊柱炎、感染及燒傷創(chuàng)面等病因病機、辨證論治、臨床心得的總結(jié),闡明了導(dǎo)師西學(xué)中用,中西并重的理論觀點,系統(tǒng)展現(xiàn)了導(dǎo)師整體辨證、標(biāo)本兼顧、內(nèi)外互補、筋骨并重、攻補合宜、身心同治的臨證思路及用藥特點。研究結(jié)果：所有患者手術(shù)成功,其中89例患者得到6個月以上隨訪,A組42例,B組47例。VAS評分和ODI指數(shù)均顯示兩組患者治療后疼痛和活動功能均有明顯改善(P0.05),A組術(shù)前VAS(6.48±1.19),術(shù)后7天(4.00±1.53)；術(shù)前ODI(78.33±7.28),術(shù)后7天(38.7±3.13)：B組術(shù)前VAS(6.40±0.92),術(shù)后7天(4.49±0.98)；術(shù)前ODI(76.45±6.52),術(shù)后7天(37.6±3.24)。A組與B組相比較,術(shù)后7天VAS評分和ODI指數(shù)差異均有統(tǒng)計學(xué)意義(P0.05)；A組與B組相比較,術(shù)后6個月骨密度T值差異有統(tǒng)計學(xué)意義(P0.05)。A組術(shù)前T值(-2.58±1.58),術(shù)后6個月(-2.09±1.22),B組術(shù)前T值(-2.41±1.92),術(shù)后6個月(-1.46±1.56)。隨訪期間,A組發(fā)生椎體再發(fā)骨折8例,B組2例,兩組椎體骨折再發(fā)率差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論：跟師結(jié)論：葉偉洪教授學(xué)術(shù)思想不拘泥于古法,尋求與時俱進,既繼承又創(chuàng)新,在豐富的中醫(yī)臨床經(jīng)驗和理論基礎(chǔ)上,同時結(jié)合現(xiàn)代科學(xué)技術(shù)和診療手段,中西醫(yī)融會貫通。對于現(xiàn)代中醫(yī)的未來發(fā)展方向,他尤其倡導(dǎo)西學(xué)為中用,中西結(jié)合并重的醫(yī)療理念,這種模式極有可能成為中國新的醫(yī)學(xué)發(fā)展模式；中醫(yī)傳統(tǒng)理念強調(diào)整體觀和辨證論治的思維,葉偉洪教授在此基礎(chǔ)上又結(jié)合自身臨床經(jīng)驗,提出“辨證的整體觀和辨證求因、審因論治”等診斷思維,進一步豐富了中醫(yī)理論；對骨傷疑難病癥的治療,他又提出了“病證結(jié)合、標(biāo)本兼顧、內(nèi)外互補、筋骨并重”的治療觀點,這更加貼近現(xiàn)代臨床實際。根據(jù)“攻補合宜”的治療思想,以及“攻下逐瘀、活血通絡(luò)”的治療思路,葉偉洪教授創(chuàng)制了許多方藥,經(jīng)過臨床反復(fù)驗證以及實驗研究的證明,療效確切。他的“身心同治,道法自然,科學(xué)養(yǎng)生”的調(diào)護理念,對病人的全面康復(fù),以及現(xiàn)代社會的科學(xué)發(fā)展和人類的身心健康均有重要的指導(dǎo)意義。以壯骨強筋片為主,配合壯骨強筋片、降鈣素,結(jié)合飲食、勞逸調(diào)護等方法,綜合治療肝腎不足型骨質(zhì)疏松癥,在提高病人骨密度、緩解疼痛、改善生活質(zhì)量及預(yù)防骨折等方面效果明顯。其作用機制可能在于從多途徑、多靶點干預(yù)和作用于骨質(zhì)疏松癥發(fā)病的各環(huán)節(jié)、各因素,調(diào)節(jié)人體的整體功能,恢復(fù)機體的生理狀態(tài)和動態(tài)平衡,促進骨形成和抑制骨吸收,起到提高骨量的作用,最終達到使疾病痊愈的目的。該方法既融合了中西醫(yī)的精華,又摒棄了中西醫(yī)的缺陷,具有優(yōu)勢互補,標(biāo)本兼治,遠近期療效確切,使用方便,不良反應(yīng)少,費用低的特點,值得臨床進一步推廣應(yīng)用。該研究為中西醫(yī)結(jié)合防治骨質(zhì)疏松癥提供了理論依據(jù)和有效藥物,為治療骨質(zhì)疏松癥提供了新的思路、方法和途徑,不僅具有一定的科學(xué)性和先進性,而且具有較高的學(xué)術(shù)價值和臨床意義�？蒲薪Y(jié)論：基于我們的試驗分析,經(jīng)皮椎體成形術(shù)后,相比單純采用常規(guī)聯(lián)合抗骨質(zhì)疏松治療,中藥制劑壯骨強筋片聯(lián)合常規(guī)抗骨質(zhì)疏松治療,可以更有效減輕術(shù)后患者疼痛,改善脊柱功能,增加骨密度,降低椎體壓縮骨折再發(fā)率。
[Abstract]:Objective: to master Objective: comprehensive summary of Professor Ye Weihong's academic thought and clinical experience and academic thought, and combined with clinical practice, innovation and development on the basis of inheritance, carry out zhuangguqiangjin learning research of comprehensive treatment of liver and kidney deficiency type osteoporosis in 1 years, to observe the effect and explore the effect the mechanism of academic ideas and clinical thoughts to elucidate the tutor, which is better in clinical application. Objective: the elderly patients with osteoporosis in large quantities, these patients very prone to vertebral compression fractures, the risk of postoperative non-surgical vertebral fractures is higher. This paper aims to explore the percutaneous vertebroplasty after angioplasty, the effect of the prevention and treatment of non-surgical vertebral fractures zhuangguqiangjin tablets. Methods: with normal methods: learning with the teacher centered learning theory and independent clinical practice, analysis, induction of leaf Wei Hong academic thoughts, academic origin, inheritance, experience, academic thought and clinical experience of Professor Ye Weihong's research. Methods: 100 cases of osteoporotic vertebral compression fractures were randomly divided into A, B two groups, 50 cases in each group, were treated with percutaneous vertebroplasty in the treatment group, A after treated with anti osteoporosis drugs (salmon calcitonin, alendronate, ossification in three alcohol and calcium), treated with anti osteoporosis drugs combined with traditional Chinese medicine preparation zhuangguqiangjin B group after 7 days. Records of two groups of patients before and after surgery, 1 months, 3 months 6 months, the visual analogue scale (visual analogue scale, VAS), Osweatry disability index (Osweatry disability index, ODI), bone mineral density (bone mineral density, BMD) T, and 6 months after the operation of non surgical vertebral fractures. The number of cases using the SPSS22.0 software version of the data results: with the statistical analysis. Results: the 1 Division, Professor Ye Weihong thought summary: with both a benevolent mind and heart indifferent to fame and wealth, virtue, erudite practice; precise thinking, diligent practice, full participation in the west of.2, the academic thought of Professor Ye Weihong summary: including the methodology advocated by Western learning, both Chinese and Western medicine; diagnosis to highlight the overall differentiation, dialectical for combination; treatment of diseases of both inside and outside, complementary, bones, appropriate use of reinforcement, the capture of stasis, Huoxue Tongluo method; nursing focus on physical and mental Tongzhi, imitation of nature, four aspects of science and health.3, Professor Ye Weihong 's clinical experience: all types of fractures, gouty arthritis, osteoarthritis of the knee, lumbar disc herniation, cervical spondylosis, ankylosing spondylitis, burn wound infection and other etiology and pathogenesis, syndrome differentiation, clinical experience summary, the tutor of Western used western theories and heavy, show the guide system 甯堟暣浣撹鯨璇，

本文編號：1387870