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  本文關鍵詞：踝關節(jié)扭傷中藥外敷療法證據(jù)學療效大樣本調查研究　出處：《廣州中醫(yī)藥大學》2016年碩士論文　論文類型：學位論文

  更多相關文章： 急性踝關節(jié)扭傷 祛瘀消腫膏 中藥硬膏

【摘要】：目的：目前沒有可信任或可引用的文獻(比如核心期刊)證明中藥外敷療法對踝關節(jié)扭傷的有效性,且臨床上對外踝扭傷診斷和治療方法比較多樣化。為證實臨床研究更具有可靠性,通過對中藥外敷治療急性踝關節(jié)扭傷的文獻質量評價,并進行大樣本臨床試驗研究,為中藥外敷療法的有效性提供可靠的證據(jù)學支持。方法：采用大樣本組間對照試驗,于2015年4月-2015年10月分別在廣東醫(yī)學院第一附屬醫(yī)院、廣東省第二中醫(yī)院和廣州中醫(yī)藥大學附屬骨傷科醫(yī)院,對急診及門診踝關節(jié)扭傷患者進行臨床研究,共納入294例急性踝關節(jié)扭傷患者,所有患者在簽署知情同意書并參加本研究后,根據(jù)納入和排除標準,按照分配方案分為3個組：對照組A 97例,觀察組B 99例,觀察組C 98例, A根據(jù)RICE原則進行保守治療,B采用省第二中醫(yī)院特制中藥硬膏外敷治療,C采用附屬骨傷科醫(yī)院特制祛瘀消腫膏外敷治療。在治療前、治療后2天、治療后8天、治療后15天分別對患者采用局部壓痛、腫脹度、瘀斑大小、踝關節(jié)功能活動度(ROM)及Kofoed踝關節(jié)評分標準為觀察指標加以評分,根據(jù)以上幾項積分變化結果,剖析其臨床療效。結果：經(jīng)重復測定方差分析,與RICE組比較,中藥硬膏組、祛瘀消腫膏組治療后8天及15天VAS疼痛評分均明顯降低(尸0.05)。說明中藥硬膏組、祛瘀消腫膏組治療后8天及15天止痛效果優(yōu)于RICE組。經(jīng)重復測定方差分析,與RICE組比較,中藥硬膏組、祛瘀消腫膏組治療后2天瘀斑大小評分均明顯升高(p0.05),而治療后8天及15天瘀斑大小評分均明顯降低(p0.05),說明扭傷后冰敷使毛細血管收縮以減輕局部出血,故可見治療后2天RICE組瘀斑評分較其他兩組低；而治療方面,中藥硬膏組、祛瘀消腫膏組治療后8天及15天活血化瘀效果優(yōu)于RICE組。經(jīng)重復測定方差分析,與RICE組比較,中藥硬膏組、祛瘀消腫膏組治療后2天、治療后8天、治療后15天關節(jié)活動度ROM評分均明顯升高(p0.05),說明中藥硬膏組、祛瘀消腫膏組治療后2,8,15天恢復關節(jié)功能效果優(yōu)于RICE組。經(jīng)重復測定方差分析,與RICE組比較,中藥硬膏組、祛瘀消腫膏組治療后15天關節(jié)腫脹度評分均明顯降低(p0.05),說明中藥硬膏組、祛瘀消腫膏組治療后15天消腫效果優(yōu)于RICE組。經(jīng)Ridit分析,三組組間總的臨床療效(kofoed評分)比較,均無統(tǒng)計學意義(p0.05),這說明中藥硬膏組、祛瘀消腫膏組與RICE組在治療急性踝關節(jié)扭傷的總療效方面具有同等優(yōu)勢。結論：祛瘀消腫膏組與中藥硬膏組比較RICE組,在抑制患踝炎性因子形成及加速炎性水腫消散方面更具優(yōu)勢,后期重建和調節(jié)創(chuàng)傷局部的血液循環(huán),有助于受損軟組織的恢復。祛瘀消腫膏與中藥硬膏在治療急性踝關節(jié)扭傷方面均有良好的效果,能明顯減輕患踝疼痛,活血祛瘀,消退腫脹,促進關節(jié)功能恢復。
[Abstract]:Objective: at present, there is no reliable or citation literature (such as core journal) to prove the effectiveness of external application of traditional Chinese medicine in the treatment of ankle sprain. The clinical diagnosis and treatment of lateral ankle sprain is more diversified. In order to confirm the reliability of clinical research, the quality of literature on the treatment of acute ankle sprain by external application of traditional Chinese medicine was evaluated. A large sample of clinical trials were conducted to provide reliable evidential support for the effectiveness of external application of traditional Chinese medicine. Methods: a control trial was conducted among large sample groups. From April 2015 to October 2015, he was in the first affiliated Hospital of Guangdong Medical College, the second Chinese Medicine Hospital of Guangdong Province and the affiliated Orthopedic and Trauma Hospital of Guangzhou University of traditional Chinese Medicine. A total of 294 patients with acute ankle sprain were enrolled in the clinical study of emergency and outpatient ankle sprain. After signing the informed consent form and participating in this study, all the patients were included and excluded according to the criteria of inclusion and exclusion. According to the distribution scheme, the patients were divided into three groups: the control group (n = 97), the observation group (n = 99) and the observation group (C n = 98). According to the principle of RICE, A was treated conservatively. B was treated by external application of traditional Chinese medicine ointment specially made by the second Hospital of traditional Chinese Medicine. C was treated by special external application of Quyu Xiaoyong Ointment, affiliated Orthopedic and Trauma Hospital. Before treatment, 2 days after treatment, 8 days after treatment. 15 days after treatment, the patients were evaluated with local tenderness, swelling, size of ecchymosis, ankle function motion and Kofoed ankle scoring standard. Results: after repeated analysis of variance, compared with the RICE group, the traditional Chinese medicine ointment group. The pain score of VAS in QYXD group decreased significantly 8 and 15 days after treatment (P < 0.05). The analgesic effect of Quyu Xiaozhong ointment group was better than that of RICE group on the 8th and 15th day after treatment. After repeated analysis of variance, compared with RICE group, the traditional Chinese medicine ointment group was better than that of traditional Chinese medicine ointment group. The scores of ecchymosis in Quyu Xiaozhong ointment group were significantly increased at 2 days after treatment, but significantly decreased at 8 and 15 days after treatment (P 0.05). The results showed that ice compress after sprain caused capillaries constriction to reduce local bleeding, so the ecchymosis score of RICE group was lower than that of the other two groups 2 days after treatment. In the treatment aspect, the curative effect of traditional Chinese medicine ointment group and Quyu Xiaozhong ointment group was better than that of RICE group on the 8th and 15th day after treatment. After repeated analysis of variance, compared with the RICE group, the traditional Chinese medicine ointment group was better than the RICE group. The ROM scores of joint motion were significantly increased 2 days after treatment, 8 days after treatment and 15 days after treatment in Quyu Xiaozhong ointment group, indicating that the traditional Chinese medicine ointment group and Quyu Xiaozhong ointment group had 2 minutes 8 after treatment. After 15 days, the effect of restoring joint function was better than that of RICE group. After repeated analysis of variance, compared with RICE group, Chinese herbal ointment group was better than that of traditional Chinese medicine ointment group. 15 days after treatment, the scores of swelling degree of joints in the QYXD group were significantly lower than that in the control group, indicating that the Chinese medicine ointment group was treated with traditional Chinese medicine ointment. The effect of removing swelling 15 days after treatment in Quyu Xiaozhong paste group was better than that in RICE group. By Ridit analysis, the total clinical efficacy of the three groups was compared. There was no statistical significance between the two groups, which indicated that the traditional Chinese medicine ointment group. Quyu Xiaozhong ointment group and RICE group have the same advantages in the treatment of acute ankle sprain. Conclusion: Quyu Xiaozhong paste group and traditional Chinese medicine ointment group compared with RICE group. It has more advantages in inhibiting the formation of inflammatory factors in the ankle and accelerating the dissipation of inflammatory edema, and reconstructing and regulating the local blood circulation in the later stage. Quyu Xiaozhong ointment and traditional Chinese medicine ointment have good effect in the treatment of acute ankle sprain, can obviously reduce ankle pain, promote blood circulation and remove blood stasis, swelling fade. Promote joint function recovery.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R274.3

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