本文選題：踝關節(jié)骨折　切入點：活血消腫方　出處：《安徽中醫(yī)藥大學》2016年碩士論文　論文類型：學位論文

【摘要】：目的:本課題通過對踝關節(jié)骨折的病因病機、診療、并發(fā)癥等認識,觀察比較活血消腫方組和七葉皂苷鈉組、活血消腫方加七葉皂苷鈉組治療踝關節(jié)骨折后軟組織早期腫脹疼痛的臨床療效,分析和評價踝關節(jié)骨折后早期運用活血消腫方的臨床意義,為其在臨床上進一步推廣使用提供依據(jù)。方法:本課題研究納入病例均為2015年2月至2015年12月期間在安徽中醫(yī)藥大學第一附屬醫(yī)院骨傷科住院患者,選擇符合標準的病例總計60例,其中,男性38例,女性22例,年齡區(qū)間18~64歲,平均(38.77±3.86)歲。隨機分為三組,每組各20例,分別是活血消腫方組(下文簡稱為中藥組)、七葉皂苷鈉組、活血消腫方加七葉皂苷鈉組(下文簡稱為聯(lián)合用藥組)。三組均予以相同的常規(guī)處理,同時,中藥組于患者入院后第一天開始予以口服活血消腫方,一日一劑,至手術當天停用;七葉皂苷鈉組于患者入院后第一天開始予以靜脈滴注七葉皂苷鈉,一日一次,至手術當天停用;聯(lián)合用藥組于患者入院后第一天開始予以口服活血消腫方加靜脈滴注七葉皂苷鈉,用藥方法及劑量同前,至手術當天停用。分別觀察并記錄三組受試者在治療前、治療第3天、治療第5天、治療第7天時踝關節(jié)軟組織腫脹程度評分、腫脹度、疼痛程度(VAS評分)、術前等待時間、患肢深靜脈血栓形成例數(shù)、圍手術期并發(fā)癥發(fā)生例數(shù)以及治療前后肝腎功能主要指標變化等方面。將60例受試者所有的臨床數(shù)據(jù)運用統(tǒng)計學軟件SPSS 19.0進行數(shù)據(jù)處理,分析比較三組觀察指標的變化情況,評估三組的臨床療效。結果:1、本課題納入的三組受試對象治療前在性別、年齡、病因、骨折部位、患肢踝關節(jié)腫脹程度等一般資料經(jīng)統(tǒng)計分析處理后,均無統(tǒng)計學差異(P0.05),提示三組之間存在可比性。2、踝關節(jié)軟組織腫脹積分方面:治療前三組比較差異無顯著性(P0.05);治療第3天聯(lián)合用藥組與治療前比較差異顯著(P0.05),但其他兩組差異無統(tǒng)計學意義(P0.05);治療第5天、第7天三組與治療前比較差異明顯(P0.05、P0.01),對三組分別行SNK-q檢驗,兩兩比較差異均有顯著性(P0.05、P0.01)。其中聯(lián)合用藥組降低的幅度明顯優(yōu)于單一用藥組,療效最顯著,中藥組次之。3、踝關節(jié)軟組織腫脹度方面:治療前三組比較差異無顯著性(P0.05);治療第3天聯(lián)合用藥組、中藥組與治療前比較有統(tǒng)計學意義(P0.05),但七葉皂苷鈉組差異無統(tǒng)計學意義(P0.05);治療第5天、第7天三組與治療前比較差異顯著(P0.05、P0.01),對三組分別行SNK-q檢驗,兩兩比較均有顯著差異(P0.05、P0.01)。其中聯(lián)合用藥組消腫的速度更迅速,起效更快,療效顯著優(yōu)于單一用藥組;而中藥組隨著治療時間的增加,消腫效果也優(yōu)于七葉皂苷鈉組。4、踝關節(jié)消腫療效方面:治療第3天,三組消腫臨床療效比較,差異無顯著性(P0.05);治療第5天、第7天三組治療前后消腫臨床療效比較差異顯著(P0.05、P0.01),治療第7天中藥組與七葉皂苷鈉組比較差異存在顯著性(P0.05)。其中聯(lián)合用藥組在治療第5、7天時達到優(yōu)、良的受試者人數(shù)明顯高于單一用藥組,消腫的臨床療效最顯著,中藥組療效次之。5、踝關節(jié)疼痛VAS積分方面:治療前三組比較差異無顯著性(P0.05);治療第3天、第5天、第7天三組與治療前比較均有顯著差異(P0.05、P0.01),行SNK-q檢驗發(fā)現(xiàn)治療第3天中藥組與七葉皂苷鈉組比較差異無統(tǒng)計學意義(P0.05),其余不同時間點兩兩比較均存在差異(P0.05、P0.01)。其中聯(lián)合用藥組止痛的效果更明顯,尤其是在治療第5、7天,明顯優(yōu)于單一用藥組,且隨著治療時間的增加,中藥組止痛的療效也較七葉皂苷鈉組明顯。6、術前等待時間方面:三組比較差異有顯著性(P0.05),行SNK-q檢驗提示聯(lián)合用藥組與七葉皂苷鈉組、中藥組比較差異顯著(P0.01、P0.05),中藥組與七葉皂苷鈉組比較差異存在統(tǒng)計學意義(P0.05)。其中聯(lián)合用藥組能夠顯著縮短術前消腫過程,療效最明顯,而中藥組次之。7、DVT陽性率方面:三組比較差異無統(tǒng)計學意義(P0.05)。8、圍手術期并發(fā)癥方面:聯(lián)合用藥組、中藥組與七葉皂苷鈉組比較差異有統(tǒng)計學意義(P0.05)。結論:活血消腫方能夠有效的消除踝關節(jié)骨折后軟組織早期腫脹疼痛、縮短術前消腫周期、降低圍手術期并發(fā)癥的發(fā)生率,有利于軟組織盡早修復,臨床療效顯著,使用安全�；钛[方是臨床治療踝關節(jié)骨折后軟組織早期腫脹疼痛行之有效的方劑,經(jīng)濟實用、安全有效,具有良好的臨床應用價值,值得臨床推廣運用。
[Abstract]:Objective: this topic through the diagnosis and treatment of etiology and pathogenesis of ankle fractures, complications were compared between the understanding of Chinese medicinal decoction group and seven sodium aescinate group, the clinical curative effect of early soft tissue swelling and pain of Chinese medicinal decoction plus seven sodium aescinate group for the treatment of ankle fractures and clinical significance of early application of Chinese medicinal decoction analysis and evaluation of ankle fracture, the clinical use to provide the basis for further promotion. Methods: This study included patients during the period from February 2015 to December 2015 in the orthopedic department of the First Affiliated Hospital of Anhui College of traditional Chinese medicine patients, choose the standard case of a total of 60 cases, among them, male 38 cases, female 22 cases. The age range of 18~64 years, the average (38.77 + 3.86) years old were randomly divided into three groups, 20 cases in each group, respectively blood swelling group (hereinafter referred to as the Chinese medicine group), seven sodium aescinate group, Chinese medicinal decoction plus seven leaf soap Glycoside sodium group (hereinafter referred to as the combination group). The three groups were given conventional treatment, the same at the same time, Chinese medicine group in patients admitted to the hospital after the first day of oral Chinese medicinal decoction, one dose daily, on the day of surgery to stop; seven Ye Zaogan sodium group patients were admitted to hospital after the first day of the beginning of intravenous infusion seven yezao sodium, once a day, until the day of surgery disabled; combined treatment group patients were admitted to hospital after the first day of oral Chinese medicinal decoction combined with intravenous drip of seven sodium aescinate, treatment methods and the same dose, to the day of surgery were discontinued. Observe and record the three groups of subjects before treatment, treatment the third day, for fifth days, seventh days of treatment of ankle soft tissue swelling degree, swelling degree, pain degree (VAS score), the waiting time before surgery, limb deep venous thrombosis cases, perioperative complications and the number of cases before and after treatment, liver and kidney function The main indicators of change. The subjects were 60 patients with clinical data of all using SPSS 19 statistical software for data processing, analysis of changes between the three groups were observed, to evaluate the clinical efficacy of three groups. Results: 1. The research included three groups of subjects before treatment in gender, age, etiology, the fracture site, with general data of ankle joint swelling degree by statistical analysis, there was no significant difference (P0.05), suggesting the presence of comparable.2 between the three groups, soft tissue swelling of ankle joint points: the difference between the three groups before treatment had no significant difference (P0.05); third days of treatment and combined treatment group before treatment was significantly different (P0.05), but no statistical significance between the two groups (P0.05); for fifth days, seventh days and the difference between the three groups before treatment significantly (P0.05, P0.01), the three groups underwent SNK-q examination, 22 had significant differences (P0.05 , P0.01). Which is to reduce the combination group was significantly better than the single drug group, the most significant effect, traditional Chinese medicine group.3, ankle soft tissue swelling: the differences between the three groups before treatment had no significant difference (P0.05); third days of treatment in combination group, Chinese medicine group before treatment were statistically significant (P0.05), but there was no significant difference between the seven sodium aescinate group (P0.05); for fifth days, seventh days between the three groups before and after treatment was significant (P0.05, P0.01), the three groups were compared by SNK-q test, there were significant differences between the 22 (P0.05, P0.01). The combination group swelling rate rapidly, faster onset and the curative effect was significantly better than the single drug group and Chinese medicine group; with the increase of treatment time, swelling effect is better than seven sodium aescinate group.4, side effects of ankle swelling: third days of treatment, three groups of detumescence clinical curative effect comparison, no significant difference (P0.05); treatment The fifth day, the seventh day of the three groups before and after treatment and clinical efficacy significant difference (P0.05, P0.01), seventh days of treatment with traditional Chinese medicine group and seven sodium aescinate group there is significant difference (P0.05). The combined treatment group to achieve excellent in the treatment of the first 5,7 days, the number of subjects were significantly higher than the single good the medication group, the most significant swelling of the clinical curative effect of traditional Chinese medicine, the.5 pain VAS ankle score: the difference between the three groups before treatment had no significant difference (P0.05); for third days, fifth days, seventh days, three groups compared with before treatment had significant difference (P0.05, P0.01), SNK-q test found that no significant difference was found in third days of treatment with traditional Chinese medicine group and seven sodium aescinate group (P0.05), the remaining 22 different time points there were differences (P0.05, P0.01). The combination group, the analgesic effect is more obvious, especially in the treatment of the first 5,7 days, significantly better than the single drug group, and With the increase of treatment time, the effect of traditional Chinese medicine group also had analgesic seven sodium aescinate group was.6, the preoperative waiting time: there were significant differences between three groups (P0.05), SNK-q test combined treatment group and seven sodium aescinate group, Chinese medicine group was significantly different (P0.01, P0.05), Chinese medicine group and seven sodium aescinate group compared the difference was statistically significant (P0.05). The combined treatment group can significantly shorten the preoperative swelling process, the most obvious effect, and the traditional Chinese medicine group.7, DVT positive rate: three groups had no statistically significant difference (P0.05.8), perioperative complications: combined treatment group and there was a significant difference between the Chinese medicine group and seven sodium aescinate group (P0.05). Conclusion: Chinese medicinal decoction can eliminate early soft tissue swelling and pain after ankle fracture effectively, shorten preoperative swelling period, reduce the incidence of perioperative complications, favorable Early repair of soft tissue has significant clinical effect and safety. Huoxue swelling prescription is an effective prescription for the treatment of early soft tissue swelling and pain after ankle fracture. It is economical, practical, safe and effective, and has good clinical application value. It is worthy of clinical promotion and application.

【學位授予單位】：安徽中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R274.9

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