發(fā)布時(shí)間：2018-03-18 19:40

  本文選題：老年骨質(zhì)疏松癥　切入點(diǎn)：股骨粗隆間骨折　出處：《廣州中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本研究主要目的為探討中藥骨康顆粒內(nèi)服外用相結(jié)合對(duì)老年骨質(zhì)疏松性股骨粗隆間骨折術(shù)后疼痛康復(fù)的臨床療效,通過對(duì)骨折術(shù)后疼痛的緩解,進(jìn)一步影響髖關(guān)節(jié)活動(dòng)度、骨密度及日常生活自理能力,客觀評(píng)價(jià)本院中藥配方顆粒骨康顆粒對(duì)老年骨質(zhì)疏松性股骨粗隆間骨折術(shù)后疼痛康復(fù)的療效,為本試驗(yàn)中的療法在臨床上推廣應(yīng)用提供臨床依據(jù)。方法:將符合診斷標(biāo)準(zhǔn)及納入標(biāo)準(zhǔn)的87例患者列為研究對(duì)象,在全部納入者知情同意的情況下隨機(jī)分為兩組,對(duì)照組給予維D鈣咀嚼片、鮭降鈣素及骨化三醇膠丸治療,共43例,男20例,女23例;治療組在對(duì)照組治療方案的基礎(chǔ)上再加服骨康顆粒及用低頻脈沖治療儀直接患處皮膚透用骨康顆粒制成的骨康液治療,共44例,男22例,女22例。兩組治療時(shí)間為3個(gè)月,兩組均采用視覺模擬評(píng)級(jí)(VAS)評(píng)定法、髖關(guān)節(jié)功能Harris評(píng)分表、雙能X線骨密度(BMD)測(cè)量法及日常生活自理能力(ADL)評(píng)分法,在治療前后分別對(duì)患者髖關(guān)節(jié)各項(xiàng)功能進(jìn)行評(píng)估,再經(jīng)統(tǒng)計(jì)分析得出客觀的評(píng)價(jià)。結(jié)果:經(jīng)治療后觀察比較,治療組患者臨床癥狀改善明顯優(yōu)于對(duì)照組,髖關(guān)節(jié)功能改善亦優(yōu)于對(duì)照組。經(jīng)統(tǒng)計(jì)學(xué)分析,以Harris評(píng)分及分級(jí)為標(biāo)準(zhǔn),臨床療效中在傳統(tǒng)抗骨質(zhì)疏松癥治療方法的基礎(chǔ)上結(jié)合骨康顆粒內(nèi)服外用的總有效率為82.5%,傳統(tǒng)的抗骨質(zhì)疏松癥的對(duì)照組的總有效率為67.56%,兩組間差異有統(tǒng)計(jì)學(xué)意義(p0.05)。治療后,兩組在VAS疼痛評(píng)分中,治療前后評(píng)分均有明顯下降,且均具有統(tǒng)計(jì)學(xué)意義(p0.05);治療后,治療組VAS評(píng)分較對(duì)照組低,且差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。在髖關(guān)節(jié)功能Harris評(píng)分及日常生活自理能力(ADL)評(píng)分中,治療前后比較評(píng)分均顯著提高,差異具有統(tǒng)計(jì)學(xué)意義(p0.05),且治療后治療組的Harris評(píng)分及ADL評(píng)分較對(duì)照組高,且差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。在對(duì)髖關(guān)節(jié)骨密度的比較中,治療前后兩組平均骨密度值均有所增加,差異無統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論:骨康顆粒是針對(duì)老年骨質(zhì)疏松性股骨粗隆間骨折術(shù)后疼痛的病因病機(jī)及病理表現(xiàn)為脆性骨折術(shù)后局部氣滯血瘀,加之肝腎虧虛氣血不足等特點(diǎn),以局部與整體相結(jié)合辨證論治,對(duì)癥選藥組方,內(nèi)服以補(bǔ)益肝腎、強(qiáng)筋壯骨,外用以借助低頻脈沖中藥離子導(dǎo)入對(duì)患處的局部刺激活血化瘀、消腫止痛,內(nèi)外結(jié)合可有效緩解老年骨質(zhì)疏松性股骨粗隆間骨折術(shù)后的疼痛,從而促進(jìn)患病側(cè)髖關(guān)節(jié)的活動(dòng)度以提高患者的日常生活自理能力,同時(shí)對(duì)骨質(zhì)疏松性骨折術(shù)后及預(yù)防再骨折等有防治結(jié)合的作用,最終達(dá)到促進(jìn)髖關(guān)節(jié)功能恢復(fù)的目的。
[Abstract]:Objective: to explore the clinical effect of the combination of internal and external application of Gukang granule on postoperative pain recovery of senile osteoporotic femoral intertrochanteric fracture, and to relieve the pain after fracture. To further influence hip motion, bone mineral density (BMD) and self-care ability of daily life. Objective to evaluate the curative effect of Gukang granule, a traditional Chinese medicine prescription, on postoperative pain recovery of senile osteoporotic femoral intertrochanteric fracture. Methods: 87 patients who met the diagnostic criteria and the inclusion criteria were selected as the study subjects, and were randomly divided into two groups with the informed consent of all the participants. The control group was treated with vitamin D calcium chewable tablets, salmon calcitonin and calcitonin and oscitic triol colloid pills, 43 cases were male 20 cases, female 23 cases; In the treatment group, 44 cases (22 males and 22 females) were treated with Gukang granules and treated with Gukang granules on the skin directly affected by low frequency pulse therapy instrument. The treatment time of the two groups was 3 months, the treatment group was treated with Gukang granules on the basis of the treatment plan of the control group. Both groups were assessed with visual analogue rating (VAS), hip function Harris scale, dual energy X-ray bone mineral density (BMD) measurement and ADL score before and after treatment. Results: after treatment, the clinical symptoms of the patients in the treatment group were significantly better than those in the control group, and the improvement of hip function was also superior to that of the control group. By statistical analysis, the Harris score and grading were taken as the standard. The total effective rate was 82.5 in combination with the traditional anti-osteoporosis treatment method, and 67.56 in the traditional anti-osteoporosis control group. The difference between the two groups was statistically significant (P 0.05). After treatment, the total effective rate was 82.5 and 67.56 in the traditional anti-osteoporosis control group, and the difference between the two groups was statistically significant. After treatment, the VAS score of the treatment group was lower than that of the control group, and the VAS score of the treatment group was significantly lower than that of the control group. The difference was statistically significant (P 0.05). In the scores of hip function Harris and ADL, the scores before and after treatment were significantly higher than those before and after treatment. The difference was statistically significant (P 0.05), and the scores of Harris and ADL in the treatment group were higher than those in the control group, and the difference was statistically significant (P 0.05). In the comparison of bone mineral density of hip joint, the average BMD of both groups increased before and after treatment. Conclusion: the causes and pathogenesis of postoperative pain in senile osteoporosis intertrochanteric fracture are characterized by local stagnation of qi and blood stasis after brittle fracture and deficiency of liver and kidney deficiency of qi and blood. Combined with local and integral differentiation of symptoms and signs, select the prescription for symptoms, take orally to tonify the liver and kidney, strengthen the muscles and strong bones, and external use to promote blood circulation and remove blood stasis and relieve swelling and pain by introducing low frequency pulsed Chinese medicine ions. The combination of internal and external therapy can effectively relieve the pain after the operation of osteoporotic femoral intertrochanteric fracture, thus promote the motion of the affected hip joint and improve the self-care ability of the patient in daily life. At the same time, it can prevent and cure osteoporosis fracture and prevent refracture, which can promote the recovery of hip joint function.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R274.9

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