【摘要】：目的：觀察骨傷復(fù)元湯應(yīng)用于小腿開放性骨折游離骨塊回植術(shù)后的臨床療效。方法：30例符合診斷標(biāo)準(zhǔn)及納入標(biāo)準(zhǔn)的小腿開放性骨折患者,采用隨機(jī)對(duì)照試驗(yàn)的分組方法,根據(jù)入院順序隨機(jī)分為試驗(yàn)組15例,對(duì)照組15例。所有病例均對(duì)傷肢進(jìn)行一期清創(chuàng)手術(shù),內(nèi)固定或外固定支架固定骨折后,將游離骨塊顆粒化與富血小板血漿(PRP)混合回植于骨缺損處,再將抗生素骨水泥鏈珠置入骨折端周圍,閉合傷口。試驗(yàn)組術(shù)后第1天開始服用骨傷復(fù)元湯,連續(xù)服用6周；對(duì)照組未服用。所有患者在術(shù)后第2周,第3周于骨塊回植部位再次注射PRP。兩組患者于術(shù)后第2天、第4天、第7天評(píng)估并記錄術(shù)后疼痛評(píng)分；于術(shù)后第1天,第3天,第7天測(cè)量計(jì)算并記錄患肢肢體腫脹度；于術(shù)后第1天,第7天抽取晨起空腹靜脈血,測(cè)定并記錄血液流變學(xué)指標(biāo)；于術(shù)后第1天、第2周、第3周、第4周測(cè)定并記錄血清中堿性磷酸酶(ALP)含量；于術(shù)后第6周、第10周、第16周、第24周拍攝X線片,評(píng)定并記錄骨痂生長(zhǎng)情況。隨訪記錄兩組患者骨愈合時(shí)間。結(jié)果：術(shù)后隨訪10個(gè)月,所有患者均完成隨訪。所有病例骨折端均愈合,愈合時(shí)間為4-8個(gè)月,平均6.1個(gè)月。3例在治療過程中出現(xiàn)傷口紅腫,血象升高,對(duì)癥給予敏感抗生素治療后癥狀消失。兩組患者術(shù)后第2天,第4天疼痛評(píng)分無統(tǒng)計(jì)學(xué)差異,術(shù)后第7天試驗(yàn)組與對(duì)照組疼痛評(píng)分均降低,試驗(yàn)組明顯低于對(duì)照組,具有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者術(shù)后第1天,第3天患肢腫脹度無統(tǒng)計(jì)學(xué)差異,術(shù)后第7天試驗(yàn)組患肢腫脹度明顯低于對(duì)照組,‘具有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后第7天試驗(yàn)組血液流變學(xué)指標(biāo)明顯低于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后第2周,第3周,第4周試驗(yàn)組與對(duì)照組血清中堿性磷酸酶均升高,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后第6周、第10周、第16周和第24周試驗(yàn)組的骨痂生長(zhǎng)情況評(píng)分高于對(duì)照組；試驗(yàn)組的骨愈合時(shí)間平均值低于對(duì)照組,并且統(tǒng)計(jì)學(xué)上有顯著性差異(P0.05)。結(jié)論：骨傷復(fù)元湯能減緩患者術(shù)后疼痛,減輕患者肢體腫脹,改善骨折端血液循環(huán),促進(jìn)回植骨塊骨痂生長(zhǎng),縮短骨折的臨床愈合時(shí)間,用于小腿開放性骨折游離骨塊回植術(shù)后臨床療效確切。
[Abstract]:Objective: to observe the clinical effect of Fuyuan decoction on open fracture of lower leg after free bone mass replantation. Methods: thirty patients with open fracture of the leg who met the diagnostic criteria and included the criteria were randomly divided into trial group (n = 15) and control group (n = 15) according to the admission order. All the patients underwent primary debridement of the injured limb. After the fracture was fixed with internal or external fixator, the free bone granulation and platelet-rich plasma (PRP) were mixed back into the bone defect. Then the antibiotic bone cement chain beads were placed around the fracture end to close the wound. The experimental group took Gushangfuyuan decoction on the first day after operation for 6 weeks, while the control group did not. All patients were re-injected with PRP. at the site of bone graft replantation at week 2 and week 3 after operation. The pain scores were evaluated and recorded on the 2nd, 4th and 7th day after operation, and the swelling degree of the affected limbs was calculated and recorded on the 1st, 3rd and 7th day after operation. The serum alkaline phosphatase (ALP) levels were measured and recorded on the first day, the second week, the third week, the fourth week after the operation, and the fasting venous blood samples were taken from the first day, the seventh day after the operation, and the blood rheological indexes were measured and recorded. X-ray films were taken at 6 weeks, 10 weeks, 16 weeks and 24 weeks after operation to evaluate and record callus growth. Bone healing time was recorded in both groups. Results: all patients were followed up for 10 months. The healing time was 4-8 months with an average of 6.1 months. 3 cases showed redness and swelling in the wound and increased blood image. The symptoms disappeared after the treatment with sensitive antibiotics. There was no significant difference in pain score between the two groups on the second day and the fourth day after operation. On the 7th day after operation, the pain scores of the trial group and the control group were all decreased, which was significantly lower than that of the control group (P0.05). There was no statistical difference between the two groups on the first day and the third day after operation, but on the 7th day after operation, the swelling degree of the affected limb in the experimental group was significantly lower than that in the control group (P0.05). On the 7th day after operation, the hemorheological indexes in the experimental group were significantly lower than those in the control group (P0.05). After 2 weeks, 3 weeks, 4 weeks after operation, the serum alkaline phosphatase in the experimental group and the control group were increased, the difference between the two groups was statistically significant (P0.05). At the 6th week, 10th week, 16th week and 24th week after operation, the callus growth score in the experimental group was higher than that in the control group; the average bone healing time in the experimental group was lower than that in the control group, and there was statistically significant difference (P0.05). Conclusion: Fuyuan decoction can relieve postoperative pain, reduce limb swelling, improve blood circulation at fracture end, promote callus growth of bone graft, and shorten the healing time of fracture. The clinical effect of free bone mass replantation for open fracture of lower leg is definite.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R274.1

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