本文選題：全膝關(guān)節(jié)置換術(shù)后 + 術(shù)后疼痛��； 參考：《廣州中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:觀察骨傷外洗劑對膝骨性關(guān)節(jié)炎晚期患者行全膝關(guān)節(jié)置換術(shù)后療效的影響,為中醫(yī)藥緩解全膝關(guān)節(jié)置換術(shù)后疼痛,提高臨床療效,促進早期功能康復(fù)提供臨床依據(jù)與新思路。方法:選取廣州中醫(yī)藥大學附屬東莞中醫(yī)院骨一科2015年3月-2016年12月符合本研究納入標準的60例擇期行全膝關(guān)節(jié)置換術(shù)后患者為研究對象。采用隨機數(shù)字表法將患者分為對照組和觀察組,各30例。術(shù)后第2天開始兩組患者均予常規(guī)康復(fù)治療,包括口服西樂葆及功能鍛煉。術(shù)后2周拆線,拆線3天后觀察組在常規(guī)治療基礎(chǔ)上給予骨傷外洗劑治療,連續(xù)治療2周。觀察兩組患者術(shù)后4周后的臨床癥狀及體征,采用美國紐約特種外科醫(yī)院膝關(guān)節(jié)(HSS)評分表及疼痛視覺模擬(VAS)評分表進行評估,并用統(tǒng)計學軟件及方法對數(shù)據(jù)統(tǒng)計分析。結(jié)果:①兩組患者的一般情況包括年齡、性別、病程,差異無統(tǒng)計學意義(P0.05)。②術(shù)后4周總體有效率方面,對照組為70.00%,觀察組為90.000%,兩組患者組間比較,差異有統(tǒng)計學意義(P0.05)。③在HSS的總評分方面,術(shù)后2周兩組患者對比,差異無統(tǒng)計學意義(P0.05);術(shù)后4周兩組組內(nèi)對比,差異有統(tǒng)計學意義(P0.05),兩組組間比較,觀察組總體評分高于對照組,差異有統(tǒng)計學意義(P0.05)。④HSS各項評分中,術(shù)后2周兩組患者對比,差異無統(tǒng)計學意義(P0.05);術(shù)后4周兩組組內(nèi)對比,差異有統(tǒng)計學意義(P0.05),兩組組間比較中,觀察組在功能、活動度及肌力的評分中均高于對照組,差異有統(tǒng)計學意義(P0.05)。⑤在VAS評分方面,術(shù)后2周兩組患者對比,差異無統(tǒng)計學意義(P0.05);術(shù)后4周兩組組內(nèi)對比,差異有統(tǒng)計學意義(P0.05),兩組組間比較,觀察組VAS評分低于對照組,差異有統(tǒng)計學意義(P0.05)。⑥安全性指標:研究過程中未出現(xiàn)術(shù)口周圍皮膚過敏、腫痛加重或有分泌物滲出。結(jié)論:骨傷外洗劑能有效緩解TKA術(shù)后疼痛,促進術(shù)后膝關(guān)節(jié)功能康復(fù)療效顯著,它能夠有效緩解疼痛,顯著提高HSS總體評分,包括功能、活動度及肌力等方面均具有改善作用。通過中藥外用熏洗的形式發(fā)揮作用,避免口服藥物對胃腸道刺激及肝腎功能損壞,且使用方法簡單、經(jīng)濟實惠,容易被患者所接受,為中醫(yī)藥治療TKA術(shù)后的康復(fù)手段增添新內(nèi)容,值得臨床進一步推廣。
[Abstract]:Objective: to observe the effect of external lotion of bone injury on the curative effect of total knee arthroplasty in patients with advanced knee osteoarthritis, so as to relieve the pain after total knee arthroplasty with traditional Chinese medicine and improve the clinical efficacy. To promote early functional rehabilitation to provide clinical basis and new ideas. Methods: from March 2015 to December 2016, 60 patients with elective total knee arthroplasty were selected from Department of Bone of Dongguan Hospital of traditional Chinese Medicine affiliated to Guangzhou University of traditional Chinese Medicine. Patients were randomly divided into control group and observation group with 30 cases each. Two groups of patients were treated with routine rehabilitation, including oral Celebrex and functional exercise. The observation group was treated with external lotion on the basis of routine treatment for 2 weeks. The clinical symptoms and signs of the two groups were observed 4 weeks after operation. The clinical symptoms and signs of the two groups were evaluated by HSS scale of knee joint and visual analogue scale of pain in New York Special surgery Hospital. Statistical software and methods were used to analyze the data. Results the general conditions of the two groups included age, sex, course of disease, and there was no significant difference in the total effective rate at 4 weeks after operation (P 0.05.2). The total effective rate of the two groups was 70.00g in the control group and 90.000 in the observation group. The difference was statistically significant (P 0.05) in the total score of HSS. 2 weeks after operation, there was no significant difference between the two groups (P 0.05), but at 4 weeks after operation, there was significant difference between the two groups (P 0.05), and between the two groups, there was no significant difference between the two groups. The overall score of the observation group was higher than that of the control group, and the difference was statistically significant. Among the scores of P0.05U. 4HSS, there was no significant difference between the two groups at 2 weeks after operation, but there was no significant difference between the two groups at 4 weeks after operation. The difference was statistically significant (P 0.05). In the comparison between the two groups, the scores of function, activity and muscle strength in the observation group were higher than those in the control group. The difference was statistically significant (P 0.05) in the VAS score, compared with that in the two groups at 2 weeks after operation. There was no significant difference between the two groups at 4 weeks after operation, the difference was statistically significant (P 0.05). Compared with the control group, the VAS score of the observation group was lower than that of the control group. There was no skin allergy, aggravation of swelling and pain or exudation of secretions during the study. Conclusion: Gushangwai lotion can effectively relieve the pain after TKA and promote the rehabilitation of knee joint function. It can effectively relieve pain and improve the overall score of HSS, including function, range of movement and muscle strength. In order to avoid gastrointestinal irritation and damage of liver and kidney function by external use of traditional Chinese medicine, the method is simple, economical and easy to be accepted by patients. It is worthy of further popularizing for the treatment of rehabilitation after TKA with Chinese medicine.
【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】：2017
【分類號】：R687.4

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