【摘要】：目的:探討在脛骨平臺(tái)骨折的術(shù)后治療中應(yīng)用中藥內(nèi)服和薰洗的臨床療效和安全性。方法:接受切開復(fù)位鎖定鋼板內(nèi)固定手術(shù)治療的單側(cè)脛骨平臺(tái)骨折患者78例,隨機(jī)分為2組。中藥聯(lián)合功能鍛煉組36例,術(shù)后采用中藥內(nèi)服(每日1劑,水煎,早晚各1次飯后半小時(shí)口服,共服60 d)和薰洗(每次20 min,每日2次,15 d為1個(gè)療程,共治療2個(gè)療程)聯(lián)合功能鍛煉治療。功能鍛煉組42例,術(shù)后單純采用功能鍛煉治療。按照《外科學(xué)》中的骨折臨床愈合標(biāo)準(zhǔn)評(píng)估骨折愈合情況,記錄骨折愈合時(shí)間,并觀察并發(fā)癥發(fā)生情況。術(shù)后6個(gè)月,分別參照Rasmussen膝關(guān)節(jié)功能評(píng)分標(biāo)準(zhǔn)和美國(guó)特種外科醫(yī)院(hospital for special surgery,HSS)膝關(guān)節(jié)評(píng)分標(biāo)準(zhǔn)對(duì)患膝功能進(jìn)行評(píng)價(jià)。結(jié)果:78例患者均獲隨訪,隨訪時(shí)間7~31個(gè)月,中位數(shù)13個(gè)月。2組患者骨折均愈合,中藥聯(lián)合功能鍛煉組骨折愈合時(shí)間較功能鍛煉組短[(98.44±9.96)d,(109.78±10.13)d;t=4.967,P=0.001]。術(shù)后6個(gè)月,中藥聯(lián)合功能鍛煉組Rasmussen評(píng)分和HSS評(píng)分均高于功能鍛煉組[(27.42±3.18)分,(19.24±2.96)分,t=11.757,P=0.000;(91.16±4.98)分,(77.35±6.69)分,t=10.195,P=0.000]。中藥聯(lián)合功能鍛煉組術(shù)后并發(fā)切口感染1例、下肢深靜脈血栓形成1例、膝關(guān)節(jié)創(chuàng)傷性關(guān)節(jié)炎2例;功能鍛煉組術(shù)后并發(fā)切口感染1例、下肢深靜脈血栓形成2例、膝關(guān)節(jié)創(chuàng)傷性關(guān)節(jié)炎3例;2組患者并發(fā)癥發(fā)生率比較,差異無統(tǒng)計(jì)學(xué)意義(χ~2=0.006,P=0.938)。結(jié)論:對(duì)于接受切開復(fù)位鎖定鋼板內(nèi)固定手術(shù)治療的脛骨平臺(tái)骨折患者,術(shù)后在功能鍛煉的基礎(chǔ)上采用中藥內(nèi)服和薰洗,有利于骨折愈合和患膝功能恢復(fù),療效優(yōu)于單純功能鍛煉,而在安全性方面與后者相當(dāng)。
[Abstract]:Objective: to investigate the clinical efficacy and safety of traditional Chinese medicine (TCM) and fumigation in the treatment of tibial plateau fracture. Methods: 78 patients with unilateral tibial plateau fractures who received open reduction and locking plate internal fixation were randomly divided into two groups. 36 patients in the Chinese medicine combined with functional exercise group were treated with traditional Chinese medicine orally (1 dose per day, decoction, once a meal half an hour in the morning and evening for 60 days) and fumigation (20 min, per day twice a day for 15 days as a course of treatment). A total of 2 courses of treatment) combined with functional exercise treatment. 42 cases in functional exercise group were treated with functional exercise only after operation. According to the clinical healing criteria of fracture in surgery, fracture healing was evaluated, fracture healing time was recorded, and complications were observed. Six months after operation, the knee function was evaluated according to the Rasmussen knee function scale and the (hospital for special surgery,HSS knee scoring standard of American Special surgery Hospital. Results all the 78 cases were followed up for 7 ~ 31 months. The median of 13 months was 13 months. The fracture healing time of the combined functional exercise group was shorter than that of the functional exercise group [(98.44 鹵9.96) d, (109.78 鹵10.13) d]. Six months after operation, the scores of Rasmussen and HSS in the combined functional exercise group were significantly higher than those in the functional exercise group [(27.42 鹵3.18), (19.24 鹵2.96), 11.757, 0.000; (91.16 鹵4.98), (77.35 鹵6.69), (77.35 鹵6.69)] and (77.35 鹵6.69), respectively. In the traditional Chinese medicine combined functional exercise group, incision infection occurred in 1 case, deep vein thrombosis in lower extremity in 1 case, traumatic arthritis in knee joint in 2 cases, and wound infection in 1 case and deep vein thrombosis in lower extremity in 2 cases in functional exercise group. There was no significant difference in the incidence of complications in 3 patients with traumatic arthritis of the knee (蠂 2 0.006 P 0. 938). Conclusion: for the patients with tibial plateau fractures treated by open reduction and locking plate internal fixation, the internal administration and fumigation of traditional Chinese medicine on the basis of functional exercise after operation is beneficial to fracture healing and functional recovery of the affected knee. The efficacy is superior to that of simple functional exercise, and is comparable to that of the latter in terms of safety.
【作者單位】： 廣東省深圳市龍崗區(qū)第三人民醫(yī)院;
【分類號(hào)】：R687.3

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