續(xù)骨活血湯結(jié)合PFNA內(nèi)固定術治療老年股骨粗隆間骨折的療效觀察
發(fā)布時間：2019-01-14 07:37
【摘要】：目的:觀察研究續(xù)骨活血湯結(jié)合股骨近端防旋髓內(nèi)針(Proximal Femoral Nail-A,PFNA)內(nèi)固定術治療老年人股骨粗隆間骨折的臨床療效,為中醫(yī)藥結(jié)合手術治療老年人股骨粗隆間骨折的臨床研究積累經(jīng)驗。方法:本項研究所選擇的研究對象是60~89歲的股骨粗隆間骨折患者56名。將研究對象隨機分成對照組和治療組。對照組行PFNA手術治療,術后第三天給予口服鈣爾奇D片;治療組行PFNA手術治療,術后第三天給予續(xù)骨活血湯治療。兩組患者術前術后均給予常規(guī)處理。觀察兩組病人術后疼痛視覺模擬標尺法(Visual analogue scales,VAS)評分、骨折愈合率、患髖Harris評分及術后并發(fā)癥發(fā)生情況等指標并記錄數(shù)據(jù)。結(jié)果:1、將兩組術后3周內(nèi)的VAS評分做重復測量數(shù)據(jù)的方差分析,結(jié)果顯示術后第1天、一周、兩周、三周治療組與對照組相比,F=4.23,P=0.040.05,說明VAS評分變化情況具有統(tǒng)計學意義。故認為治療組在緩解股骨粗隆間骨折術后疼痛上較對照組療效更明顯。2、將兩組術后骨折臨床愈合率進行四格表卡方檢驗,比較結(jié)果顯示,術后8周兩組骨折愈合率差異有統(tǒng)計學意義(X2=4.37,P=0.040.05),術后3月兩組骨折愈合率差異有統(tǒng)計學意義(X2=4.08,P=0.040.05),故可以認為治療組術后8周、3月骨折愈合率均高于對照組。3、將兩組術后3個月、6個月患側(cè)髖關節(jié)功能評定情況作兩獨立樣本T檢驗,結(jié)果顯示術后3個月(P=0.060.05)、6個月(P=0.140.05)兩組患髖功能評定差異無統(tǒng)計學意義。尚不能認為治療組和對照組術后3個月、6個月Harris評分不相同,即兩組術后均獲得滿意髖關節(jié)功能。4、兩組并發(fā)癥發(fā)生情況:兩組術后在院期間及院外隨訪期間,均未出現(xiàn)髖內(nèi)翻、壓瘡、內(nèi)固定物松動斷裂、股骨干股骨頸骨折、深靜脈血栓形成、肺部感染等并發(fā)癥。結(jié)論:本研究結(jié)果顯示,與鈣片加服組相比,續(xù)骨活血湯加服組療效更加顯著。在中醫(yī)理論指導下,對患者整體辨證論治,臨癥加減,結(jié)合微創(chuàng)PFNA內(nèi)固定術,中藥加服組可明顯緩解術后疼痛,提高骨折愈合率,改善髖關節(jié)功能活動,預防并發(fā)癥發(fā)生。本方法體現(xiàn)了中西醫(yī)結(jié)合優(yōu)勢互補,值得臨床進一步推廣與應用。
[Abstract]:Objective: to observe the clinical effect of Xuegu Huoxue decoction combined with (Proximal Femoral Nail-A,PFNA internal fixation in the treatment of femoral intertrochanteric fracture in the elderly. To accumulate experience in the clinical study of intertrochanteric fracture of femur in elderly patients with traditional Chinese medicine combined with surgery. Methods: 56 patients with intertrochanteric fracture of femur aged 60 ~ 89 years were enrolled in this study. The subjects were randomly divided into control group and treatment group. The control group was treated with PFNA, and the treatment group was treated with PFNA on the third day after operation, and the treatment group was treated with Xuegu Huoxue decoction on the third day after operation. The patients in both groups were given routine treatment before and after operation. The visual analogue scale (Visual analogue scales,VAS) score, fracture healing rate, hip Harris score and postoperative complications were observed and recorded in the two groups. Results: 1. The VAS scores of the two groups within 3 weeks after operation were analyzed by ANOVA. The results showed that on the first day, one week, two weeks and three weeks after operation, the treatment group was compared with the control group. It showed that the change of VAS score was statistically significant. It is considered that the treatment group is more effective than the control group in relieving postoperative pain of intertrochanteric fracture. 2. The clinical healing rate of fracture in the two groups was tested by four square chi-square test. There was a significant difference in fracture healing rate between the two groups at 8 weeks after operation (X2 + 4.37) and 3 months after operation (X2 + 4.08% PX 0.040.05), so the treatment group could be considered as 8 weeks after operation. The rate of fracture healing in 3 months was higher than that in control group. 3 months after operation, the evaluation of hip joint function in the two groups was tested by two independent samples. The results showed that there were 3 months after operation (P0. 060.05). There was no significant difference in hip function between the two groups at 6 months (P < 0. 140.05). The Harris scores of the treatment group and the control group were not the same at 3 and 6 months after operation, that is, the satisfactory hip function was obtained in both groups. 4. The complications occurred in the two groups: the two groups were in hospital and during the follow-up outside the hospital. There were no complications such as hip varus, pressure sore, loosening and breaking of internal fixator, femoral neck fracture, deep vein thrombosis, pulmonary infection and so on. Conclusion: the results of this study show that compared with calcium tablet plus oral group, the treatment group of contiguous bone and activating blood decoction is more effective. Under the guidance of traditional Chinese medicine theory, the patients were treated based on syndrome differentiation and treatment. Combined with minimally invasive PFNA internal fixation, the Chinese medicine plus administration group could obviously relieve postoperative pain, improve fracture healing rate, improve hip joint function, and prevent complications. This method reflects the complementary advantages of integrated Chinese and western medicine, and is worthy of further clinical promotion and application.
【學位授予單位】：山西中醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3
本文編號：2408467
[Abstract]:Objective: to observe the clinical effect of Xuegu Huoxue decoction combined with (Proximal Femoral Nail-A,PFNA internal fixation in the treatment of femoral intertrochanteric fracture in the elderly. To accumulate experience in the clinical study of intertrochanteric fracture of femur in elderly patients with traditional Chinese medicine combined with surgery. Methods: 56 patients with intertrochanteric fracture of femur aged 60 ~ 89 years were enrolled in this study. The subjects were randomly divided into control group and treatment group. The control group was treated with PFNA, and the treatment group was treated with PFNA on the third day after operation, and the treatment group was treated with Xuegu Huoxue decoction on the third day after operation. The patients in both groups were given routine treatment before and after operation. The visual analogue scale (Visual analogue scales,VAS) score, fracture healing rate, hip Harris score and postoperative complications were observed and recorded in the two groups. Results: 1. The VAS scores of the two groups within 3 weeks after operation were analyzed by ANOVA. The results showed that on the first day, one week, two weeks and three weeks after operation, the treatment group was compared with the control group. It showed that the change of VAS score was statistically significant. It is considered that the treatment group is more effective than the control group in relieving postoperative pain of intertrochanteric fracture. 2. The clinical healing rate of fracture in the two groups was tested by four square chi-square test. There was a significant difference in fracture healing rate between the two groups at 8 weeks after operation (X2 + 4.37) and 3 months after operation (X2 + 4.08% PX 0.040.05), so the treatment group could be considered as 8 weeks after operation. The rate of fracture healing in 3 months was higher than that in control group. 3 months after operation, the evaluation of hip joint function in the two groups was tested by two independent samples. The results showed that there were 3 months after operation (P0. 060.05). There was no significant difference in hip function between the two groups at 6 months (P < 0. 140.05). The Harris scores of the treatment group and the control group were not the same at 3 and 6 months after operation, that is, the satisfactory hip function was obtained in both groups. 4. The complications occurred in the two groups: the two groups were in hospital and during the follow-up outside the hospital. There were no complications such as hip varus, pressure sore, loosening and breaking of internal fixator, femoral neck fracture, deep vein thrombosis, pulmonary infection and so on. Conclusion: the results of this study show that compared with calcium tablet plus oral group, the treatment group of contiguous bone and activating blood decoction is more effective. Under the guidance of traditional Chinese medicine theory, the patients were treated based on syndrome differentiation and treatment. Combined with minimally invasive PFNA internal fixation, the Chinese medicine plus administration group could obviously relieve postoperative pain, improve fracture healing rate, improve hip joint function, and prevent complications. This method reflects the complementary advantages of integrated Chinese and western medicine, and is worthy of further clinical promotion and application.
【學位授予單位】：山西中醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3
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