【摘要】：目的:探討手術(shù)配合活血續(xù)骨湯治療腕舟狀骨陳舊性骨折的臨床療效。方法:收集2015年6月-2016年6月收治的腕舟狀骨陳舊性骨折病例。符合入選標(biāo)準(zhǔn)的40例,隨機(jī)分成2組,分別為手術(shù)+中藥組和單純手術(shù)組。手術(shù)組手術(shù)方法為腕舟狀骨切開復(fù)位取自體橈骨莖突植骨螺紋釘加壓內(nèi)固定。手術(shù)+中藥組在術(shù)后第2d開始口服活血續(xù)骨湯,療程3月。兩組患者均于術(shù)后第3d、7d、14d進(jìn)行患側(cè)腕關(guān)節(jié)疼痛評分,于手術(shù)后第1、3、6個月行血液流變學(xué)檢測,術(shù)前及術(shù)后第3d、第1、3、6個月行PT、APTT、D-二聚體檢測,術(shù)后1、3、6個月進(jìn)行患側(cè)腕關(guān)節(jié)功能評分,術(shù)后第3、6個月行腕關(guān)節(jié)CT,觀察骨折愈合情況,并在術(shù)前、術(shù)后第3d、第3、6個月檢測骨折端骨密度。所記錄兩組數(shù)據(jù)使用SPSS20.0進(jìn)行統(tǒng)計學(xué)處理。結(jié)果:(1)兩組患者在年齡、手術(shù)部位、術(shù)前腕功能評分比較,均未見顯著性差異(P0.05),具有可比性。(2)術(shù)后疼痛程度比較:兩組患者術(shù)后3d疼痛評分比較無明顯差異(P0.05),術(shù)后7d、14d有顯著差異(P0.05)。(3)腕關(guān)節(jié)活動功能比較:兩組患者術(shù)前、術(shù)后第1個月無明顯差異(P0.05),術(shù)后第3、6個月比較有顯著差異(P0.05)。(4)血液流變學(xué)指標(biāo)比較:兩組患者血液流變學(xué)指標(biāo)術(shù)后1月無明顯差異(P0.05),術(shù)后3、6月有顯著性差異(P0.05)。(5)PT、APTT比較:兩組患者PT、APTT術(shù)前及術(shù)后第3d、第1、3、6個月比較無明顯差異(P0.05)。(6)D-二聚體比較:兩組患者D-二聚體術(shù)前及術(shù)后第3d無明顯差異(p0.05),術(shù)后第1、3、6個月D-二聚體值有顯著性差異(P0.05)。(7)總體臨床療效比較:兩組患者術(shù)后3、6月復(fù)查腕關(guān)節(jié)CT,觀察總體骨折愈合療效上存在著明差異(p0.05)。(8)骨折端骨密度比較:兩組患者骨折端骨密度在手術(shù)前、術(shù)后第3d骨折端骨密度無明顯差異(P0.05),手術(shù)后第3、6個月骨折端骨密度有顯著性差異(P0.05)。結(jié)論:腕舟狀骨陳舊性骨折采用切開復(fù)位植骨螺紋釘加壓內(nèi)固定術(shù),術(shù)后配合口服中藥活血續(xù)骨湯,早期可明顯減輕腕部疼痛癥狀。能夠明顯改善腕關(guān)節(jié)活動功能,促進(jìn)骨折端骨密度增加,從而促進(jìn)腕舟狀骨陳舊性骨折術(shù)后骨折愈合。
[Abstract]:Objective: to investigate the clinical effect of operation combined with Huoxue Xiegu decoction in the treatment of old fracture of carpal scaphoid bone. Methods: old fracture of scaphoid bone was collected from June 2015 to June 2016. Forty patients who met the criteria were randomly divided into two groups: the traditional Chinese medicine group and the simple operation group. The operative method of operation group was open reduction of scaphoid bone and internal fixation with screw of styloid process of radius. The operation group began to take Huoxue Xiegu decoction on the 2nd day after operation, the course of treatment was 3 months. The patients in both groups were assessed for wrist pain on the 3rd and 7th day postoperatively, and hemorheology at the 1st day and the 6th month after the operation. The PT,APTT,D- dimer was detected at the 3rd day before operation and at the 3rd day after the operation, and the PT,APTT,D- dimer was measured at the 6th month after operation, and 1 day after operation, 3 days after the operation, the patients in the two groups received the PT,APTT,D- dimer test. The fracture healing was observed by CT, at the 3rd and 6th month after operation, and the bone mineral density of the fracture end was measured at the 3rd, 3rd and 6th month after operation before operation and at the 3rd, 3rd and 6th month after operation. Two groups of data were recorded using SPSS20.0 for statistical processing. Results: (1) there was no significant difference in age, site of operation and preoperative carpal function score between the two groups (P0.05). (2) comparison of postoperative pain degree: there was no significant difference in pain score between the two groups 3 days after operation (P0.05), 7 days after operation, There was significant difference (P0.05). (3) in wrist movement function between the two groups: there was no significant difference between the two groups before operation and at the first month after operation (P0.05). At the 3rd and 6th month after operation, there was significant difference (P0.05). (4) in hemorheological indexes: there was no significant difference in hemorheology indexes between the two groups at one month after operation (P0.05). There was significant difference in PT,APTT between 3 and 6 months after operation (P0.05). (5). The comparison of PT,APTT between the two groups: before and 3 days after PT,APTT, the 1st day, the 3rd day, the third day after PT,APTT in the two groups, There was no significant difference in 6-month (P0.05). (6) D- dimer: there was no significant difference between the two groups in D- dimer before and after operation (p0. 05), but there was no significant difference between the two groups (p0. 05), but there was no significant difference between the two groups (p0. 05). Comparison of the total clinical efficacy of 6-month D- dimer (P0.05). (7): CT, of wrist joint was reexamined 3 and 6 months after operation in the two groups. There was no significant difference in bone mineral density between the two groups (p0. 05). (8) before operation and 3 days after operation (P0.05). The bone mineral density (BMD) at the end of the fracture at the 3rd and 6th month after operation was significantly different (P0.05). Conclusion: open reduction and internal fixation with bone grafting screw and oral Chinese medicine Huoxue Xiegu decoction can obviously reduce wrist pain in the early stage of carpal scaphoid bone old fracture. It can obviously improve wrist movement function, promote bone mineral density increase at fracture end, thus promote fracture healing after carpal scaphoid bone old fracture.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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