万钟+万长浩
【摘要】 目的:分析研讨舒筋健骨汤熏洗辅助康复训练队骨折后膝关节功能恢复的临床效果。方法:随机从本院康复科2015年8月-2016年9月期间收治的膝关节周围骨折患者中选取90例,用随机数字表法分为两组,每组各45例。对照组接受常规康复训练,研究组接受舒筋健骨汤熏洗辅助康复训练,观察并对比两组膝关节状况、关节活动状况、疗效等。结果:研究组治疗总有效率为93.33%高于对照组77.78%,两组比较差异有统计学意义(P<0.05)。对比两组患者治疗后HSS评分、ROM、腰椎L2~4骨密度、股骨颈骨密度,研究组均优于对照组,组间比较差异均有统计学意义(P<0.05)。结论:骨折后膝关节功能恢复期间可将舒筋健骨汤熏洗用以辅助康复训练进行干预,疗效突出,对提升恢复疗效存在有利作用,值得进一步推广和应用。
【关键词】 膝关节功能恢复; 康复训练; 舒筋健骨汤; HSS评分; 疗效
【Abstract】 Objective:To investigate clinical effects of Shu Jin Jian Gu Tang combined with rehabilitation exercise on function of knee joint after fracture.Method:90 patients with fractures around the knee who received rehabilitation therapy in our hospital from August 2015 to September 2016 were collected as research objects.According to method of random number table,those patients were divided into the control group and the research group,45 cases in each group.The control group was given rehabilitation exercise,while the research group was given Shu Jin Jian Gu Tang combined with rehabilitation exercise.Knee joint condition,joint activity condition and curative effect were compared between the two groups.Result:After treatment,the total therapeutic effect of the research group was 93.33%,higher than the control group of 77.78%,the difference was statistically significant(P<0.05).The scores of HSS,ROM,lumbar L2-4 bone density,and femoral neck bone density in the research group were statistically higher than those of control group,the differences were statistically significant(P<0.05).Conclusion:Shu Jin Jian Gu Tang combined with rehabilitation exercise is effective for patients with recovery of knee joint after fracture,which can significantly improve curative effect.
【Key words】 Recovery of knee joint function; Rehabilitation exercise; Shu Jin Jian Gu Tang; Scores of HSS; Curative effect
First-authors address:Nanchang Hongdu Hospital of TCM,Nanchang 330008,China
doi:10.3969/j.issn.1674-4985.2017.34.019
膝關节周围骨折包含胫骨平台骨折、髌骨骨折、股骨髁上骨折,属于临床较为常见的一种高能量损伤性骨折疾病,因关节受高能量暴力性损伤,短时间中会引发关节粘连、挛缩,出现关节异常,限制关节活动,症状多表现为降低关节附近肌力、关节屈伸异常,减退本体感觉,属于临床骨科医生所面临的一个难题[1-2]。临床治疗此疾病的主要方式则为外科手术,但术后会发生关节黏连,且长时间制动会造成肌肉萎缩、关节障碍等,严重影响患者术后生活质量。因此,确保康复干预方式的有效性则相当重要。此研究用分组研讨方式分析90例患者,意在研讨舒筋健骨汤熏洗辅助康复训练队骨折后膝关节功能恢复的效果,具体报告如下。
1 资料与方法
1.1 一般资料 随机从本院康复科2015年
8月-2016年9月期间收治的膝关节周围骨折患者90例,纳入标准:(1)膝关节或附近发生骨折,有接受支具固定、石膏固定、手术治疗史;(2)拆除支具、石膏后,膝关节出现功能性障碍,表现为伸直或屈伸僵硬,对工作和生活存在不便;(3)膝关节屈曲在60°内,肌肉萎缩,股四头肌肌力<Ⅳ级;(4)膝关节发生肿胀疼痛,限制活动[3]。采用随机数字表法分为两组,每组各45例。对照组男24例,女21例;年龄49~66岁,平均(56.8±7.8)岁;15例胫骨平台骨折,19例股骨髁上骨折,11例髌骨骨折。研究组男25例,女20例;年龄49.6~67岁,平均(56.9±7.6)岁;16例胫骨平台骨折,18例股骨髁上骨折,11例髌骨骨折。两组患者的一般资料比较差异均无统计学意义(P>0.05),具有可比性。endprint
1.2 方法 对照组接受常规性康复训练,术后1 d患者进行股四头肌收缩锻炼,15 min/次,锻炼强度为患者不疲劳、耐受疼痛则可,3次/d,直至患者出院。术后第3天将患肢提高,屈伸训练膝关节,先用膝关节功能锻炼器被动性活动,30 min/次,
2次/d。首先从0°~30°进行活动,每天可增加10°,逐步将其增加到90°~120°,可持续锻炼15~30 d,观察患者状况,可让患者进行膝关节主动锻炼,20 min/次,3次/d,连续治疗30 d为一疗程。研究组接受舒筋健骨汤熏洗辅助性治疗,康复训练方式和对照组一致。药方为20 g透骨草、20 g木瓜、10 g当归、30 g川芎、30 g乳香、30 g没药、10 g红花、15 g川牛膝、15 g独活、15 g威灵仙、20 g苍术、15 g木香、30 g川乌、30 g草乌、20 g白芷、15 g荆芥、20 g防风、20 g五加皮,加3000 mL水煎熬,煮沸30 min后,把药渣过滤掉,倒入盆中,熏蒸膝关节,直至温度合适后,用毛巾侵入药水,外敷在膝关节部位,20~40 min/次,连续治疗30 d为一疗程。
1.3 判定标准 依据《中药新药临床研究指导原则》分显效、有效、无效[3],显效:无任临床症状,关节伸直0°,活动>120°,膝关节功能均正常;有效:各症状均消失,ROM范围在90~120°,伸直受限在10°以下,膝关节功能逐步恢复正常;无效:以上标准均未达到,或逐步恶化。总有效=显效+有效。判定患者HSS膝关节功能评分[3],测定治疗后腰椎L2~4骨密度、股骨颈状况,测定ROM状况。
1.4 统计学处理 使用SPSS 13.0统计学软件进行分析,计量资料采用(x±s)表示,比较采用t检验,计数资料采用率(%)表示,比较采用 字2检验,以P<0.05为差异有统计学意义。
2 结果
2.1 两组患者的治疗效果比较 研究组治疗总疗效率为93.33%高于对照组的77.78%,两组比较有统计学意义( 字2=9.7829,P=0.0017)。见表1。
2.2 两组患者治疗后的HSS评分、ROM、腰椎L2~4骨密度、股骨颈骨密度比较 治疗后,研究组HSS评分、ROM、腰椎L2~4骨密度、股骨颈骨密度均明显优于对照组,两组比较差异有统计学意义(P<0.05)。见表2。
3 讨论
正常状况下,膝关节活动度伸0°、屈曲130°,膝关节周围骨折术后,长期制动会造成淋巴和静脉淤滞、缓慢回流、水肿等,关节周围的疏松性结缔组织会演变为致密性组织,导致关节僵硬,正常活动受到影响[4-6]。同时制动可让关节软骨营养发生异常,出现纤维化、萎缩坏死,让关节狭窄而出现粘连,限制关节活动,膝关节正常活动度屈曲<130°,围术期不系统性康复治疗对术后膝关节活动状况存在不利影响[7-10]。
治疗关节周围骨折的基本原则为将病理性组织修复后进行固定处理,直至组织愈合后,再给予功能性锻炼,因此术后给予康复锻炼对关节功能康复意义重大,术后锻炼方法和时间也需进行科学的选择[11-14]。临床经验丰富的医生往往会将康复方法、内固定方式、手术方式以及患者实际状况等联系起来综合性考虑,进而确保膝关节功能恢复的良好性。手术、创伤可造成局部经络不通、气血壅塞,气血无法满足静脉肌肉需求,长期下去肌肉则会发生萎缩、屈伸不利、静脉挛缩,导致膝关节功能异常,但又无法强行性被动活动,以免发生二次损伤,加大其经济负担和痛苦程度[15-17]。中医上给予活血化瘀、舒筋通络疗法,用舒筋健骨汤进行熏洗,扩张患部血管,让药物从皮肤等部位吸收进入到全身[18-19],进而发挥强壮筋骨、活血化瘀、溫经止痛、疏筋通络的作用,药方内木瓜、透骨草可活血止痛、舒筋活络,赤芍、川牛膝、红花、没药、乳香、川芎等药物有止痛祛淤活血的作用[20-21],五加皮可强筋状骨等功效。本文研究结果显示,研究组治疗总疗效率93.33%明显高于对照组的77.78%,两组比较差异有统计学意义(P<0.05)。同时对比两组患者治疗后HSS评分、ROM、腰椎L2~4骨密度、股骨颈骨密度,研究组均明显优于对照组,比较差异均有统计学意义(P<0.05)。这与有关研究结果相符合,也同时证实了舒筋健骨汤熏洗联合康复训练的良好疗效。
综上所述,骨折后膝关节功能恢复期间可将舒筋健骨汤熏洗用以辅助康复训练进行干预,疗效突出,对提升恢复疗效存在有利作用,值得进一步推广和应用。
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(收稿日期:2017-07-10) (本文编辑:周亚杰)endprint