[1]常峥,符朝程,刘文龙,等.新伤湿敷液外敷在胫骨平台骨折术前治疗中的应用[J].中医正骨,2020,32(06):18-21,26.
　CHANG Zheng,FU Zhaocheng,LIU Wenlong,et al.External application of Xinshang Shifu(新伤湿敷)solution to preoperative treatment of tibial plateau fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(06):18-21,26.
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新伤湿敷液外敷在胫骨平台骨折术前治疗中的应用()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期数:
2020年06期
页码:
18-21,26
栏目:
临床研究
出版日期:
2020-06-20

文章信息/Info

Title:
External application of Xinshang Shifu(新伤湿敷)solution to preoperative treatment of tibial plateau fractures
作者:
常峥1; 符朝程1; 刘文龙2; 刘志军1
(1.常德市第一中医医院,湖南常德415000; 2.湖南中医药大学,湖南长沙410208)
Author(s):
CHANG Zheng1; FU Zhaocheng1; LIU Wenlong2; LIU Zhijun1
1.The First Hospital of Traditional Chinese Medicine of Changde,Changde 415000,Hunan,China 2.Hunan University of Chinese Medicine,Changsha 410208,Hunan,China
关键词:
胫骨骨折;  胫骨平台;  新伤湿敷液;  中药外敷;  临床试验
Keywords:
tibial fractures;  tibial plateau;  Xinshang Shifu solutions;  external applications(TCD);  clinical trial
摘要:
目的:观察新伤湿敷液外敷在胫骨平台骨折术前治疗中的应用价值。方法:将60例接受手术治疗的胫骨平台骨折患者随机分为2组,每组30例。常规治疗组术前给予甘露醇脱水消肿、低分子肝素钙抗凝治疗,并指导患者行股四头肌等长收缩、足踝关节功能锻炼; 外敷组在常规治疗基础上采用新伤湿敷液外敷患处治疗,每日2次,待肢体肿胀消除后停用。记录并比较2组患者患肢肿胀率、患肢疼痛视觉模拟量表(visual analogue scale,VAS)评分及手术等待时间。结果:外敷组退出1例,常规治疗组退出2例。①患肢肿胀率。时间因素和分组因素存在交互效应(F=35.234,P=0.000); 2组患者患肢肿胀率总体比较,组间差异有统计学意义,即存在分组效应(F=-1.986,P=0.012); 治疗前后不同时间点患肢肿胀率的差异有统计学意义,即存在时间效应(F=619.710,P=0.000); 2组患者患肢肿胀率随时间呈先升高后降低趋势,但变化趋势不完全一致[(7.83±1.52)%,(9.73±1.90)%,(10.84±2.00)%,(5.63±1.23)%,F=387.336,P=0.000;(7.67±1.65)%,(9.49±1.70)%,(10.79±1.66)%,(6.68±1.63)%,F=459.514,P=0.000]; 治疗前及治疗1 d、3 d后,2组患者患肢肿胀率的组间差异均无统计学意义(t=0.381,P=0.705; t=0.497,P=0.621; t=0.097,P=0.923); 治疗7 d后外敷组患肢肿胀率低于常规治疗组(t=-2.775,P=0.008)。②患肢疼痛VAS评分。时间因素和分组因素存在交互效应(F=12.362,P=0.000); 2组患者患肢疼痛VAS评分比较,组间差异有统计学意义,即存在分组效应(F=-6.974,P=0.000); 治疗前后不同时间点患肢疼痛VAS评分的差异有统计学意义,即存在时间效应(F=251.136,P=0.000); 2组患者患肢疼痛VAS评分随时间呈降低趋势,但变化趋势不完全一致[(7.50±0.36)分,(7.15±0.31)分,(6.89±0.19)分,(4.92±0.46)分,F=322.490,P=0.000;(7.55±0.36)分,(7.36±0.28)分,(7.34±0.32)分,(6.13±0.41)分,F=94.309,P=0.000]; 治疗前,2组患者患肢疼痛VAS评分的差异无统计学意义(t=-0.937,P=0.353); 治疗1 d、3 d、7 d后外敷组患肢疼痛VAS评分均低于常规治疗组(t=-2.720,P=0.009; t=-6.414,P=0.000; t=-10.520,P=0.000)。③手术等待时间。外敷组手术等待时间短于常规治疗组手术等待时间[(8.31±3.15)d,(10.21±3.51)d,t=-4.219,P=0.000]。结论:对于接受手术治疗的胫骨平台骨折患者,术前在常规治疗的基础上采用新伤湿敷液外敷,可以消除肿胀、缓解疼痛、缩短手术等待时间。
Abstract:
Objective:To observe the applied values of external application of Xinshang Shifu(新伤湿敷,XSSF)solution to preoperative treatment of tibial plateau fractures.Methods:Sixty patients who would receive surgery for tibial plateau fractures were selected and randomly divided into conventional therapy group and external application group,30 cases in each group.All patients were treatd with dehydration and detumescence therapy using mannitol and anticoagulant therapy using low-molecular-weight heparins calcium(LMWHC),and were instructed to perform quadriceps femoris isometric contraction and ankle functional exercises before the surgery; moreover,the patients in external application group were treatd with external application of XSSF solution at the fractured parts,twice a day,till the limb swelling was eliminated.The affected limb swelling rate,visual analogue scale(VAS)scores and operating-room waiting time were recorded and compared between the 2 groups.Results:One patient in external application group and 2 patients in conventional therapy group dropped out of the study.There was interaction between time factor and group factor in affected limb swelling rate(F=35.234,P=0.000).There was statistical difference in affected limb swelling rate between the 2 groups in general,in other words,there was group effect(F=-1.986,P=0.012).There was statistical difference in affected limb swelling rate between different timepoints before and words,there was time effect(F=619.710,P=0.000).The affected limb swelling rate presented a time-dependent trend of increasing firstly and decreasing subsequently in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(7.83+-1.52,9.73+-1.90,10.84+-2.00,5.63+-1.23%,F=387.336,P=0.000; 7.67+-1.65,9.49+-1.70,10.79+-1.66,6.68+-1.63%,F=459.514,P=0.000).There was no statistical difference in affected limb swelling rate between the 2 groups before treatment and after 1- and 3-day treatment(t=0.381,P=0.705; t=0.497,P=0.621; t=0.097,P=0.923).The affected limb swelling rate was lower in external application group compared to conventional therapy group after 7-day treatment(t=-2.775,P=0.008).There was interaction between time factor and group factor in affected limb pain VAS scores(F=12.362,P=0.000).There was statistical difference in affected limb pain VAS scores between the 2 groups,in other words,there was group effect(F=-6.974,P=0.000).There was statistical difference in affected limb pain VAS scores between different timepoints before and after the treatment,in other words,there was time effect(F=251.136,P=0.000).The affected limb pain VAS scores presented a time-dependent decreasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(7.50+-0.36,7.15+-0.31,6.89+-0.19,4.92+-0.46 points,F=322.490,P=0.000; 7.55+-0.36,7.36+-0.28,7.34+-0.32,6.13+-0.41 points,F=94.309,P=0.000).There was no statistical difference in affected limb pain VAS scores between the 2 groups before the treatment(t=-0.937,P=0.353).The affected limb pain VAS scores were lower in external application group compared to conventional therapy group after 1-,3- and 7-day treatment(t=-2.720,P=0.009; t=-6.414,P=0.000; t=-10.520,P=0.000).The operating-room waiting time was shorter in external application group compared to conventional therapy group(8.31+-3.15 vs 10.21+-3.51 days,t=-4.219,P=0.000).Conclusion:For patients with tibial plateau fractures who will receive surgery,the combination therapy of conventional treatment and external application of XSSF solution can eliminate swelling,relieve pain and shorten operating-room waiting time before surgery.

参考文献/References:

[1]WEAVER M J,HARRIS M B,STROM A C,et al.Fracture pattern and fixation type related to loss of reduction in bicondylar tibial plateau fractures[J].Injury,2012,43(6):864 -869.
[2]魏英俊,徐克武,蒋宜伟,等.胫骨骨折内固定术后感染的相关危险因素[J].中医正骨,2018,30(5):37-39.
[3]赵刚,和桓德,陈朝伟,等.复杂胫骨平台骨折的手术治疗[J].中国矫形外科杂志,2014,22(20):1902-1905.
[4]王娜.分析胫骨平台骨折术后冰袋冷敷对手术切口渗血及肢体肿胀的影响[J].实用临床护理学电子杂志,2019,4(13):112.
[5]王巧霞,宋金娟,张金燕,等.自制多功能下肢抬高体位架在下肢骨折患者中的临床应用[J].甘肃科技,2019,35(10):141-142.
[6]郑永浩,李元贞,刘保健,等.消定膏配合RICE疗法治疗急性踝关节扭伤的临床观察[J].世界最新医学信息文摘,2017,17(26):120-121.
[7]刘义,刘志军.新伤湿敷液治疗急性踝关节扭伤30例临床观察[J].湖南中医杂志,2017,33(3):77-78.
[8]肖潇,邵先舫,刘志军.新伤湿敷液治疗急性闭合性软组织损伤60例临床观察[J].湖南中医杂志,2018,34(3):87-88.
[9]汤亚军,刘志军.新伤湿敷液治疗闭合性胫腓骨骨折30例临床观察[J].湖南中医杂志,2018,34(8):96-98.
[10] 程晋,刘文龙,夏锴,等.新伤湿敷液外敷治疗全膝关节置换术后肿胀的疗效观察[J].时珍国医国药,2019,30(7):1647-1649.
[11] 谭威,刘文龙,梁慧慧,等.中医手法复位、小夹板外固定联合新伤湿敷液外敷治疗桡骨远端骨折35例临床观察[J].湖南中医杂志,2019,35(8):63-64.
[12] 田伟.实用骨科学[M].北京:人民卫生出版社,2008:470-471.
[13] 郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:339-342.
[14] 许晓凤,黄双英,朱旭霞.艾灸配合土豆片外敷治疗β-七叶皂苷钠致静脉炎临床研究[J].上海针灸杂志,2014,33(7):629-630.
[15] 邱丽娜,王晓庭,郭红宇.中药封包联合红外线治疗甘露醇静脉滴注引起静脉炎43例[J].浙江中医杂志,2016,51(3):211.
[16] 秦天芝,肖鹏.活血利水法在髌骨骨折术后肢体肿痛中的临床疗效分析[J].中国中医骨伤科杂志,2014,22(11):27-28.
[17] 赵春栋,周松,高开拓.伤科消肿汤口服联合甘露醇静脉滴注治疗胫腓骨骨折术后肢体肿胀的临床研究[J].中医正骨,2016,28(12):21-25.
[18] 张泽宇,舒永辉,朱权,等.中药内服和薰洗在胫骨平台骨折术后治疗中的应用[J].中医正骨,2016,28(11):17-20.
[19] 丑建伟,洪斌,罗勋,等.中西医结合治疗复杂性胫骨平台骨折临床观察[J].湖北中医药大学学报,2016,18(4):88-91.
[20] 陈海波,郑志辉,林淑贞.桃红四物汤联合中药熏洗对SchatzkerV型胫骨平台骨折内固定术后患者愈合情况及炎症因子的影响[J].中国药师,2019,22(8):1461-1464.
[21] 韩士鼎,周正新,杨春恒.中药内外兼治胫骨平台骨折术后肿胀及疼痛的临床疗效观察[J].中医药临床杂志,2017,29(3):388-390.
[22] 白志津,田学忠,白彦东,等.消肿膏外敷对复杂性胫骨平台骨折患者术后肿胀程度影响及康复作用研究[J].辽宁中医杂志,2019,46(12):2568-2571.
[23] 张帆.中药贴敷联合桃红四物汤加减治疗骨折早期肢体肿胀的效果分析[J].世界最新医学信息文摘,2019,19(74):181-182.
[24] 魏学庆,沈国军,张桂成,等.解剖钢板固定联合中医疗法治疗胫骨平台骨折20例[J].中医正骨,2015,27(2):34-36.
[25] 尚蕾.中药熏洗联合针灸在胫骨骨折术后的应用效果观察[J].亚太传统医药,2018,14(4):160-162.
[26] 马宏丹,王露,郭东艳.经皮给药系统与新载体的研究进展[J].陕西中医,2017,38(9):1319-1320.
[27] HU Y M,LIU C,CHENG K W,et al.Sesquiterpenoids from Homalomena occulta affect osteoblast proliferation,differentiateon and mineralization in vitro[J].Phytochemistry,2008,69(12):2367-2373.

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备注/Memo

备注/Memo:
(收稿日期:2020-03-17本文编辑:时红磊)基金项目:湖南省中医药管理局项目(2019104)通讯作者:刘志军E-mail:lkp1957@126.com
更新日期/Last Update: 2020-10-10