[1]王琪,郭磊,白平,等.益气续骨合剂加虫类通络方在踝关节骨折术后康复治疗中的应用[J].中医正骨,2021,33(07):17-22.
　WANG Qi,GUO Lei,BAI Ping,et al.Application of Yiqi Xugu Heji(益气续骨合剂)and Chonglei Tongluo Fang(虫类通络方)to postoperative anke rehabilitation in patients with ankle fractures:a clinical study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(07):17-22.
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益气续骨合剂加虫类通络方在踝关节骨折术后康复治疗中的应用()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年07期
页码:
17-22
栏目:
临床研究
出版日期:
2021-07-20

文章信息/Info

Title:
Application of Yiqi Xugu Heji(益气续骨合剂)and Chonglei Tongluo Fang(虫类通络方)to postoperative anke rehabilitation in patients with ankle fractures:a clinical study
作者:
王琪; 郭磊; 白平; 王涛; 郭英; 李克锋; 温辉; 黄文泽
(昆明市中医医院,云南 昆明 650599)
Author(s):
WANG Qi; GUO Lei; BAI Ping; WANG Tao; GUO Ying; LI Kefeng; WEN Hui; HUANG Wenze
Kunming Municipal Hospital of Traditional Chinese Medicine,Kunming 650599,Yunnan,China
关键词:
骨折;  踝关节;  中医康复;  益气续骨合剂;  虫类通络方
Keywords:
fractures; bone;  ankle joint;  rehabilitation(TCM);  Yiqi Xugu Heji;  Chonglei Tongluo Fang
摘要:
目的:探讨益气续骨合剂加虫类通络方在踝关节骨折术后康复治疗中的应用价值。方法:踝关节骨折患者60例,随机分为2组,每组30例。2组患者均行切开复位钢板内固定手术治疗,术后均行常规踝关节功能康复锻炼。术后第2天起,分别给予益气续骨合剂加虫类通络方颗粒口服(益气续骨合剂加虫类通络方组)和骨力胶囊口服(骨力胶囊组),均为每日早、中、晚餐后半小时各服1次,连续服用4周。分别于术前及服药2周后、服药4周后,采用疼痛视觉模拟量表(visual analogue scale,VAS)评分评价踝关节疼痛程度,根据关节肿胀度对踝关节肿胀情况进行评分,测量踝关节屈伸活动度。治疗结束后第3天,采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分评价踝关节功能。并分别于术前、治疗结束后第3天,采用酶联免疫吸附法检测患者血清中白细胞介素-1β(interleukin-1β,IL-1β)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、C反应蛋白(C-reaction protein,CRP)水平。结果:①踝关节疼痛VAS评分及关节肿胀评分。治疗前后不同时间点之间踝关节疼痛VAS评分、关节肿胀评分的差异均有统计学意义,即具有时间效应(F=298.997,P=0.000; F=94.908,P=0.000); 2组患者踝关节疼痛VAS评分、关节肿胀评分均随时间呈下降趋势,但2组的下降趋势均不完全一致[疼痛VAS评分:(7.40±1.92)分,(4.21±1.24)分,(1.59±0.56)分,F=188.543,P=0.000;(7.27±1.72)分,(5.63±1.65)分,(3.03±0.89)分,F=116.301,P=0.000。关节肿胀评分:(1.99±0.53)分,(1.06±0.36)分,(0.33±0.21)分,F=71.504,P=0.000;(2.03±0.61)分,(1.37±0.49)分,(0.96±0.32)分,F=28.470,P=0.000]。2组患者踝关节疼痛VAS评分、关节肿胀评分组间总体比较,差异均有统计学意义,即具有分组效应(F=16.142,P=0.000; F=25.274,P=0.000); 术前2组患者踝关节疼痛VAS评分、关节肿胀评分组间比较,差异均无统计学意义(t=0.283,P=0.778; t=0.226,P=0.822); 服药2周后、服药4周后,益气续骨合剂加虫类通络方组患者踝关节疼痛VAS评分、关节肿胀评分均低于骨力胶囊组(服药2周后:t=3.800,P=0.000; t=2.688,P=0.009; 服药4周后:t=7.454,P=0.000; t=6.019,P=0.000)。时间因素与分组因素存在交互效应(F=5.847,P=0.005; F=5.066,P=0.009)。②踝关节屈伸活动度。治疗前后不同时间点之间踝关节屈伸活动度的差异有统计学意义,即具有时间效应(F=2 175.791,P=0.000); 2组患者踝关节屈伸活动度均随时间呈增加趋势,但2组的增加趋势不完全一致[18.78°±0.84°,26.52°±0.96°,32.81°±1.15°,F=1 501.683,P=0.000; 19.05°±0.79°,23.47°±0.91°,28.37°±1.06°,F=639.580,P=0.000]。2组患者踝关节屈伸活动度组间总体比较,差异有统计学意义,即具有分组效应(F=295.236,P=0.000); 术前2组患者踝关节屈伸活动度比较,差异无统计学意义(t=1.281,P=0.205); 服药2周后、服药4周后,益气续骨合剂加虫类通络方组患者踝关节屈伸活动度均大于骨力胶囊组(t=12.618,P=0.000; t=15.544,P=0.000)。时间因素与分组因素存在交互效应(F=93.380,P=0.000)。③踝关节功能。治疗结束后第3天,益气续骨合剂加虫类通络方组踝关节AOFAS踝与后足评分高于骨力胶囊组[(81.89±10.74)分,(75.04±11.23)分,t=2.415,P=0.019]; 益气续骨合剂加虫类通络方组踝关节功能优10例、良16例、中3例、差1例,骨力胶囊组踝关节功能优6例、良13例、中7例、差4例,益气续骨合剂加虫类通络方组患者踝关节功能优于骨力胶囊组(Z=1.981,P=0.048)。④血清炎症因子水平。术前,2组患者血清IL-1β、TNF-α、CRP水平比较,组间差异均无统计学意义[(29.65±7.14)pg·mL-1,(27.98±7.02)pg·mL-1,t=0.914,P=0.365;(34.25±7.35)pg·mL-1,(33.18±7.61)pg·mL-1,t=0.554,P=0.582;(38.94±10.26)mg·L-1,(37.15±9.68)mg·L-1,t=0.695,P=0.490]; 治疗结束后第3天,2组患者血清IL-1β、TNF-α、CRP水平均低于术前(益气续骨合剂加虫类通络方组:t=6.283,P=0.000; t=7.328,P=0.000; t=16.419,P=0.000; 骨力胶囊组:t=3.141,P=0.003; t=4.215,P=0.000; t=14.942,P=0.000); 且益气续骨合剂加虫类通络方组均低于骨力胶囊组[(19.85±4.69)pg·mL-1,(23.08±4.87)pg·mL-1,t=2.617,P=0.011;(21.59±5.96)pg·mL-1,(25.94±5.53)pg·mL-1,t=2.930,P=0.005;(7.65±1.92)mg·L-1,(9.63±2.84)mg·L-1,t=3.164,P=0.002]。结论:对于踝关节骨折术后患者,在常规踝关节功能康复锻炼的基础上,采用益气续骨合剂加虫类通络方治疗,可减轻炎症反应,缓解踝关节疼痛和肿胀,改善踝关节屈伸活动度,促进踝关节功能恢复。
Abstract:
To explore the applied values of Yiqi Xugu Heji(益气续骨合剂,YQXGHJ)and Chonglei Tongluo Fang(虫类通络方,CLTLF)in postoperative anke rehabilitation in patients who undergoing surgery for treatment of ankle fractures.Methods:Sixty patients with ankle fractures were enrolled in the study and were randomly divided into 2 groups,30 cases in each group.All patients in the 2 groups were treated with open reduction and plate internal fixation,followed by conventional ankle functional rehabilitation exercises.Moreover,30 patients were further treated with oral application of YQXGHJ and CLTLF(YQXGHJ and CLTLF group),while the others with Guli(骨力,GL)capsules(GL capsule group)for consecutive 4 weeks,3 times a day at 30 minutes after breakfast,lunch and dinner respectively.The ankle pain degree was evaluated by using pain visual analogue scale(VAS)scores,the ankle swelling was scored according to the swelling degree of joints,and the ankle flexion-extension range of motion(ROM)was measured before the surgery and after 2- and 4-week medication respectively.The ankle function was evaluated by using American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot scores at the 3rd day after the end of the treatment,and the serum levels of interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α)and C-reaction protein(CRP)were detected by using enzyme linked immunosorbent assay(ELISA)before the surgery and at the 3rd day after the end of the treatment respectively.Results:There was statistical difference in ankle pain VAS scores and swelling scores between different timepoints before and after the treatment,in other words,there was time effect(F=298.997,P=0.000; F=94.908,P=0.000).The ankle pain VAS scores and swelling scores presented a time-dependent decreasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(pain VAS score:7.40±1.92,4.21±1.24,1.59±0.56 points,F=188.543,P=0.000; 7.27±1.72,5.63±1.65,3.03±0.89 points,F=116.301,P=0.000; swelling score:1.99±0.53,1.06±0.36,0.33±0.21 points,F=71.504,P=0.000; 2.03±0.61,1.37±0.49,0.96±0.32 points,F=28.470,P=0.000).There was statistical difference in ankle pain VAS scores and swelling scores between the 2 groups in general,in other words,there was group effect(F=16.142,P=0.000; F=25.274,P=0.000).There was no statistical difference in ankle pain VAS scores and swelling scores between the 2 groups before the surgery(t=0.283,P=0.778; t=0.226,P=0.822).The ankle pain VAS scores and swelling scores were lower in YQXGHJ and CLTLF group compared to GL capsule group after 2- and 4-week medication(after 2-week medication:t=3.800,P=0.000; t=2.688,P=0.009; after 4-week medication:t=7.454,P=0.000; t=6.019,P=0.000).There was interaction between time factor and group factor in ankle pain VAS scores and swelling scores(F=5.847,P=0.005; F=5.066,P=0.009).There was statistical difference in ankle flexion-extension ROM between different timepoints before and after the treatment,in other words,there was time effect(F=2 175.791,P=0.000).The ankle flexion-extension ROM presented a time-dependent increasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(18.78±0.84,26.52±0.96,32.81±1.15 degrees,F=1 501.683,P=0.000; 19.05±0.79,23.47±0.91,28.37±1.06 degrees,F=639.580,P=0.000)...

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备注/Memo

备注/Memo:
基金项目:昆明市科技计划项目(2019-1-S-25318000001020)
通讯作者:郭磊 E-mail:guolei73@hotmail.com
更新日期/Last Update: 1900-01-01