[1]张晓芳,项杰.大黄芒硝散超声透入在闭合性胫腓骨骨折术前治疗中的应用[J].中医正骨,2022,34(05):1-5.
　ZHANG Xiaofang,XIANG Jie.Application of phonophoresis with rhubarb-mirabilite powders in preoperative treatment of closed tibiofibular fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(05):1-5.
点击复制

大黄芒硝散超声透入在闭合性胫腓骨骨折术前治疗中的应用()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期数:
2022年05期
页码:
1-5
栏目:
临床研究
出版日期:
2022-05-20

文章信息/Info

Title:
Application of phonophoresis with rhubarb-mirabilite powders in preoperative treatment of closed tibiofibular fractures
作者:
张晓芳; 项杰
(杭州市富阳中医骨伤医院,浙江 杭州 311400)
Author(s):
ZHANG Xiaofang; XIANG Jie
Fuyang TCM Orthopedic-Traumatological Hospital,Hangzhou 311400,Zhejiang,China
关键词:
胫骨骨折;  腓骨;  骨折; 闭合性;  大黄;  芒硝;  超声透入疗法;  肿胀;  疼痛;  临床试验
Keywords:
tibial fractures;  fibula;  fractures; closed;  rhei radix et rhizoma;  natrii sulfas;  phonophoresis;  swelling;  pain;  clinical trial
摘要:
目的:探讨大黄芒硝散超声透入在闭合性胫腓骨骨折术前治疗中的应用价值。方法:将符合要求的105例闭合性胫腓骨骨折患者随机分为3组,每组35例。常规治疗组术前采用口服地奥司明片和静脉滴注甘露醇注射液治疗,大黄芒硝散外敷组在常规治疗(同常规治疗组)的基础上给予外敷大黄芒硝散治疗,超声透入组在常规治疗(同常规治疗组)的基础上给予大黄芒硝散超声透入治疗。地奥司明片,每日2次,每次2片,连续服用1周; 甘露醇注射液,每次125 mL,每日2次,连续静脉滴注3 d; 大黄芒硝散外敷于肿胀部位,每日1次,连续外敷1周; 大黄芒硝散超声透入,每次30 min,每日1次,连续治疗1周。分别于治疗前和治疗开始后1 d、3 d、7 d,比较3组患者的术前下肢疼痛视觉模拟量表(visual analogue scale,VAS)评分和下肢肿胀评分。结果:①术前下肢疼痛VAS评分。时间因素和分组因素存在交互效应(F=51.571,P=0.000)。3组患者术前下肢疼痛VAS评分总体比较,差异有统计学意义,即存在分组效应(F=594.449,P=0.000)。治疗前后不同时间点之间术前下肢疼痛VAS评分的差异有统计学意义,即存在时间效应(F=32.243,P=0.000); 3组患者的术前下肢疼痛VAS评分随时间延长均呈下降趋势,但3组的下降趋势不完全一致[(6.03±0.95)分,(5.00±0.71)分,(1.77±0.73)分,(1.02±0.71)分,F=285.490,P=0.000;(6.11±0.96)分,(5.34±0.63)分,(3.28±0.62)分,(2.08±0.65)分,F=356.243,P=0.000;(6.40±1.03)分,(5.31±0.67)分,(3.88±0.67)分,(2.37±0.68)分,F=119.090,P=0.000]; 治疗前及治疗开始后1 d,3组患者的术前下肢疼痛VAS评分比较,差异均无统计学意义(F=1.365,P=0.260; F=2.614,P=0.078); 治疗开始后3 d、7 d,超声透入组患者的术前下肢疼痛VAS评分均低于大黄芒硝散外敷组和常规治疗组(P=0.000,P=0.000; P=0.000,P=0.000),大黄芒硝散外敷组患者的术前下肢疼痛VAS评分均低于常规治疗组(P=0.000,P=0.000)。②术前下肢肿胀评分。时间因素和分组因素存在交互效应(F=5.979,P=0.000)。3组患者术前下肢肿胀评分总体比较,差异有统计学意义,即存在分组效应(F=203.423,P=0.000)。治疗前后不同时间点之间术前下肢肿胀评分的差异有统计学意义,即存在时间效应(F=6.636,P=0.000); 3组患者的术前下肢肿胀评分随时间延长均呈下降趋势,但3组的下降趋势不完全一致[(2.65±0.48)分,(2.37±0.49)分,(1.40±0.49)分,(0.77±0.54)分,F=130.845,P=0.000;(2.57±0.50)分,(2.45±0.50)分,(1.62±0.54)分,(1.11±0.58)分,F=62.884,P=0.000;(2.62±0.49)分,(2.48±0.51)分,(1.85±0.55)分,(1.37±0.59)分,F=47.654,P=0.000]; 治疗前及治疗开始后1 d,3组患者的术前下肢肿胀评分比较,差异均无统计学意义(F=0.276,P=0.759; F=0.493,P=0.612); 治疗开始后3 d,超声透入组与大黄芒硝散外敷组患者的术前下肢肿胀评分的差异无统计学意义(P=0.079),超声透入组患者的术前下肢肿胀评分低于常规治疗组(P=0.000),大黄芒硝散外敷组与常规治疗组患者的术前下肢肿胀评分的差异无统计学意义(P=0.082); 治疗开始后7 d,超声透入组患者的术前下肢肿胀评分低于大黄芒硝散外敷组和常规治疗组(P=0.013,P=0.000),大黄芒硝散外敷组与常规治疗组患者的术前下肢肿胀评分的差异无统计学意义(P=0.067)。结论:对于闭合性胫腓骨骨折患者,术前在常规治疗的基础上采用大黄芒硝散超声透入治疗,能有效缓解患肢疼痛和消除患肢肿胀。
Abstract:
Objective:To explore the applied values of phonophoresis with rhubarb-mirabilite powders(RMP)in preoperative treatment of closed tibiofibular fractures.Methods:One hundred and five patients with closed tibiofibular fractures were enrolled in the study and were randomly divided into conventional treatment group,RMP external application group and RMP phonophoresis group,35 cases in each group.All patients in the 3 groups were treated with oral application of diosmin tablets(twice a day,2 tablets at a time for consecutive 7 days)and intravenous drip infusion of mannitol injection(twice a day,125 mL at a time for consecutive 3 days)before the surgery.Moreover,the patients in RMP external application group were further treated with external application of RMP(once a day for consecutive 7 days)at the swelling parts,and the ones in RMP phonophoresis group with phonophoresis of RMP(once a day,30 minutes at a time for consecutive 7 days).The preoperative lower limb pain visual analogue scale(VAS)score and lower limb swelling score were compared between the 3 groups before the treatment and at 1,3 and 7 days after the beginning of the treatment respectively.Results:①There was interaction between time factor and group factor in preoperative lower limb pain VAS score(F=51.571,P=0.000).There was statistical difference in preoperative lower limb pain VAS scores between the 3 groups in general,in other words,there was group effect(F=594.449,P=0.000).There was statistical difference in preoperative lower limb pain VAS scores between different timepoints before and after the treatment,in other words,there was time effect(F=32.243,P=0.000).The preoperative lower limb pain VAS scores presented a time-dependent decreasing trend in the 3 groups,while the 3 groups were inconsistent with each other in the variation tendency(6.03±0.95,5.00±0.71,1.77±0.73,1.02±0.71 points,F=285.490,P=0.000;6.11±0.96,5.34±0.63,3.28±0.62,2.08±0.65 points,F=356.243,P=0.000;6.40±1.03,5.31±0.67,3.88±0.67,2.37±0.68 points,F=119.090,P=0.000).There was no statistical difference in the preoperative lower limb pain VAS scores between the 3 groups before the treatment and at 1 day after the beginning of the treatment(F=1.365,P=0.260; F=2.614,P=0.078),howerer,at 3 and 7 days after the beginning of the treatment,the preoperative lower limb pain VAS scores were lower in RMP phonophoresis group compared to RMP external application group and conventional treatment group(P=0.000,P=0.000; P=0.000,P=0.000),and were lower in RMP external application group compared to conventional treatment group(P=0.000,P=0.000).②There was interaction between time factor and group factor in preoperative lower limb swelling score(F=5.979,P=0.000).There was statistical difference in preoperative lower limb swelling scores between the 3 groups in general,in other words,there was group effect(F=203.423,P=0.000).There was statistical difference in preoperative lower limb swelling scores between different timepoints before and after the treatment,in other words,there was time effect(F=6.636,P=0.000).The preoperative lower limb swelling scores presented a time-dependent decreasing trend in the 3 groups,while the 3 groups were inconsistent with each other in the variation tendency(2.65±0.48,2.37±0.49,1.40±0.49,0.77±0.54 points,F=130.845,P=0.000; 2.57±0.50,2.45±0.50,1.62±0.54,1.11±0.58 points,F=62.884,P=0.000; 2.62±0.49,2.48±0.51,1.85±0.55,1.37±0.59 points,F=47.654,P=0.000).There was no statistical difference in the preoperative lower limb swelling scores between the 3 groups before the treatment and at 1 day after the beginning of the treatment(F=0.276,P=0.759; F=0.493,P=0.612).At 3 days after the beginning of the treatment,the preoperative lower limb swelling scores were not significantly different from each other between RMP phonophoresis group and RMP external application group(P=0.079)as well as between RMP external application group and conventional treatment group(P=0.082),whereas it was lower in RMP phonophoresis group compared to conventional treatment group(P=0.000).At 7 days after the beginning of the treatment,the preoperative lower limb swelling scores were lower in RMP phonophoresis group comapred to RMP external application group and conventional treatment group(P=0.013,P=0.000),whereas there was no statistical difference between RMP external application group and conventional treatment group(P=0.067).Conclusion:Combination of conventional therapies with RMP phonophoresis can effectively relieve pain and eliminate swelling of the affected limbs in patients who will receive surgery for closed tibiofibular fractures.

参考文献/References:

[1] 李国梁,王旭洋,赵建勇,等.腓骨穿针内固定联合孟氏架外固定治疗胫腓骨骨折的临床研究[J].中医正骨,2021,33(4):22-27.
[2] 郭悦,董鑫宇,苏秀云,等.六自由度并联机器人模拟中医正骨手法复位简单骨折的可行性研究[J].中医正骨,2020,32(7):1-5.
[3] 黄默冉,陈云丰,王磊.成人胫骨下端骨折内固定治疗进展[J].国际骨科学杂志,2019,40(2):96-99.
[4] 杜志军.三七散外敷在闭合性踝关节骨折术前治疗中的应用[J].中医正骨,2021,33(3):61-63.
[5] 余学文,周重刚,吴漫,等.消瘀和伤散治疗足踝部骨折肿胀临床研究[J].中国中医药现代远程教育,2019,17(15):72-75.
[6] LJUNGQVIST O,SCOTT M,FEARON K C.Enhanced recovery after surgery:a review[J].JAMA Surg,2017,152(3):292-298.
[7] 周俊桐.伤科接骨片联合冰消散对胫腓骨骨折术后疼痛及肢体肿胀的影响[J].中国民间疗法,2020,28(19):55-57.
[8] 吴谐,张丽娟,黄文霞,等.冰硝散外敷与乙醇湿敷对胫腓骨骨折早期肢体疼痛和肿胀的疗效观察[J].临床与病理杂志,2020,40(6):1459-1465.
[9] 李兰兰,陈林静,唐飞.大黄芒硝在促进剖宫产产妇腹部切口愈合中的临床应用[J].中华中医药学刊,2017,35(12):3230-3232.
[10] 钟露斌,卢明峰,潘三元,等.大黄芒硝散外敷治疗全膝关节置换术后伤口肿痛的疗效观察[J].中医药导报,2017,23(21):90-91.
[11] 邹光翼,金红婷,梁伟,等.超声药物透入疗法联合自拟颈痛方治疗神经根型颈椎病效果观察[J].中国乡村医药,2018,25(13):17-18.
[12] 胥少汀,葛宝丰,徐印坎.实用骨科学[M].4版.北京:人民军医出版社,2012:1046-1049.
[13] 黄桂成,王拥军.中医骨伤科学[M].北京:中国中医药出版社,2016:171-172.
[14] 石荣光.实用骨科护理学[M].北京:中医古籍出版社,2009:484.
[15] 戚晓红,余卫平.病理生理学[M].北京:科学出版社,2001:53-55.
[16] 钟春花,陈小灵.芒硝湿敷对减轻pilon骨折肿胀和疼痛的观察与护理[J].当代护士,2019,26(9):117-119.
[17] 赵崇智,徐志强,潘海文,等.中医治疗骨折早期肿胀的研究进展[J].中国中医急症,2016,25(8):1564-1567.
[18] 王玉,杨雪,夏鹏飞,等.大黄化学成分、药理作用研究进展及质量标志物的预测分析[J].中草药,2019,50(19):4821-4833.
[19] 于建玉,廖欣,丁厚伟,等.中药大黄药理作用研究进展及其临床应用[J].中国现代药物应用,2016,10(11):286-287.
[20] 张玉松,罗达,程芳芳,等.煅石膏的研究进展及含钙止血材料应用概况[J].中国实验方剂学杂志,2021,27(1):223-228.
[21] 杨炀,税丕先,陈滟,等.中药大黄在临床应用中的功效以及对其药理作用[J].基因组学与应用生物学,2017,36(3):1226-1231.
[22] LIU A J,SONG L,LI Y,et al.Active compounds of rhubarb root and rhizome in animal model experiments of focal cerebral ischemia[J/OL].Evid Based Complement Alternat Med,2015[2021-04-25].https://pubmed.ncbi.nlm.nih.gov/26495006/.
[23] 尹俏,朱昌全.朴硝及其炮制品的药理作用[J].临床合理用药,2021,14(3):149-150.
[24] 段远芳,安月,陈静霞.刺络拔罐联合超声药物透入治疗绝经后骨质疏松性腰背痛临床观察[J].上海针灸杂志,2020,39(8):1047-1052.
(收稿日期:2021-05-30 本文编辑:时红磊)

相似文献/References:

[1]肖善富,张喜善,于凤珍.髌下小切口钢丝纽扣式内固定治疗胫骨髁间隆突骨折[J].中医正骨,2015,27(11):34.
[2]孟维娜,明立功,王新德,等.关节镜下清理联合腓骨近1/3段截骨治疗膝骨关节炎[J].中医正骨,2015,27(11):40.
[3]葛波涌,王玉波,王明太,等.交锁髓内钉内固定治疗胫骨干骨折的临床研究[J].中医正骨,2015,27(10):8.
　GE Boyong,WANG Yubo,WANG Mingtai,et al.Clinical study on the internal fixation with interlocking intramedullary nail for the treatment of tibial shaft fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(05):8.
[4]明立功,孟维娜,王新德,等.腓骨近端截骨治疗内侧间室膝骨关节炎的近期疗效观察[J].中医正骨,2015,27(10):25.
[5]全先辉,万春友,刘磊,等.Taylor空间支架外固定治疗胫腓骨开放性骨折[J].中医正骨,2015,27(10):30.
[6]何 涛.有限切开植骨钢板内固定治疗 SchatzkerⅡ、Ⅲ型胫骨平台骨折[J].中医正骨,2015,27(09):22.
[7]何忠,黄宗权,王强,等.胫骨中下段螺旋形骨折合并后踝裂纹骨折的诊治体会[J].中医正骨,2015,27(09):28.
[8]王庆东,李付彬,徐向峰,等.关节镜下可吸收螺钉内固定治疗儿童胫骨髁间嵴骨折[J].中医正骨,2015,27(12):52.
[9]李楠,李锋.胫骨平台骨折的手术治疗进展[J].中医正骨,2015,27(12):78.
[10]张一鸣,张学民,陆洲.经皮解剖型锁定钢板固定治疗胫骨远端骨折[J].中医正骨,2015,27(02):47.
[11]曾令法,施水彬,李秀山,等.急诊一期内固定术治疗GustiloⅢB型胫腓骨下段骨折[J].中医正骨,2015,27(04):38.
[12]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.
　ZHAO Chundong,ZHOU Song,GAO Kaituo.Clinical study on oral application of Shangke Xiaozhong Tang(伤科消肿汤)combined with intravenous drip infusion of mannitol for treatment of postoperative limb swelling in patients with peroneotibial fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(05):21.
[13]计忠宇,于鸿,马红茹,等.长腿石膏固定治疗儿童胫腓骨骨折865例[J].中医正骨,2016,28(12):67.
[14]尚延春,孟庆阳,柴巍巍.腓骨颈截骨入路切开复位钢板内固定治疗胫骨平台后外侧骨折[J].中医正骨,2018,30(01):55.
[15]李国梁,王旭洋,赵建勇,等.腓骨穿针内固定联合孟氏架外固定治疗胫腓骨骨折的临床研究[J].中医正骨,2021,33(04):22.
　LI Guoliang,WANG Xuyang,ZHAO Jianyong,et al.A clinical study of fibular Kirschner wire internal fixation combined with Meng’s fixator external fixation for treatment of tibiofibular fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(05):22.

备注/Memo

备注/Memo:
基金项目:杭州市富阳区科技计划项目(2019SK002) 通讯作者:项杰 E-mail:xj19860330@163.com
更新日期/Last Update: 1900-01-01