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“三会穴”穴位注射治疗胫腓骨骨折术后患者的临床研究

The Clinical Study of Sanhui Acupoint Injection in Fracture of Tibia and Fibula after Operation

作者: 专业:针灸推拿学 导师:陈兴华 年度:2015 学位:硕士  院校: 广州中医药大学

Keywords

tibia and fibula fracture, three postoperative acupoint, clinical observation, acupoint injection

        研究背景:在工伤事故引起的全身骨折中,胫腓骨骨折是最为常见的类型,胫腓骨骨折术后早期康复手段的合理选择对患者康复进程以及改善生活质量有重大意义,其中穴位注射的合理应用,充分发挥了中医简、效、廉的优越性。研究目的:采用“三会穴”穴位注射的方法,通过观察胫腓骨骨折术后康复早期的患者的骨折愈合疗效标准评定、VAS疼痛评分、SF-36生存质量评分等指标,以研究“三会穴”穴位注射对改善胫腓骨骨折术后的关节活动功能,减轻疼痛,改善生存质量的疗效。研究方法:采用区组随机对照的方法,将90例符合标准的病例分3组进行临床研究,每组30例,分别予穴位注射法、针刺法、穴位注射结合针刺法治疗,4个疗程后,观察各组治疗前后的骨折愈合疗效标准评定、VAS疼痛评分、SF-36生存质量评分。研究结果:1.治疗前三组患者的年龄、性别及胫腓骨骨折的骨折愈合基础情况差异无统计学意义(p>0.05);2.治疗后组内比较:穴位注射、针刺组、穴位注射结合针刺组的VAS痛觉评分、SF-36生存质量评分与治疗前比较差异均有显著统计学意义(p(0.01);3.治疗后三组间比较:VAS痛觉评分,针刺组与穴位注射结合针刺组的差异有显著统计学意义(p(0.01);穴位注射组与针刺组、穴位注射组与穴位注射结合针刺组差异的VAS痛觉评分差异无统计学意义(p>0.05);SF-36生存质量评分,在生理功能PF、总体健康GH方面,穴位注射组与针刺组、针刺组与穴位注射结合针剌组、穴位注射与穴位注射结合针刺组的差异没有统计学意义(p>0.05);在生理职能RP、活力VT、社会功能SF、精神健康MH方面,针刺组与穴位注射组,针刺组与穴位注射结合针刺组的差异均有显著性意义(p<0.01),穴位注射组与穴位注射结合针刺组的差异没有统计学意义(p>0.05);在躯体疼痛BP、情感职能RE方面,穴位注射组与针刺组、穴位注射与穴位注射结合针刺组差异没有统计学意义(p>0.05),针刺组与穴位注射结合针刺组的差异有显著性意义(p<0.01);4.4疗程治疗结束后,穴位注射组优14例,良10例,可4例,总有效率为85.7%,针刺组优7例,良11例,可12例,总有效率为60.0%,穴位注射结合针刺组优16例,良9例,可4例,总有效率为86.2%,经统计学分析,穴位注射组优于针刺组,穴位注射结合针刺组优于针刺组。研究结论:穴位注射能减少胫腓骨骨折患者术后的疼痛,促进术后关节功能愈合,提高胫腓骨骨折术后患者生存质量。
    BackgroundTibia and fibula fracture which are the most common,occurred With work-related injury accident, how to choose the treatment after operation seems significance with the rehabitation proceeding and the quality of life, acupoint injection exert the superiority.ObjectiveThis study was designed to prove the healing of fracture of tibia and fibula, reduce the pain, improve the quality of life, by using the treatment about injection of Danshen to the postoperative acupoint.Methods90 case were randomly divided into 3 groups, of 30 cases in each group, respectively by acupoint injection, acupuncture or acupoint injection combined with acupuncture treatment, they were observed before and after 4 courses of treatment about standard of curative effect, VAS pain score, SF-36 quality of life scores for evaluation about rehabilitation levelResultsAfter 4 courses of treatment, the acupuncture group was excellent in 7 cases, good in llcases, with a total effective rate of 60.0%, when acupoint injection group was excellent in 14, good in 10, with a total effective rate of 85.7%, and 16 cases of acupoint injection combined with acupuncture of excellent, good in 9 cases, with a total effective rate of 86.2%. through statistical analysis, both acupoint injection and that combined with acupuncture group are better than acupuncture group.compared with treatment before, all of three group shows that has significant difference (p<0.01),as tested by standard of curative effect,VAS pain score, SF-36 quality of life scoresConelusionit shows that the curative effect of acupoint injection can improve rehabilitation in the fracture of tibia and fibula after operation.
        

“三会穴”穴位注射治疗胫腓骨骨折术后患者的临床研究

中文摘要3-5
Abstract5-6
引言9-11
第一章 文献研究11-27
    第一节 中医学对于胫腓骨骨折的认识11-18
        一、中医对胫腓骨骨折的认识11
        二、中医对骨伤病机的认识11-15
        三、中医对胫腓骨骨折术后分期辨证的认识15-16
        四、中医对胫腓骨骨折术后治疗的应用16-17
        五、中医对胫腓骨骨折术后并发症的治疗17-18
    第二节 现代医学对胫腓骨骨折的认识18-21
        一、胫腓骨骨折病因18
        二、胫腓骨骨折的损伤机制及分类18-19
        三、胫腓骨骨折的的症状及诊断19
        四、胫腓骨骨折愈合机理19-20
        五、胫腓骨骨折的临床治疗20-21
        六、胫腓骨骨折的术后康复治疗21
    第三节 中医治疗骨折术后的研究新进展21-23
        一、中药促进骨折愈合的机理研究21-23
        二、穴位促进骨折术后愈合的机理研究23
    第四节 穴药结合疗法促进骨折术后愈合的应用进展23-25
        一、穴位埋线疗法23-24
        二、穴位贴敷疗法24
        三、穴位注射疗法24-25
    第五节 促进骨折术后愈合的穴位的应用研究25-27
第二章 临床研究27-44
    第一节 研究对象27-28
        一、病例来源27
        二、诊断标准27
        三、纳入标准27
        四、排除标准27
        五、剔除病例标准27-28
        六、退出(脱落)标准28
    第二节 研究方法28-30
        一、分组28
        二、治疗方法28-29
        三、观察指标29
        四、疗效评定标准29-30
        五、统计方法30
    第三节 研究结果30-37
        一、各组一般资料比较30
        二、各组年龄及性别比较30-31
        三、三组治疗前胫腓骨骨折基础愈合情况比较31-32
        四、三组VAS评分比较32-33
        五、三组SF-36评分比较33-36
        六、三组治疗后胫腓骨骨折愈合总疗效比较36-37
    第四节 讨论37-42
        一、穴位注射治疗胫腓骨骨折术后的中医理论依据37-38
        二、本研究选穴处方依据38-39
        三、研究结果分析39-40
        四、三会穴穴位注射治疗胫腓骨骨折术后的现代机理探讨40-42
    第五节 问题与展望42-44
结语44-45
参考文献45-49
附录49-54
致谢54
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