| 闵重函，周瑛，荆琳.诱导膜技术联合中医康复治疗胫骨骨缺损的疗效研究[J].实用中西医结合临床,2023,23(4):9-13,32 |
| 诱导膜技术联合中医康复治疗胫骨骨缺损的疗效研究 |
| Clinical Effect Study on Induction Membrane Technique Combined with TCM Rehabilitation in Repairing Tibial Bone Defects |
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| DOI： |
| 中文关键词: 胫骨骨缺损 中医康复 诱导膜技术 |
| 英文关键词: Tibial bone defects TCM rehabilitation Induced membrane technology |
| 基金项目:浙江省嘉兴市科学技术局公益类项目（编号：2020AD10004） |
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| 中文摘要: |
| 目的：观察中医康复对诱导膜技术治疗胫骨骨缺损患者肢体功能康复的影响。方法：选取医院2019年1月至2021年5月收治的142例符合诊疗标准的胫骨骨髓炎患者，随机分为中医康复组和对照组，各71例。所有患者接受两次手术。第1次手术进行清创、病灶切除，并安置抗生素骨水泥。在抗感染治疗2个月以上，确认感染被消灭的情况下，予以第2次手术，去除骨水泥后进行自体松质骨植骨。每次手术拆线后中医康复组都予以中医推拿治疗和石氏伤科特色外用药物治疗，每2日1次，疗程为2个月；对照组采用术后伤肢肌肉等长收缩锻炼、肢体智能运动训练治疗护理器（CPM）协助增加膝、踝关节屈曲、背伸活动范围，并逐渐过渡到支具辅助下下肢半负重、至全负重下的自主屈伸锻炼。在第2次手术后第6个月、第12个月的观察点上分别对两组患者采用Edwards胫骨骨折疗效评价系统和植骨区域CT值的测量数据分析，评价治疗后6个月和12个月时的肢体功能和骨愈合情况。结果：两组术后12个月Edwards总分均高于术后6个月，差异有统计学意义（P＜0.05）；中医康复组术后6个月和术后12个月Edwards总分均高于对照组，差异有统计学意义（P＜0.05）；术后6个月，中医康复组Edwards疼痛、肿胀、足活动度、踝活动度项目评分和CT值均优于对照组，差异有统计学意义（P＜0.05）；术后12个月，中医康复组Edwards疼痛、肿胀、运动、足活动度、踝活动度项目评分和CT值均优于对照组，差异有统计学意义（P＜0.05）；组织学研究分析，中医康复组生物膜组织密度和毛细血管网密集程度均高于对照组。结论：中医康复有助于诱导膜技术治疗胫骨骨缺损患者肢体功能的康复，有利于促进植骨后骨愈合。 |
| 英文摘要: |
| Objective: To observe the effect of TCM rehabilitation on the rehabilitation of limb function in patients with tibial bone defect treated by induced membrane technology. Methods: A total of 142 patients with tibial osteomyelitis who met the diagnosis and treatment criteria admitted to the hospital from January 2019 to May 2021 were selected and randomly divided into TCM rehabilitation group and control group, with 71 cases in each group. All patients accepted twice operations. The main tasks of first operation contain debridement, focal excision, and placement of antibiotic bone cement. After anti infection treatment for more than 2 months, the infection is confirmed to be eliminated, the second operation would be performed to autogenous cancellous bone graft after removal of bone cement. After the time the surgical suture removed of each operation the patients in TCM rehabilitation group were treated with TCM massage therapy and Shi's traumatology characteristic external medicine, once every 2 days for 2 months. In the control group, isometric contraction exercise was performed on the injured limb and limb intelligence sports trainingtherapy caregiver (CPM) assisted to increase the range of motion of knee and ankle flexion and dorsiflexion. And gradually transition to the lower extremity with the support of half load to full load autonomous flexion and extension exercise. The Edwards tibial fracture efficacy evaluation system and the CT values of the bone graft area were used to evaluate the limb function and bone healing at 6 and 12 months after the second operation at observation points. Results: The total scores of Edwards were higher in both groups 12 months after surgery than 6 months after surgery, and the difference was statistically significant (P＜0.05). The total scores of Edwards in TCM rehabilitation group were higher than those in control group at 6 months and 12 months after surgery, and the difference was statistically significant (P＜0.05). Six months after surgery, Edwards pain, swelling, foot motion, ankle motion item scores and CT values in the TCM rehabilitation group were better than those in the control group, with statistical significance (P＜0.05). 12 months after surgery, Edwards pain, swelling, movement, foot motion, ankle motion and CT values in the TCM rehabilitation group were better than those in the control group, the difference was statistically significant (P＜0.05). Histological analysis showed that the biofilm tissue density and capillary network density in the TCM rehabilitation group were higher than those in the control group. Conclusion: TCM rehabilitation is helpful to the rehabilitation of limb function of patients with tibial bone defect treated by induced membrane technology, and is conducive to promoting bone healing after bone grafting. |
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