第三代陶瓷对陶瓷初次人工全髋关节置换配合补阳还五汤加味方的临床应用效果观察  

Observation on Effect of Third-Generation Alumina-On-Alumina Ceramic Bearings and Buyang Huanwu Decoction in Treatment of First Total Hip Arthroplasty

作　　者：陈忠义[1] 朱萍[1] 冯兴兵[1] 周晓波[1] 

机构地区：[1]台州医院骨科,浙江台州317000

出　　处：《中华中医药学刊》2014年第6期1523-1527,共5页Chinese Archives of Traditional Chinese Medicine

摘　　要：目的：观察第三代陶瓷对陶瓷初次人工全髋关节置换配合补阳还五汤加味方的临床应用效果．探讨置换术的关键手术技巧与补阳还五汤加味方的临床应用意义。方法：将医院2005年—2009年期间接受第三代陶瓷对陶瓷初次人工全髋关节置换术的2t0例（256髋）符合入组标准的患者按随机数字表分为2组，使用的陶瓷球头和臼衬均为第三代氧化铝陶瓷产品（德国ceramtel公司生产，cplochingen商品名为BioloxFoay），使用Smith＆Nephew公司的非骨水泥全髋关节假体（Reflection杯，Synergy柄），两组患者术后均进行常规的功能训练、抗生素治疗及对症治疗，对照组105例患者术后再给予肝素类药物抗凝剂预防血栓治疗，观察组105例患者在对照组治疗的基础上再给予补阳还五汤加味方预防血栓，术后7d使用血管彩超观察深静脉血栓形成情况，检测凝血活酶时间（AVrr）和凝血酶原时间（PT）指标变化，所有患者随访3—5年，进行影像学的评价及Harris评分。结果：随访期间未出现非骨水泥全髋关节假体松动，无陶瓷杯或陶瓷头碎裂，无异响，无脱位；观察组术后出现8例（7．62％）DVT，对照组出现26例（24．76％）DVT，观察组的术后DVT发生率明显低于对照组，差异具有统计学意义，χ^2=11．370，P〈0．01，观察组和对照组术后APTT、术后PT、随访后Harris评分分别为（90±1．5）分比（91±2．0）分，（35．36±3．27）s比（32．13±4．12）s，（13．81±1．25）s比（12．21±1．34）s，两组治疗后Harris评分均明显升高，观察组术后APTT、术后PT明显高于对照组。结论：陶瓷对陶瓷配伍因它具有的耐磨性，可靠性适用于年轻和活跃的患者，正确的假体植入位置，合适的软组织张力，解除可能引起撞击的因素，正确的陶瓷内衬及头的置入技术是影响手术效果的最重要的环节，术后配合补阳还五Objective：To investigate the effect of Third - Generation Alumina - on - Alumina Ceramic Bearings and Buyang Huanwu Decoction in the treatment of first Total Hip Arthroplasty and to explore the key technique of arthroplasty and significance of Buyang Huanwu Decoction. Method： 210 patients treated with Third - Generation Alumina - on - Alumina Ceramic Bearings during the 2005 to 2009 were randomly divided into two groups by the random number table. The ceramic head and acetabular liner were the third generation products （ Germany Ceramtel company, Biolox Forty） and Smith ＆ Nephew uncemented total hip prosthesis （Reflection Acetabular System,Synergy Cementless Stem System） was used. Both groups were given routine functions, antibiotic therapy and symptomatic treatment. The control group was given heparin drugs and the observation group was given Buyang Huanwu Decoction. The deep vein thrombosis was observed by vascular uhrasound observation, detecting APTr and PT. All patients were followed up for 5 years and then all patients were given radiographic evaluation and Harris score. Results：No prosthesis loosening, no ceramic liner or head was broken and no abnormal sound or no dislocation during the follow - up period. The DVT incidence of observation group was 8 case （7.62%）, and the DVT incidence of control group was 26 cases （24.76%）. The DVT incidence of observation group was significantly lower than that of the control group, χ^2 = 11. 370, P 〈 0.01. The APTT , PT and Harris score of observation group and control group were 90 ± 1.5 vs 91 ± 2.0, （35.36 ± 3.27 ） s vs （32.13 ± 4.12 ） s, （ 13.81 ± 1.25 ） s vs （ 12.21 ± 1.34） s. Harris scores of both group were significantly higher after treatment and the APTT and PT of observation group were significantly higher after treatment than that of the control group. Conclusion：The ceramic -on -ceramic compatibility has better wear resistance and is suitable for young and active patients. The right prosthesis position and

关 键 词：陶瓷 人工全髋关节置换术 聚乙稀 补阳还五汤 深静脉血栓 

分 类 号：R318.17[医药卫生—生物医学工程]