畲药活血通经方外敷在旋后外旋型Ⅲ度、Ⅳ度踝关节骨折术后治疗中的应用及作用机制研究  

A clinical study of external application of Huoxue Tongjing Fang(活血通经方)to postoperative treatment of supination-extorsion-type gradeⅢandⅣankle fractures and its mechanism of action

作　　者：邹光翼 陈佳琦[1] 梁伟[1] 鄢连和[1] 朱美晓[1] 魏永敏[1] 王双虎[1] 耿培武[1] 华爱莲 叶静[1] 童培建[3] ZOU Guangyi;CHEN Jiaqi;LIANG Wei;YAN Lianhe;ZHU Meixiao;WEI Yongmin;WANG Shuanghu;GENG Peiwu;HUA Ailian;YE Jing;TONG Peijian(The People's Hospital of Lishui City,Lishui 323000,Zhejiang,China;The First People's Hospital of Yuhang,Hangzhou 311100,Zhejiang,China;Zhejiang Provincial Hospital of Traditional Chinese Medicine,Hangzhou 310006,Zhejiang,China)

机构地区：[1]丽水市人民医院,浙江丽水323000 [2]杭州市余杭区第一人民医院,浙江杭州311100 [3]浙江省中医院,浙江杭州310006

出　　处：《中医正骨》2020年第12期31-37,共7页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：丽水市科技计划项目(2016GYX45)。

摘　　要：目的:探讨畲药活血通经方外敷在旋后外旋型Ⅲ度、Ⅳ度踝关节骨折术后治疗中的应用价值,并探讨其作用机制。方法:将80例行切开复位钢板内固定术的旋后外旋型Ⅲ度、Ⅳ度踝关节骨折患者随机分为2组,每组40例。常规治疗组术后用支具固定并抬高患肢,给予常规抗感染治疗;术后第1天在手术切口周围持续冰敷,每天4次,每次1h;并于术后第1天开始足趾屈伸功能锻炼及踝关节功能锻炼,每次15min,每天4次,共4周。畲药外敷组在常规治疗的基础上于术后第1天开始采用畲药活血通经方外敷患处,每日换药1次,共4周。分别于术后第1天、第7天和第14天记录并比较2组患者的足踝部疼痛视觉模拟量表(visual analogue scale,VAS)评分和足踝部周径,分别于术后第1天、第90天和第180天记录并比较2组患者的美国足与踝关节协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足功能评分,并分别于术后第1天、第7天和第14天记录并比较2组患者的白细胞介素(interleukin,IL)-6、IL^-10的血清含量。结果:①足踝部疼痛VAS评分。时间因素和分组因素存在交互效应(F=1.430,P=0.000);2组患者足踝部疼痛VAS评分总体比较,组间差异有统计学意义,即存在分组效应(F=2.144,P=0.033);术后不同时间点足踝部疼痛VAS评分的差异有统计学意义,即存在时间效应(F=215.900,P=0.000);2组患者术后的足踝部疼痛VAS评分均呈降低趋势[畲药外敷组:(7.53±1.58)分,(4.78±1.17)分,(2.70±1.24)分,F=129.700,P=0.000;常规治疗组:(7.45±1.55)分,(5.65±0.89)分,(3.70±0.91)分,F=104.600,P=0.000],但2组的变化趋势不完全一致;术后第1天2组患者足踝部疼痛VAS评分的差异无统计学意义(t=0.214,P=0.831);术后第7天、第14天畲药外敷组足踝部疼痛VAS评分均低于常规治疗组(t=3.769,P=0.000;t=4.100,P=0.000)。②足踝部周径。时间因素和分组因素存在交互效应(F=107.200,P=0.000);2组患者足踝部�Objective:To explore the applied values of external application of Huoxue Tongjing Fang(活血通经方,HXTJF)to postop-erative treatment of supination-extorsion-type grade Ⅲ and Ⅳ ankle fractures and to explore its mechanism of action.Methods:Eighty pa-tients who received open reduction and plate internal fixation for treatment of supination-extorsion一type grade Ⅲ and Ⅳ ankle fractures were selected and randomly divided into conventional therapy group and HXTJF external application group,40 cases in each group.All pa-tients in the 2 groups were treated with orthosis fixation,raising the injured limbs and anti-infection after the surgery,and the continuous ice compress was performed around the surgical incision on the postoperative day 1,four times a day,1 hour at a time.Meanwhile,all pa-tients were instructed to perform toes flexion and extension functional exercises and ankle functional exercises since the postoperative day 1,four times a day,15 minutes at a time for consecutive 4 weeks.Moreover,the patients in HXTJF extermal application group were treated with external application of HXTJF at the fractured parts since the postoperative day 1,and the dressings chang were performed once a day for4 weeks.The ankle pain visual analogue scale(VAS)scores,ankle circumferences and the serum contents of interleukin(IL)-6 and IL^-10 were recorded and compared between the 2 groups on postoperative day 1,7 and 14 respectively.The American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot function scores were recorded and compared between the 2 groups on postoperative day 1,90 and 180 re-spectively.Results:There was interaction between time factor and group factor in ankle pain VAS scores(F=1.430,P=0.000).There was statistical difference in ankle pain VAS scores between the 2 groups in general,in other words,there was group effect(F=2.144,P=0.033).There was statistical difference in ankle pain VAS scores between different timepoints after the surgery,in other words,there was time effect(F=215.900,P=0.000).T

关 键 词：踝关节 骨折 中药外敷 白细胞介素-6 白细胞介素-10 临床试验 

分 类 号：R687.3[医药卫生—骨科学]