体外冲击波联合中药熏洗及功能锻炼治疗屈指肌腱粘连的临床研究
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摘要
目的:探讨体外冲击波联合中药熏洗及功能锻炼治疗屈指肌腱粘连的疗效。方法:将60例屈指肌腱粘连患者随机分为治疗组和对照组各30例,对照组于术后3周开始进行中药熏洗配合功能锻炼,治疗组在对照组治疗基础上,接受患处体外冲击波治疗,分别观察治疗前及治疗开始后第1、2、3、4周末患者疼痛情况、测量记录治疗前及治疗开始后第1、2、4、6周末各患指主动活动度TAM值以及优良率。结果:两组患者治疗前、治疗后1、2、3周疼痛评分比较,差异均无统计学意义(P>0.05);治疗组患者治疗后4周疼痛评分显著低于对照组,差异有统计学意义(P<0.05);两组患者治疗前、治疗后1、2、4周患指活动度比较,差异均无统计学意义(P>0.05),治疗组患者治疗6周后患指活动度显著优于对照组,差异有统计学意义(P<0.05)。治疗组优良率为70.91%,对照组优良率为47.17%,治疗组优于对照组,差异有统计学意义(P<0.05)。结论:体外冲击波联合中药熏洗及功能锻炼治疗屈指肌腱粘连有较好疗效,能缓解患者疼痛,缩短患指屈伸活动恢复的康复治疗时间。
Objective: To explore the effect of extracorporeal shock wave combined with fumigation and washing of traditional Chinese medicine and functional exercise on flexor tendon adhesion. Methods: The 60 patients with flexor tendon adhesions were devided into treatment group and control group randomly, 30 cases in each. The control group received Chinese herbal fumigation and washing combined with functional exercise 3 weeks after operation. The treatment group received extracorporeal shock wave therapy on the basis of the treatment of the control group. The pain of the patients before treatment and at the 1st, 2nd, 3rd and 4th weekends after treatment were observed, and the TAM values and the excellent and good rates of the active activity of the affected fingers before treatment and at the 1st, 2nd, 4th and 6th weekends after treatment were measured and recorded. Results: There was no significant difference in pain score between the two groups before treatment and 1, 2 and 3 weeks after treatment(P>0.05). The pain score of the treatment group 4 weeks after treatment was significantly lower than that of the control group(P<0.05). There was no significant difference between the two groups before treatment, at 1, 2, 4 weeks after treatment(P>0.05), and the activity of patients in the treatment group was significantly better than that of the control group after 6 weeks(P<0.05). The excellent and good rate of the treatment group was 70.91% after treatment, significantly higher than that of the control group(47.17%),the difference was statistically significant(P<0.05). Conclusion: Extracorporeal shock wave combined with fumigation and washing of traditional Chinese medicine and functional exercise has better curative effect on flexor tendon adhesion. It can alleviate the pain of patients, and shorten the rehabilitation time of flexion and extension activities of affected fingers.
Objective: To explore the effect of extracorporeal shock wave combined with fumigation and washing of traditional Chinese medicine and functional exercise on flexor tendon adhesion. Methods: The 60 patients with flexor tendon adhesions were devided into treatment group and control group randomly, 30 cases in each. The control group received Chinese herbal fumigation and washing combined with functional exercise 3 weeks after operation. The treatment group received extracorporeal shock wave therapy on the basis of the treatment of the control group. The pain of the patients before treatment and at the 1st, 2nd, 3rd and 4th weekends after treatment were observed, and the TAM values and the excellent and good rates of the active activity of the affected fingers before treatment and at the 1st, 2nd, 4th and 6th weekends after treatment were measured and recorded. Results: There was no significant difference in pain score between the two groups before treatment and 1, 2 and 3 weeks after treatment(P>0.05). The pain score of the treatment group 4 weeks after treatment was significantly lower than that of the control group(P<0.05). There was no significant difference between the two groups before treatment, at 1, 2, 4 weeks after treatment(P>0.05), and the activity of patients in the treatment group was significantly better than that of the control group after 6 weeks(P<0.05). The excellent and good rate of the treatment group was 70.91% after treatment, significantly higher than that of the control group(47.17%),the difference was statistically significant(P<0.05). Conclusion: Extracorporeal shock wave combined with fumigation and washing of traditional Chinese medicine and functional exercise has better curative effect on flexor tendon adhesion. It can alleviate the pain of patients, and shorten the rehabilitation time of flexion and extension activities of affected fingers.
引文
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[8]Chen Y J,W urtzT,Wang C J,et al.Recruitment of mesenchymolstem cells and expression of TGF-beta 1and VECF in the early stage of shock wave-promoted bone regeneration of segmental defect in rats[J].J Orthop Res,2004(22):526-534.
[2]姜士超,刘珅,范存义.肌腱粘连机制及预防的研究进展[J].中国修复重建外科杂志,2013,27(5):633-636.
[3]李敏.一氧化氮与肌腱愈合[J].中国组织工程研究,2012,15(50):9496-9500.
[4]夏长所,杨选影,韩迎秋,等.TGF-β1中和抗体对TGF-β诱导的肌腱胶原产生和术后粘连形成的影响[J].中国修复重建外科杂志,2009,23(6):698-703.
[5]Taylor S H,Al-youha S,Van Agtmael T,et al.Tendon is covered by abasement membrane epithelium that is required for cell retention and the prevention of adhesion formation[J].PLoS One,2011,6(1):e16337.
[6]Fu M,Sun CK,Lin YC,et al.Extracorporeal shock wave therapy reverses ischemia-related left ventricular dysfunction and remodeling:molecular-cellular and functional assessment[J].PLoS One,2011,6(9):e24342.
[7]马玲,贾子善,肖红雨,等.体外冲击波干预治疗对大鼠肌腱损伤修复的观察[J].解放军医学院学报,2015,36(9):932-934.
[8]Chen Y J,W urtzT,Wang C J,et al.Recruitment of mesenchymolstem cells and expression of TGF-beta 1and VECF in the early stage of shock wave-promoted bone regeneration of segmental defect in rats[J].J Orthop Res,2004(22):526-534.