【摘要】 目的观察钢板内固定加压联合分期治疗对胫骨骨折血液流变学及血清磷钙水平的影响。方法将91例闭合性单纯胫骨骨折分为2组,对照组38例进行钢板内固定加压治疗,治疗组53例在对照组基础上加分期针刺治疗。比较2组治疗前后血液流变学及血清磷钙水平变化,统计临床疗效、膝关节HSS评分及骨折愈合时间。结果 2组术后1个月、2个月及3个月,HSS评分项中关节疼痛、行走能力、活动度、屈曲畸形、肌力及稳定性、总分均较本组治疗前逐渐提高,差异有统计学意义(P<0.05)。同一评价时段2组组间比较显示,治疗组各项评分及总分高于对照组,差异有统计学意义(P<0.05)。治疗1个月时,治疗组血液流变学各项指标均较本组治疗前明显下降,基本恢复正常水平,差异有统计学意义(P<0.05),而对照组只有全血粘度低切及红细胞电泳时间、血沉较本组治疗前下降,其余指标无明显变化,仍高于治疗前及治疗组同期,差异有统计学意义(P<0.05)。治疗结束后,2组血液流变学各项指标均较本组治疗前明显下降,差异有统计学意义(P<0.05),但治疗组各指标数值低于对照组,差异有统计学意义(P<0.05)。治疗28 d及治疗结束后,2组血清磷、钙及25羟维生素D水平均较本组治疗前升高,且治疗组高于对照组,差异有统计学意义(P<0.05)。治疗组治愈率及总有效率与对照组比较差异均有有统计学意义(P<0.05)。治疗组影像学愈合时间及功能愈合时间均较对照组短,差异有统计学意义(P<0.05)。结论针刺分期治疗胫骨骨折具有良好的临床效果,有利于功能锻炼,促进关节功能恢复,具有骨折愈合时间短、关节功能恢复佳的优点,其作用可能为针刺能够促进血液循环,加速钙磷在骨骼中的沉积,提高成骨活动有关。更多还原

【Abstract】 Objective To observe the effects of steel plate internal fixation compression combined with staging acupuncture on hemorheology and serum levels of calcium phosphate in treatment of tibial fractures. Methods Ninety patients with closed simple tibial fractures were divided into two groups,and 38 patients in control group were treated by steel plate internal fixation compression,however,the other 53 patients in treatment group,on the basis of control group,were treated by staging acupuncture. The changes of hemorheological indexes and serum levels of phosphorus,calcium before and after treatment were observed and compared between two groups. Moreover the therapeutic effects,HSS scores and fracture healing time were observed in both groups. Results On 1 month,2 months and 3 months after operation,HSS scores including joint pain,walking ability,activity,flexion deformity,muscle strength,stability,and total scores were gradually increases in both groups,as compared with those before treatment(P < 0. 05). Moreover the scores in treatment group were significantly higher than those in control group(P < 0. 05). On 1 month after treatment,the hemorheological parameters in treatment group were significantly decreased,as compared with those before treatment(P < 0. 05),however,only whole blood viscosity and low shear erythrocyte electrophoresis time,erythrocyte sedimentation rate in control group were obviously decreased,as compared with those before treatment,and the other indexes were not significantly changed,which were still higher than those before treatment and those in the same period in treatment group(P < 0. 05). At the end of treatment,the hemorheological parameters in both groups were significantly decreased,as compared with those before treatment(P < 0. 05),moreover,these parameters in treatment group were significantly lower than those in control group(P < 0. 05). On 28 days after treatment and at the end of treatment,the serum levels of phosphorus,calcium,25-hydroxy vitamin D were obviously increased in both groups,as compared with those before treatment,moreover,the levels in treatment group were significantly higher than those in control group(P < 0. 05). There were significant differences in cure rate and total effective rate between two groups(P <0. 05). Besides the imaging healing time and functional healing time in treatment group were significantly shorter than those in control group(P < 0. 05). Conclusion The staging acupuncture has better therapeutic effects on tibial fractures,which is in favor of functional exercise,and can promote recovery of joint function,with the fracture healing time being shorter and the advantages of good recovery of joint function,and its action mechanism may be correlated to promoting blood circulation,accelerating calcium and phosphorus deposition in bone and improving bone formation activity.更多还原