【摘要】 目的:观察新伤湿敷液外敷在胫骨平台骨折术前治疗中的应用价值。方法:将60例接受手术治疗的胫骨平台骨折患者随机分为2组,每组30例。常规治疗组术前给予甘露醇脱水消肿、低分子肝素钙抗凝治疗,并指导患者行股四头肌等长收缩、足踝关节功能锻炼;外敷组在常规治疗基础上采用新伤湿敷液外敷患处治疗,每日2次,待肢体肿胀消除后停用。记录并比较2组患者患肢肿胀率、患肢疼痛视觉模拟量表(visual analogue scale,VAS)评分及手术等待时间。结果:外敷组退出1例,常规治疗组退出2例。①患肢肿胀率。时间因素和分组因素存在交互效应(F=35.234,P=0.000);2组患者患肢肿胀率总体比较,组间差异有统计学意义,即存在分组效应(F=-1.986,P=0.012);治疗前后不同时间点患肢肿胀率的差异有统计学意义,即存在时间效应(F=619.710,P=0.000);2组患者患肢肿胀率随时间呈先升高后降低趋势,但变化趋势不完全一致[(7.83±1.52)%,(9.73±1.90)%,(10.84±2.00)%,(5.63±1.23)%,F=387.336,P=0.000;(7.67±1.65)%,(9.49±1.70)%,(10.79±1.66)%,(6.68±1.63)%,F=459.514,P=0.000];治疗前及治疗1 d、3 d后,2组患者患肢肿胀率的组间差异均无统计学意义(t=0.381,P=0.705;t=0.497,P=0.621;t=0.097,P=0.923);治疗7 d后外敷组患肢肿胀率低于常规治疗组(t=-2.775,P=0.008)。②患肢疼痛VAS评分。时间因素和分组因素存在交互效应(F=12.362,P=0.000);2组患者患肢疼痛VAS评分比较,组间差异有统计学意义,即存在分组效应(F=-6.974,P=0.000);治疗前后不同时间点患肢疼痛VAS评分的差异有统计学意义,即存在时间效应(F=251.136,P=0.000);2组患者患肢疼痛VAS评分随时间呈降低趋势,但变化趋势不完全一致[(7.50±0.36)分,(7.15±0.31)分,(6.89±0.19)分,(4.92±0.46)分,F=322.490,P=0.000;(7.55±0.36)分,(7.36±0.28)分,(7.34±0.32)分,(6.13±0.41)分,F=94.309,P=0.000];治疗前,2组患者患肢疼痛VAS评分的差异无统计学意义(t=-0.937,P=0.353);治疗1 d、3 d、7 d后外敷组患肢疼痛VAS评分均低于常规治疗组(t=-2.720,P=0.009;t=-6.414,P=0.000;t=-10.520,P=0.000)。③手术等待时间。外敷组手术等待时间短于常规治疗组手术等待时间[(8.31±3.15)d,(10.21±3.51)d,t=-4.219,P=0.000]。结论:对于接受手术治疗的胫骨平台骨折患者,术前在常规治疗的基础上采用新伤湿敷液外敷,可以消除肿胀、缓解疼痛、缩短手术等待时间。更多还原

【Abstract】 Objective:To observe the applied values of external application of Xinshang Shifu(新伤湿敷,XSSF)solution to preoperative treatment of tibial plateau fractures.Methods:Sixty patients who would receive surgery for tibial plateau fractures were selected and randomly divided into conventional therapy group and external application group,30 cases in each group.All patients were treatd with dehydration and detumescence therapy using mannitol and anticoagulant therapy using low-molecular-weight heparins calcium(LMWHC),and were instructed to perform quadriceps femoris isometric contraction and ankle functional exercises before the surgery;moreover,the patients in external application group were treatd with external application of XSSF solution at the fractured parts,twice a day,till the limb swelling was eliminated.The affected limb swelling rate,visual analogue scale(VAS)scores and operating-room waiting time were recorded and compared between the 2 groups.Results:One patient in external application group and 2 patients in conventional therapy group dropped out of the study.There was interaction between time factor and group factor in affected limb swelling rate(F=35.234,P=0.000).There was statistical difference in affected limb swelling rate between the 2 groups in general,in other words,there was group effect(F=-1.986,P=0.012).There was statistical difference in affected limb swelling rate between different timepoints before and after the treatment,in other words,there was time effect( F = 619. 710,P = 0. 000). The affected limb swelling rate presented a time-dependent trend of increasing firstly and decreasing subsequently in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency( 7. 83 +/-1. 52,9. 73 +/-1. 90,10. 84 +/-2. 00,5. 63 +/-1. 23%,F = 387. 336,P = 0. 000; 7. 67 +/-1. 65,9. 49 +/-1. 70,10. 79 +/-1. 66,6. 68 +/-1. 63%,F = 459. 514,P = 0. 000). There was no statistical difference in affected limb swelling rate between the 2 groups before treatment and after 1-and 3-day treatment( t = 0. 381,P = 0. 705; t = 0. 497,P = 0. 621; t = 0. 097,P = 0. 923). The affected limb swelling rate was lower in external application group compared to conventional therapy group after 7-day treatment( t =-2. 775,P = 0. 008). There was interaction between time factor and group factor in affected limb pain VAS scores( F = 12. 362,P = 0. 000). There was statistical difference in affected limb pain VAS scores between the 2 groups,in other words,there was group effect( F =-6. 974,P = 0. 000). There was statistical difference in affected limb pain VAS scores between different timepoints before and after the treatment,in other words,there was time effect( F = 251. 136,P = 0. 000). The affected limb pain VAS scores presented a time-dependent decreasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency( 7. 50 +/-0. 36,7. 15 +/-0. 31,6. 89 +/-0. 19,4. 92 +/-0. 46 points,F = 322. 490,P = 0. 000; 7. 55 +/-0. 36,7. 36 +/-0. 28,7. 34 +/-0. 32,6. 13 +/-0. 41 points,F = 94. 309,P = 0. 000). There was no statistical difference in affected limb pain VAS scores between the 2 groups before the treatment( t =-0. 937,P = 0. 353). The affected limb pain VAS scores were lower in external application group compared to conventional therapy group after 1-,3-and 7-day treatment( t =-2. 720,P = 0. 009; t =-6. 414,P = 0. 000; t =-10. 520,P = 0. 000). The operating-room waiting time was shorter in external application group compared to conventional therapy group( 8. 31 +/-3. 15 vs 10. 21 +/-3. 51 days,t =-4. 219,P = 0. 000). Conclusion: For patients with tibial plateau fractures who will receive surgery,the combination therapy of conventional treatment and external application of XSSF solution can eliminate swelling,relieve pain and shorten operating-room waiting time before surgery.更多还原