中医综合疗法预防肘关节三联征术后肘关节僵硬的病例对照研究

Case-control study on comprehensive traditional Chinese medicine therapy for preventing postsurgery stiffness after operation for terrible triad of the elbow

目的 ：探讨中医综合疗法预防肘关节三联征术后肘关节僵硬的临床疗效。方法 ：2008年12月至2013年12月收集肘关节三联征经内固定术后的患者32例,分为两组。其中,对照组17例,男12例,女5例;平均年龄（41.0±7.1）岁;采用以往程序法行康复治疗。治疗组15例,男10例,女5例;平均年龄（41.3±7.6）岁;按照中医综合治疗法行康复治疗,术后0~2周早期行被动训练,术后3~4周中期从助力被动训练向主动功能锻炼过渡,术后5~12周后期主动训练,各阶段以中药内服、外用以及推拿理疗配合应用。采用Mayo评分对两组患者随访终末期肘关节功能进行评估比较,并记录两组患者治疗满意度和并发症。结果：所有患者获得随访,平均随访时间7.5个月,未发现内固定失效松脱、明显骨折移位和异位骨化等现象。治疗组肘关节功能Mayo评分高于对照组（t=12.78,P=0.00）;治疗组治疗满意度高于对照组（χ2=8.719,P=0.003）。对照组中,7例需返院行粘连松解术,而治疗组仅1例,差异有统计学意义（χ2=4.626,P=0.032）。结论 ：中医综合疗法通过分阶段不同疗法组合,可以预防肘关节三联征术后肘关节僵硬的发生,值得临床推广应用。

Objective：To study therapeutic effects of comprehensive traditional Chinese medicine therapy for preventing postsurgery stiffness after operation for terrible triad of the elbow. Methods：From December 2008 to December 2013,32 patients with elbow triad were randomly divided into two groups ：therapy group and control group. There were 17 patients in control group,including 12 males and 5 females with a mean age of（41.0±7.1） years old. The patients in control group were received the past procedure therapy. There were 15 patients in therapy group,including 10 males and 5 females with a mean age of（41.3±7.6） years old. The patients in therapy group were received comprehensive traditional Chinese medicine therapy,including passive exercise training at early stage（0 to 2 weeks after operation）,transition from passive to active exercise training at middle stage（ 3 to 4 weeks after operation）,and active exercise training at late stage（5 to 12 weeks after operation）. Other treatment methods,such as orally taking or externally use of Chinese herbal medicine,manipulation and physiotherapy,were used at all stages. The Mayo Elbow Performance Score,patient satisfaction and complications were evaluated and analyzed.Results：All the patients were followed up,and the mean duration was 7.5 months. There were no complications such as internal fixation loosing,obvious displacement fracture and heterotopic ossification occurred. The Mayo score and patient satisfaction in therapy group were higher than those in control group（t=12.78,P=0.00; χ2=8.719,P=0.003）. Seven patients needed reoperation in control group,compared with 1 patient in therapy group（χ2=4.626,P =0.032）. Conclusion：The comprehensive traditional Chinese medicine therapy is effective to prevent postoperative stiffness after operation for terrible triad of the elbow by using different methods at different stages,which is worthy of spread and application.