无痛手法整复术配合归骨活血胶囊治疗桡骨远端骨折的疗效研究

Study on Clinical Efficacy of Painless Close Manipulative Restoration Surgery Combined with Guigu Huoxue Capsule in Treatment of Distal Radius Fractures

目的：观察并探讨无痛手法整复术配合归骨活血胶囊治疗桡骨远端骨折的临床疗效。方法：将2012年7月—2014年6月入选的120例桡骨远端骨折病例随机分为观察组和对照组,每组60例,观察组患者予无痛手法整复并小夹板固定疗法,对照组患者予常规手法整复并小夹板固定疗法,两组复位后均口服归骨活血胶囊,记录并比较两组复位前后疼痛视觉模拟评分（VAS）、患肢末端血氧饱和度、D-二聚体浓度变化及并发症发生情况,复位8周后,判定骨折愈合情况,复位12周后判定腕关节功能。结果：观察组复位中、术后1 d VAS评分显著低于对照组（P〈0.05）,复位中、术后1 d指端血氧饱和度水平显著高于对照组（P〈0.05）,复位中、术后1 d、3 d D-二聚体水平显著低于对照组水平（P〈0.05）。观察组一次性手法整复达到解剖复位的比例（100.0%）明显高于对照组（85.0%）（fisher P=0.003）,术后1周出现骨折端移位的比例明显低于对照组（χ^2=4.904,P=0.027）。两组患者复位后8周骨折愈合总体构成差异显著（Z=2.154,P=0.031）,观察组总体有效率（96.7%）明显高于对照组（85.0%）（χ^2=4.904,P=0.027）,平均愈合时间（7.7±1.9）周明显少于对照组（9.0±2.3）周（u=3.375,P=0.001）。观察组腕关节功能优良率（91.7%）高于对照组（81.7%）（χ^2=2.596,P=0.107）。观察组复位过程中不良反应发生率及复位后并发症发生率低于对照组。结论：无痛手法整复术较传统手法整复术治疗桡骨远端骨折能有效降低复位中应激反应与疼痛水平,有助于提高复位、固定的可靠性,改善骨折预后,配合口服归骨活血胶囊疗效更佳。

Objective： To observe and explore the clinical efficacy of painless close manipulative restoration surgery combined with Guigu Huoxue Capsule in the treatment of distal radius fractures. Methods： 120 distal radius fracture patients during Jul. 2012 to Jun. 2014 were selected and randomly divided into observation group and control group,60 cases in each. The patients of observation group were treated with close painless manipulative restoration surgery and small splint fixation therapy and those in control group treated with conventional manipulative reconstructive surgery and small splint fixation therapy. And then two groups were given Guigu Huoxue Capsule. The variation on pain visual analogue scale（ VAS）,distal limb blood oxygen saturation,D- dimer concentration and complication incidences of two groups were compared. After 8 weeks,fracture healing efficacies were determined. After 12 weeks,wrist joint functions of two groups were determined. Results： VAS scores during reconstruction and 1 d post operation of observation group were significantly lower than those of the control group（ P〈0.05）. Besides,limb blood oxygen saturation during reconstruction and 1 d post operation was significantly higher than the control group＇s（ P〈0.05）. D- dimer levels during reconstruction and 1 d and 3 d post operation were significantly lower than those of control group（ P〈0.05）. The proportion（ 100%） of reaching anatomical reduction of observation group was significantly higher than that of the control group＇ s（ 85%）（ fisher P = 0. 003） and fracture displacement ratio after 1 week was significantly lower than that of the control group（ χ^2=4. 904 P = 0. 027）. Constitutions of fracture healing efficacy of two groups had significant difference after restoration for 8 weeks（ Z = 2. 154 P = 0. 031） and the total effective ratio（ 96. 7%） of observation group was significantly higher than the control group＇s（ 85. 0%）（ χ^2=4. 904 P = 0. 027）. The average healing time[（ 7. 7 ± 1. 9） weeks] of observation group was less than control group＇s（ 9. 0 ± 2. 3） weeks（ u = 3. 375,P = 0. 001）. The observation group＇s whose excellent ratio（ 91. 7%） of wrist joint function after 12 weeks was higher than the control group＇s（ 81. 7%）（ χ^2=2. 596 P = 0. 107）. Adverse reactions and complication of observation group during restoration and postoperation were lower than the control group＇s. Conclusion： Compared with conventional restoration manipulation,painless restoration in treatment of distal radius fracture can effectively reduce stress reaction and pain degree during restoration,helpful to improve reliability of restoration and fixation and the prognosis and the clinical efficacy is better combined with oral administration of Guigu Huoxue Capsule.