补气活血利水法配合功能康复训练对踝关节骨折术后早期康复进程及凝血指标的影响

Effect of the method for benefiting qi,activating blood circulation and clearing damp combined with functional rehabilitation training on early rehabilitation process and coagulation indicators after ankle fracture surgery

目的:探究应用补气活血利水法,自拟消肿活血汤配合功能康复训练对踝关节骨折术后早期康复进程及凝血指标的影响。方法:选取进行手术治疗的踝关节骨折患者86例,采用随机数字表法分为对照组和治疗组,各43例。两组患者的手术方案基本一致,对照组术后视患者情况予以下肢功能康复训练,治疗组在对照组的基础上应用补气活血利水法,给予自拟消肿活血汤治疗,两组均治疗4周。比较两组术后1 d、术后4周后踝关节主动活动度、肿胀值、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(FIB)和D-二聚体(D-D)等凝血功能指标和关节疼痛、瘀斑、关节肿胀及关节红热等证候积分的差异,并对治疗效果进行评价。结果:两组治疗有效率分别为93.02%和76.74%,治疗组高于对照组,差异有统计学意义。术后1周、4周,两组踝关节背伸和跖屈角度均较治疗前提高,且治疗组高于对照组,差异有统计学意义。术后1、3、7 d及4周,治疗组的踝关节肿胀值均低于对照组,差异有统计学意义。治疗组术后4周,PT、APTT均高于对照组,FIB、D-D均低于对照组,差异有统计学意义。治疗组术后4周后各证候积分均低于对照组,差异有统计学意义。结论:应用补气活血利水法自拟的消肿活血汤配合功能康复训练可促进踝关节骨折术后早期康复,改善患者术后凝血功能,缓解临床症状,提高术后踝关节主动活动度,疗效突出。

Objective:To explore the effect of the method for benefiting qi,activating blood circulation and clearing damp,Xiaozhong Huoxue decoction combined with functional rehabilitation training on early rehabilitation process and coagulation indicators after ankle fracture surgery.Methods:A total of 86 patients with ankle fractures undergoing surgical treatment were selected.They were divided into control group and treatment group by random number table method,with 43 patients in each group.Surgical plans of the two groups were basically the same.Patients in the control group were given lower limb rehabilitation training based on their postoperative condition,while patients in the treatment group were treated with Xiaozhong Huoxue decoction based on the treatment of control group.Both groups were treated for 4 weeks.The ankle active range of motion,swelling,coagulation function indicators[prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),D-dimer(D-D)],and scores for joint pain,ecchymosis,joint swelling,joint redness and heat at treatment day and 4 weeks after treatment were compared between the two groups.Curative effect was evaluated.Results:The response rate in treatment group was higher than that in control group(93.02%vs.76.74%,P<0.05).At 1 week and 4 weeks after treatment,the angle of ankle dorsiflexion and plantar flexion were improved in the two groups(P<0.05),and the angles of treatment group were larger than those of control group(P<0.05).At 1 day,3 days,7 days and 4 weeks after surgery,ankle swelling values of treatment group were lower than those of control group(P<0.05).At 4 weeks after treatment,PT and APTT in treatment group were longer than those in control group,while FIB and D-D were lower than those in control group(P<0.05).The syndrome scores of treatment group were lower than those of the control group at 4 weeks after surgery(P<0.05).Conclusion:The method for benefiting qi,activating blood circulation and clearing damp,Xiaozhong Huoxue decoction combined with functional rehabilitation training can promote early recovery after ankle fracture surgery,improve postoperative coagulation function,relieve clinical symptoms,and improve postoperative ankle active range of motion,with significant curative effect.