Clinical Observation of Chinese Medicinal Prescriptions for Swelling and Pain in The Postoperative Treatment of Mixed Hemorrhoids

Objective:To observe the clinical effect of traditional Chinese medicine(TCM)on reducing swelling and pain in patients with mixed hemorrhoids.Methods:Sixty patients with mixed hemorrhoids who were admitted to the Hospital of Traditional Chinese Medicine of Qiqihar from January 2023 to January 2024 were selected and divided into two groups.The treatment group(n=30)was treated with mixed hemorrhoid ligation combined with traditional Chinese swelling and pain medicine,and the control group(n=30)was only treated with mixed hemorrhoid ligation.The pain level,edema score,and prognosis of the two groups after the intervention were analyzed.The clinical efficacy was used as the evaluation criterion to compare the clinical effects of different treatment options.Results:After the treatment,the pain score,edema score,and prognostic wound score of the treatment group were all lower than those of the control group(P 0.05).The total clinical effectiveness of the treatment group(100%)was higher than that of the control group(76.67%),(χ^(2)=4.2857,P<0.05).Conclusion:The application of traditional Chinese swelling and pain medicine in treating patients with mixed hemorrhoids effectively reduced the patient’s pain,reduced the degree of wound edema,promoted wound healing,and improved the patient’s prognosis.The curative effect was significant and had a positive impact.

Traditional Chinese medicine ointment combined with tuina therapy in treatment of pain and swelling after total knee arthroplasty

BACKGROUND The most effective treatment for knee joint pain is total knee arthroplasty(TKA),but the risk of pain and swelling in patients after surgery is high.Ice application,ankle pump exercise and non-steroidal anti-inflammatory painkillers are the primary clinical treatments after surgery.However,long-term use of nonsteroidal anti-inflammatory pain relievers can easily cause gastrointestinal damage.Traditional Chinese medicine(TCM)ointments and tuina therapy integrate TCM and manipulation,which effectively promotes the penetration of TCM into the skin lesions,improves local blood circulation and inflammatory reaction and has good long-term effects on patients.AIM To evaluate the efficacy of TCM ointment combined with tuina therapy in the treatment of pain and swelling after TKA.METHODS The randomized controlled clinical trial enrolled 80 patients who underwent TKA via the same procedure.The patients were randomly divided among the treatment group(n=40)and the control group(n=40).The control group was given an analgesia pump in addition to oral painkillers as the postoperative intervention.The treatment group received TCM ointment with tuina therapy in addition to the analgesia pump and oral painkillers in the postoperative period.The following variables were recorded 3 d before surgery and 3 d,7 d and 14 d after surgery:Visual analogue scale(VAS)score;skin temperature;circumferences at 15 cm above and below the patella;maximum active knee flexion angle;and the knee injury and Osteoarthritis Outcome score(KOOS).RESULTS After treatment,VAS was significantly lower in the treatment group than the control group at 7 d(t=7.536,P<0.001)and 14 d(t=8.563,P<0.001).The skin temperature of participants in the treatment group was significantly lower than that in the control group at 7 d(t=2.968,P=0.004)and 14 d(t=4.423,P<0.001).The circumference values of the two positions in the treatment group were lower than those in the control group at 7 d[t=2.315,P=0.023(above);t=2.121,P=0.037(below)]and 14 d[t=2.374,P=0.020(above);t=2.095,P=0.039(below)].After 14 d of treatment,the maximum active knee flexion angle and KOOS of the two groups were significantly improved but were significantly higher in the treatment group(P<0.05 for both).CONCLUSION TCM ointment and tuina therapy have significant advantages over standard care in the treatment of pain and swelling after TKA.This additional treatment may improve knee function but additional studies are needed to confirm our observations.

Therapeutic effect of neurogrowth factor in the treatment of gingival pain and swelling in patients with dental pulp necrosis after root canal therapy

Objective: To explore the clinical efficacy of neurogrowth factor in the treatment of gingival pain and swelling in patients with dental pulp necrosis after root canal therapy and the effect on the serum inflammatory cytokines. Methods: A total of 156 patients with gingival pain and swelling after root canal therapy due to dental pulp necrosis were included in the study and randomized into the control group (n=78) and teh treatment group (n=78). The patients in the control group were given metronidazole tablets. On the above basis, the patients in the treatment group were given local injection of neurogrowth factors. 10-day treatment was regarded as one course, and the patients were continuously treated for 2 courses. The improvement of clinical symptoms before and after treatment in the two groups was evaluated. Gingival sulcus index and serum inflammatory cytokines before and after treatment in the two groups were detected and compared. Results: When compared with before treatment, the periodontal soft tissue swelling, tooth mobility, and periapical pain scores after treatment in the two groups were significantly reduced, and those in the treatment group were significantly lower than those in the control group. When compared with before treatment, the gingival sulcus bleeding index 1 and 2 courses after treatment in the two groups was significantly reduced, and that 2 courses after treatment was significantly lower than that after 1 course treatment. The gingival sulcus bleeding index 1 and 2 courses after treatment in the treatment group was significantly lower than that in the control group. When compared with before treatment, the serum IL-8 and IL-6 levels after treatment in the two groups, and TNF-α level after treatment in the treatment group were significantly reduced, and the above indicators in the treatment group were significantly lower than those in the control group. Conclusions: The neurogrowth factors in the treatment of gingival pain and swelling in patients with dental pulp necrosis after root canal therapy can effectively improve the clinical symptoms, and inhibit the inflammatory reaction, with a significant efficacy.

Painful sesamoid of the great toe

The painful sesamoid can be a chronic and disabling problem and isolating the cause can be far from straightforward. There are a number of forefoot pathologies that can present similarly to sesmoid pathologies and likewise identifying the particular cause of sesamoid pain can be challenging. Modern imaging techniques can be helpful. This article reviews the anatomy,development and morphological variability present in the sesamoids of the great toe. We review evidence on approach to history, diagnosis and investigation of sesamoid pain. Differential diagnoses and management strategies, including conservative and operative are outlined. Our recommendations are that early consideration of magnetic resonance imaging and discussion with a specialist musculoskeletal radiologist may help to identify a cause of pain accurately and quickly. Conservative measures should be first line in most cases.Where fracture and avascular necrosis can be ruled out,injection under fluoroscopic guidance may help to avoid operative intervention.

大黄芒硝散肘部外敷治疗儿童GartlandⅡ型肱骨髁上骨折术后肿痛的疗效观察

目的:观察大黄芒硝散肘部外敷辅助治疗儿童GartlandⅡ型肱骨髁上骨折术后肿痛的临床疗效。方法:选择芜湖市中医医院采用闭合复位克氏针内固定治疗GartlandⅡ型肱骨髁上骨折51例患儿作为研究对象,随机分为观察组(30例)与对照组(21例),对照组进行常规治疗,观察组在常规治疗的基础上加用大黄芒硝散肘部外敷,观察2组术前、术后3d、术后6d疼痛评分、肘关节肿胀度及住院天数、术后是否发生并发症。结果:观察组术后3d、6d疼痛评分、肘关节肿胀度及住院天数均显著低于对照组,差异有统计学意义;对照组发现2例术后患肘出现张力性水泡,观察组未发生张力性水泡。结论:对GartlandⅡ型肱骨髁上骨折的患儿术后采用大黄芒硝散外敷可显著减轻肿痛症状,减少并发症,缩短住院时间,值得临床推广应用。

Multi‑Functional Fibrous Dressings for Burn Injury Treatment with Pain and Swelling Relief and Scarless Wound Healing

As one of the most common forms of skin injuries,skin burns are often accompanied by edema pain,suppuration of infection,slow tissue regeneration,and severe scar formation,which significantly delay wound healing as well as affect the quality of life.We prepared multifunctional electrospun poly(L-lactide-co-glycolide)/gelatin(P/G)-based dressings to synergistically harness the therapeutic benefits of peppermint essential oil(T),burn ointment(B),and Oregano essential oil(O)(P/G@TBO)for skin regeneration in punch and burn injury models.The P/G@TBO can afford the sustained release of bioactive cues for up to 72 h as well as remarkably promote cell migration(ca.P/G@TBO,89%vs.control group,51%)at 24 h.The P/G@TBO membranes also showed significant angiogenic effect as well as antibacterial and anti-inflammatory properties than that of the control group in vitro.Moreover,P/G@TBO dressings enabled fast wound healing(ca.P/G@TBO,100%wound closure vs.control group,95%)in a full-thickness excisional defect model up to 14 days in rats.Further evaluation of membranes in different animal models,including tail wagging model,facial itch model,and hot burn injury model showed significant pain relieve effect as well as itching and swelling relief functions during earlier stages of wound healing.Membranes were next transplanted into a scalded wound model in rats and an ear punch wound model in rabbits,which manifested antibacterial and anti-inflammatory properties and promoted re-epithelialization to achieve scarless wound healing percentage wound closure at day 28:P/G@TBO,96%vs.control group 66%.Taken together our approach of simultaneously harnessing T,B,and O to enable multifunctionality to fibrous dressings may hold great promise for burn wound healing applications and other related disciplines.

Ultrasonic piezotome surgery: is it a benefit for our patients and does it extend surgery time? A retrospective comparative study on the removal of 100 impacted mandibular 3rd molars

Aim of the study was to evaluate if there is a constant and significant reduction in traumaticity when mas- sively traumatic oral surgical procedures such as the removal of third molars are conducted with only ul- trasonic surgical devices (Piezotomes) expressed in a reduction of postsurgical pain and swelling on the patient’s side since such clinical experiences by the authors suggested this. Since oral surgeons criticize a higher time consumption for surgeries with Piezoto- mes also the objective time consumption was evalu- ated and compared to the traditional methods. Mate- rial and Methods: 56 female and male patients were selected that already underwent a removal of an im- pacted third mandibular molar on one side with rota- ry instruments by bone destructive burring with a still persisting comparable third mandibular molar on the contralateral side complaining about recur- rent pain episodes and were already documented for pain and swelling before. The ultrasonic surgical re- moval with the Piezotome was conducted with a buc- cal osteotomy of the compacta lateral to the impacted third molar, preservation of the resected compacta in saline solution, removal of the third molar by single or multiple dentotomy and full anatomical restitution of the surgical site with the preserved buccal com- pacta. The swelling was documented by kephalome- try 24/48/72 hours and 1 week post surgery, the pain index by the total consumption of ibuprofen-400 mg—tablets. Lesions of the mandible nerve were documented. Netto surgery time was taken from the first incision to the last suture of the procedure. Re-sults: 6 patients had to be excluded from evaluation due to incomplete post surgical follow up. A signify-cant (***, p > 0.999) decrease in pain and swelling of 50% was detected both for the parameters swelling and pain with Piezotome-surgery. No lesions of the mandible nerve were detected with Piezotome sur- gery whereas surgery with rotary instruments re- sulted in 16% hypesthesia at least up to one week. Although netto surgery time was approximately 50% longer when done with the Piezotome at the begin-ning the time consumption normalized with the growing experience of the surgeons back to the time schedule when surgery was performed with rotary instruments revealing no significant differences (-, p < 0.73). Conclusions: The results of this retrospective study suggest that Piezotome-surgery is superior in atraumaticity and soft-tissue safety compared to tra- ditional procedures with burs and grants the patients significantly less post surgical pain and swelling. Al- though—as it is with all new surgical tools and pro- tocols—surgery time is longer at the beginning when purely working with ultrasonic surgical devices time consumption reduces to normal values after a learn- ing curve.

化瘀消肿止痛汤治疗SeinsheimerⅢ~Ⅴ型股骨粗隆下骨折临床研究

目的:观察化瘀消肿止痛汤治疗SeinsheimerⅢ~Ⅴ型股骨粗隆下骨折的临床疗效。方法:将70例SeinsheimerⅢ~Ⅴ型股骨粗隆下骨折患者按照随机数字表法分为观察组和对照组,每组各35例。两组患者均接受小切口环扎钢丝联合长股骨近端髓内钉内固定术治疗,对照组术后给予常规对症治疗,观察组在对照组治疗的基础上加服化瘀消肿止痛汤。比较两组患者骨折愈合情况、血液流变学指标[红细胞压积(hematocrit, Ht)、血沉(erythrocyte sedimentation rate, ESR)、血浆比黏度和全血比黏度]、骨代谢指标[骨钙素(bone-γ-carboxyglutamic acid-containing protein, BGP)、全段甲状旁腺素(intact parathyroid hormone, iPTH)、骨碱性磷酸酶(bone alkalinephos phatase, BLAP)、Ⅰ型胶原羧基端前肽(typeⅠcollagen carboxy-terminal propeptide, CICP)]及炎症因子水平[白细胞介素-6(interleukin-6,IL-6)、白细胞介素-10(interleukin-10,IL-10)及肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)]变化情况。结果:观察组骨折愈合时间短于对照组,差异有统计学意义(P<0.05)。观察组Harris评分均低于对照组,差异有统计学意义(P<0.05)。术后3个月两组Ht、ESR、血浆比黏度和全血比黏度水平低于术后1 d,且术后3个月组间比较,差异具有统计学意义(P<0.05)。术后3个月两组BGP、BLAP水平高于术后1 d, iPTH、CICP水平低于术后1 d,且术后3个月组间比较,差异具有统计学意义(P<0.05)。术后7 d两组IL-6、IL-10及TNF-α水平低于术后1 d,且术后7 d组间比较,差异具有统计学意义(P<0.05)。结论:化瘀消肿止痛汤可改善SeinsheimerⅢ~Ⅴ型股骨粗隆下骨折患者术后血液流变学指标及炎症因子水平,促进骨代谢,缩短骨折愈合时间。

新癀片治疗甲状腺结节微波消融术后颈部肿胀疼痛的效果

目的探讨新癀片治疗甲状腺结节微波消融术(microwave ablation,MWA)后颈部肿胀疼痛的疗效。方法将150例甲状腺结节行MWA后颈部肿胀疼痛患者随机分为治疗组、安慰剂组和对照组,每组50例。治疗组于术后立即口服新癀片,3片,tid,口服3 d;安慰剂组于术后立即口服安慰剂(淀粉药丸),3片,tid,口服3 d;对照组术后未口服药物。比较3组患者术后颈部肿胀、颈部疼痛情况。结果治疗组术后12、24、48、72 h颈部疼痛评分较对照组及安慰剂组显著减少,差异均有统计学意义(P<0.01);治疗组术后48、72 h颈部肿胀发生率较对照组及安慰剂组显著减少,差异均有统计学意义(P<0.01);治疗组术后72 h颈部疼痛、肿胀持续时间较对照组及安慰剂组显著缩短,差异均有统计学意义(P<0.01)。结论新癀片能够明显改善甲状腺结节MWA术后颈部肿胀程度,缓解颈部疼痛,从而改善患者术后不适感,是治疗甲状腺结节MWA术后颈部肿胀疼痛的理想药物。

参芪知甘汤联合中药熏洗对肱骨髁间骨折患者术后患肢肿胀、疼痛及并发症的影响

目的:分析参芪知甘汤联合中药熏洗对肱骨髁间骨折患者术后患肢肿胀、疼痛及并发症的影响。方法:选取2019年7月-2021年7月在我院行复位内固定术,且术后辨证分型为气滞血瘀型的肱骨髁间骨折患者176例,按照随机数字表法分为对照组与中药组各88例,对照组术后给予常规抗炎镇痛治疗,中药组给予参芪知甘汤联合中药熏洗治疗。比较两组中医证候积分、视觉模拟评分法(VAS)评分、患肢周径、术后恢复状况、凝血功能及术后并发症发生率。结果:中药组中医症候积分低于对照组,差异有统计学意义(P <0.05),干预后3 d、5 d及7 d,中药组VAS评分及患肢最大周径均小于对照组,差异有统计学意义(P <0.05);中药组患肢消肿及止痛时间均短于对照组,差异有统计学意义(P <0.05);中药组凝血酶原时间、凝血酶时间及活化部分凝血酶时间均高于对照组,纤维蛋白原值均低于对照组,差异有统计学意义(P <0.05);中药组总并发症发生率小于对照组(5.68%vs 17.05%),差异有统计学意义(P <0.05)。结论:参芪知甘汤联合中药熏洗可缓解肱骨髁间骨折术后患肢肿胀与疼痛,改善凝血功能,减少深静脉血栓(DVT)与并发症的发生。

雷火灸联合护理干预促进膝关节周围骨折术后功能恢复效果观察

目的观察雷火灸联合护理干预促进膝关节周围骨折术后关节功能恢复的效果。方法采用随机数字表法将50例患者分为对照组和观察组。对照组给予常规治疗和护理,观察组在对照组基础上增加雷火灸治疗。比较两组干预效果。结果随访共得到48例患者完整结果,对照组及观察组各24例。治疗3 d、7 d后,观察组患者患侧上、下周径均小于对照组,差异有统计学意义(P<0.05)。治疗3 d、7 d后,观察组患者患侧VAS评分低于对照组,差异有统计学意义(P<0.05)。治疗1周、3周、5周后,观察组患者患侧膝HSS评分均较治疗前提高(P<0.05);治疗3周、5周后,观察组患者患侧膝HSS评分高于对照组(P<0.05)。治疗7 d后,观察组患者患侧膝关节活动度大于对照组,差异有统计学意义(P<0.05)。结论膝关节周围骨折术后护理配合实施雷火灸治疗,能有效减轻患肢肿胀、疼痛,促进康复,改善膝关节活动度及功能,有利于提高临床治疗效果。

中医药治疗全膝关节置换术后肿痛的研究进展

随着全膝关节置换手术技术的发展,关节置换已成为终末期膝骨性关节炎的主要治疗手段。术后患肢肿胀疼痛仍是目前临床常见的并发症之一,常规的治疗方法无法有效缓解术后关节肿胀疼痛,并伴有不同程度的不良反应。中医药对全膝关节置换术后肿痛的治疗方法众多,同时具有其独特的特色及优势。已有研究发现中医药治疗全膝关节置换术患肢肿胀疼痛有着确切的临床疗效、安全性高、副作用少,并且治疗费用较低。通过查阅相关文献资料,对这些治疗方法加以综述,以期为全膝关节置换术后康复方案提供新的治疗思路及方法。

手法按摩配合生物刺激反馈仪治疗产后乳汁淤积的效果分析

目的探究手法按摩配合生物刺激反馈仪治疗产后乳汁淤积的效果。方法选取2019年12月—2023年12月苏州市吴中人民医院收治的400例产后乳汁淤积患者为研究对象,根据不同的治疗方法分为对照组和观察组,各200例,对照组实施生物刺激反馈仪治疗,观察组在对照组基础上开展手法按摩治疗,对比两组治疗总有效率、乳房胀痛程度和乳汁淤积情况。结果观察组治疗总有效率为98.00%(196/200),高于对照组的77.50%(155/200),差异有统计学意义(χ^(2)=39.095,P<0.05)。观察组乳房胀痛程度中度、重度人数少于对照组,差异有统计学意义(P<0.05)。观察组乳汁淤积情况轻于对照组,差异有统计学意义(P<0.05)。结论产后乳汁淤积患者采用手法按摩配合生物刺激反馈仪治疗,能明显改善产妇乳汁淤积情况,促进乳汁排出,减轻胀痛程度。

黏膜下注射地塞米松对种植骨增量术后镇痛及消肿的疗效观察及因素分析

目的研究黏膜下注射地塞米松对种植骨增量术后镇痛及消肿的疗效,并分析种植骨增量术后疼痛和肿胀的相关因素。方法收集2023年1月至2023年12月于南京医科大学附属口腔医院特诊科就诊的牙列缺损需实施骨增量(GBR或上颌窦内提升)的患者,测量并记录术后72 h内的疼痛和肿胀情况,以及可能的影响因素,包括性别、年龄、种植数量、手术时长、口腔卫生状况、FAC术前紧张程度及PSQ疼痛敏感性值,对两组不同时间的疼痛程度和肿胀程度进行差异比较,并对可能的影响因素进行皮尔森相关性及多元线性回归分析。结果给予地塞米松干预的患者疼痛程度在12 h起显著低于对照组,而肿胀评分在48 h开始显著低于对照组。相关性分析及回归分析显示,GBR术式对术后疼痛和肿胀有显著影响(r=0.348,P=0.030/r=0.441,P=0.005),其疼痛程度的线性回归模型同样具有统计学意义(R^(2)=0.126,P=0.030)。结论黏膜下注射地塞米松能够显著缓解种植骨增量术后患者的疼痛及肿胀不适,提高诊疗舒适度。

新癀片联合复方桐叶烧伤油治疗急性痛风性关节炎患者的疗效分析

目的观察新癀片联合复方桐叶烧伤油治疗急性痛风性关节炎的疗效。方法采用前瞻性干预性研究。选取2022年1月至12月在南昌大学第一附属医院接受治疗的96例急性痛风性关节炎患者作为研究对象,采用随机数字表法将其分为3组,每组32例。A组男28例、女4例,年龄(53.37±16.53)岁,急性病程(2.56±0.92)d,在常规治疗基础上加用新癀片外敷;B组男30例、女2例,年龄(54.18±17.42)岁,急性病程(2.53±0.89)d,在常规治疗基础上加用复方桐叶烧伤油;C组男29例、女3例,年龄(53.61±17.21)岁,急性病程(2.61±0.93)d,在常规治疗基础上采用新癀片+复方桐叶烧伤油外敷,干预周期均为1周。对比3组患者一般资料(年龄、性别、体质指数、饮酒、吸烟及急性病程)、治疗前及治疗后1、3、5、7 d视觉模拟评分法(VAS)评分、治疗前及治疗后1、3、5、7 d骨关节炎指数(WOMAC)、中医证候疗效。统计学方法采用t检验、χ^(2)检验。结果3组急性痛风性关节炎患者一般资料比较,差异均无统计学意义(均P>0.05)。治疗前及治疗后1 d,3组患者VAS评分比较,差异均无统计学意义(均P>0.05);治疗后3、5、7 d,3组患者VAS评分比较,差异均有统计学意义(均P<0.05);C组治疗后3、5、7 d的VAS评分[(4.84±1.30)分、(2.97±1.31)分、(1.81±1.15)分]均低于A组[(5.63±1.26)分、(4.34±1.33)分、(2.97±1.28)分]、B组[(6.38±1.21)分、(5.38±1.21)分、(5.38±1.21)分],差异均有统计学意义(均P<0.05)。治疗前及治疗后1 d,3组患者WOMAC评分比较,差异均无统计学意义(均P>0.05);治疗后3、5、7 d,3组患者WOMAC评分比较,差异均有统计学意义(均P<0.05);C组治疗后3、5、7 d的WOMAC评分[(113.50±28.78)分、(82.66±31.82)分、(50.19±34.90)分]均低于A组[(128.09±25.59)分、(110.31±28.29)分、(87.84±33.19)分]、B组[(154.19±20.59)分、(148.19±20.59)分、(137.28±20.62)分],差异均有统计学意义(均P<0.05)。C组总有效率为96.9%(27/32),高于A组[78.1%(25/32)]、B组[53.1%(17/32)],差异有统计学意义(χ^(2)=49.937,P<0.001)。结论新癀片联合复方桐叶烧伤油治疗急性痛风性关节炎疗效较好,能缩短病程,减轻患者痛苦,同时可降低临床护理人员更换敷料频率。

犀角地黄汤治疗五步蛇咬伤的临床效果

目的探讨犀角地黄汤治疗五步蛇咬伤的临床效果。方法选择2020年1月至2023年6月在我院治疗的五步蛇咬伤患者86例作为研究对象。采用随机数字表法将所有患者分为对照组和观察组,每组43例。对照组给予基础治疗及抗蛇毒血清治疗,观察组在对照组治疗基础上给予犀角地黄汤治疗。观察比较两组患者的临床疗效、纤维蛋白原(FIB)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、白细胞(WBC)计数、肿瘤坏死因子-a(TNF-a)、高敏C-反应蛋白(hs-CRP)、患肢与健肢周径差、患肢疼痛程度评分及肿胀缓解时间。结果观察组的治疗总有效率明显高于对照组,差异有统计学意义(P<0.05)。两组患者治疗前的FIB、TT、APTT、PT、WBC、TNF-a、hs-CRP、患肢与健肢周径差及患肢疼痛程度评分比较,差异均无统计学意义(均P>0.05)。观察组治疗后的FIB高于对照组,TT、APTT、PT均低于对照组,差异均有统计学意义(均P<0.05)。观察组治疗后的WBC、TNF-a、hs-CRP、患肢与健肢周径差、患肢疼痛程度评分均低于对照组,差异均有统计学意义(均P<0.05)。结论犀角地黄汤治疗五步蛇咬伤可有效缓解患肢肿胀、疼痛程度,减轻炎症反应,改善凝血功能指标,值得临床应用。

早期功能锻炼治疗桡骨远端骨折手法复位后动态小夹板固定患者的临床疗效

目的:探讨早期功能锻炼对桡骨远端骨折手法复位后动态小夹板固定患者肢体肿胀、疼痛及功能恢复的影响。方法:选取2022年3月—2023年3月四川省骨科医院收治的94例桡骨远端骨折患者,根据随机数字表法分为试验组和对照组,各47例。对照组行手法复位、动态小夹板固定治疗及常规康复训练,试验组在对照组基础上予以早期功能锻炼。比较两组患者治疗前后肿胀值、疼痛度、腕关节功能、炎症因子水平、临床疗效及骨痂愈合情况。结果:治疗后,两组患者肿胀值、视觉模拟量表疼痛评分均低于治疗前,且试验组明显低于对照组(P<0.05)。两组患者Cooney腕关节评分组间、时间及交互比较,差异均有统计学意义(P<0.05);两组患者治疗后不同时点Cooney腕关节评分均高于治疗前,且试验组显著高于对照组,差异均有统计学意义(P<0.05)。两组患者治疗后C反应蛋白、白细胞介素-6水平均低于治疗前,且试验组明显低于对照组(P<0.05)。试验组总有效率为93.62%,对照组为76.60%,试验组显著优于对照组(P<0.05)。试验组Lane-Sandhu X线片评分大于对照组(P<0.05)。结论:桡骨远端骨折手法复位后动态小夹板固定患者行早期功能锻炼,可有效缓解患肢肿胀及疼痛,减轻炎症反应,促进腕关节功能恢复及骨痂愈合。

全膝关节置换术患者肢体肿胀管理方案的构建及实施

目的 加强全膝关节置换术患者肢体肿胀管理,以促进膝关节功能康复。方法 将76例全膝关节置换术患者按照入院时间分为对照组与试验组,每组37例。对照组实施全膝关节置换术常规护理措施。试验组实施全膝关节置换术肢体肿胀管理方案,包括术前训练、加强止血带时间管理、冷疗管理、徒手淋巴引流管理、肌内效贴管理、康复运动管理等。比较两组患肢肿胀值及消肿率、膝关节功能、疼痛程度、首次下床活时间及住院时间。结果 试验组36例、对照组37例完成研究。术后第5、7天试验组患肢肿胀值显著低于对照组,两组比较,组间效应、时间效应差异有统计学意义(均P<0.05);试验组术后第7天消肿率、膝关节功能评分及疼痛评分显著优于对照组,首次下床活动时间、住院时间显著短于对照组(均P<0.05)。结论 全膝关节置换术肢体肿胀管理方案的实施能有效缓解全膝关节置换术后患者肢体肿胀及疼痛程度,加速膝关节功能恢复,促进患者术后康复。

消肿健步汤治疗全膝关节置换术后肿痛的临床观察

目的观察消肿健步汤治疗全膝关节置换术(THA)后肿痛的临床效果并探讨其作用机制。方法80例患者采用随机数字表法分为对照组和试验组。对照组40例,1例自行换药治疗而脱落,最终纳入39例,术后给予患者常规西医治疗;试验组40例,无脱落情况,在对照组治疗基础上给予自拟消肿健步汤治疗。术前及术后3、5、7、10 d测量两组患者的患肢周径、切口周缘皮温、膝关节活动度,通过疼痛视觉模拟量表(VAS)评分评价患肢疼痛情况,并检测C反应蛋白(CRP)、D-二聚体(D-D)水平。结果两组术前患肢周径、切口周缘皮温、VAS评分、膝关节活动度、CRP和D-D水平比较差别均不大(均P>0.05)。两组术后3、5、7、10 d的髌骨上缘上及髌骨下缘下10 cm的周径、VAS评分、膝关节活动度、CRP和D-D水平,随时间均逐步改善(均P<0.05)。试验组术后3、5、7、10 d的髌骨上缘上及髌骨下缘下10 cm的周径,VAS评分、膝关节活动度、CRP和D-D水平均优于对照组(均P<0.05)。两组切口周缘皮温术后各时间点比较差别均不大(均P>0.05),两组治疗期间均无明显不良反应发生。结论消肿健步汤治疗THA后肿痛患者,可抑制机体炎症,减轻水肿,缓解疼痛,改善血液高凝状态。

术中放置引流对全膝关节置换术后疗效的影响

目的:探究全膝关节置换术(total knee arthroplasty,TKA)术中放置关节腔引流对术后失血以及关节功能恢复的影响。方法:回顾性分析2021年9月-2022年10月在南京医科大学第一附属医院行TKA治疗的终末期膝关节骨性关节炎患者,根据术中是否放置引流分为引流组与非引流组。对比两组患者术后失血情况、膝关节功能恢复指标、术后并发症及随访结果。结果:共纳入患者147例,非引流组53例,引流组94例。与非引流组比较,引流组隐性失血(hidden blood loss,HBL)少[(906.94±438.41)mL vs.(1262.85±563.46)mL,P<0.001],但输血率、总失血量差异无统计学意义(P>0.05)。非引流组术后1 d,3 d,5 d下肢肿胀程度均高于引流组,其中术后3 d分别为[(9.31±4.47)%vs.(7.74±3.75)%],差异有统计学意义(P=0.025)。引流组较非引流组术后主动膝关节活动度明显增加(P<0.001),术后3 d疼痛程度明显增高(P=0.029),术后瘀斑发生率降低(52.13%vs.79.25%,P=0.001),但术后深静脉血栓形成(deep venous thrombosis,DVT)发生率差异无统计学意义(P=0.552)。两组患者术后切口均Ⅰ期甲等愈合,未出现红肿、渗出及脂肪液化等感染情况。引流组引流管未发现引流不畅、持续出血不愈合、引流管脱出甚至断裂等情况。两组患者随访期内均无感染病例,术后1个月、3个月膝关节功能恢复情况与疼痛程度差异均无统计学意义(P>0.05)。结论:TKA术中放置引流可减少HBL,减轻患者术后早期疼痛及肿胀程度。