手法复位联合石膏固定治疗桡骨下端骨折的临床疗效观察

[目的]探讨手法复位联合石膏固定治疗桡骨下端骨折的临床疗效。[方法]选择某院2008年6月～2010年6月期间诊治的桡骨下端骨折患者88例,随机将患者分为研究组和对照组,每组44例。两组患者经相关检查和明确诊断后均行手法复位治疗,而研究组患者则在此基础上换用石膏固定治疗,并对两组患者的临床治疗效果等相关评价指标进行比较分析。[结果]与对照组患者相比,研究组患者临床治疗效果处于优的比率和总有效率均显著提高,分别高达79.55%和97.73%,而处于差的比率则显著降低,仅为2.27%,差异均具有统计学意义(P﹤0.05);与此同时,研究组患者的疼痛消失所需时间和肿胀消退所需时间以及骨折临床愈合所需时间均明显减少,差异均具有统计学意义(P﹤0.05)。[结论]手法复位与石膏固定联合治疗桡骨下端骨折,其疗效确切,效果显著,对于桡骨下端骨折具有十分重要的临床治疗价值,是桡骨下端骨折患者较为理想的综合治疗方法。     

Assessment of functional treatment versus plaster of Paris in the treatment of grade 1 and 2 lateral ankle sprains

Background

Despite the common occurrence of ankle sprains, no treatment is considered to be the gold standard for the management of such sprains. We assessed functional treatment versus plaster of Paris (POP) for the treatment of lateral ankle sprains, with pain and function employed as the outcome measures.

Materials and methods

126 Patients were eligible for inclusion. They were assigned to either the functional treatment Tubigrip (TG) group or the POP group after applying block randomization. Characteristics such as age, dominant ankle, and gender were assessed at baseline. Pain and functional assessments were done using the visual analog scale (VAS) and the Karlsson score (KS) at baseline (at the start of the study) and during the 2nd and 6th weeks, respectively. Data on other subjective parameters, such as the number of painkillers used, the number of days taken off work, and the number of sleepless nights, were requested from the patients at the end of the study. SPSS version 16 was used for analysis, and p < 0.05 was taken to indicate significance.

Results

60 Patients completed the trial in each group. The mean ages were 28.77 ± 6.72 in the TG group and 29.83 ± 6.30 in the POP group (p = 0.034). There was a slight female predominance. Right and left ankles were equally involved in the TG group, while left ankles were mainly involved in the POP group. Mean differences in VAS and KS between the two groups were statistically significant at the end of the study. The mean number of painkillers used by the patients in the TG group was higher than the number used in the POP group (p < 0.001). The mean number of days taken off work was 4.18 ± 1.73 days in the TG group, and 6.25 ± 2.73 days in the POP group (p < 0.001). The mean number of sleepless nights was higher in the POP group.

Conclusion

The results of our study indicate that functional treatment provides better functional support and pain reduction than a below-knee POP cast.

Level of evidence

Level I.     

3种方法治疗桡骨远端骨折的疗效比较

目的回顾性分析3种方法治疗桡骨远端骨折的疗效。方法回顾性分析自2010-05—2013-05诊治的桡骨远端骨折72例,其中21例采用手法复位石膏固定(石膏组),23例采用C型臂X线机透视下闭合复位外固定架固定(支架组),28例采用掌侧入路切开复位T-LCP内固定(内固定组)。结果支架组在放射学评分上优于石膏固定组,疗效评定与石膏固定组差异无统计学意义(P=0.007),内固定组在疗效及放射学评分方面均优于支架组及石膏组(χ2=10.023 4,P=0.040)。结论采用Henry入路T-LCP内固定治疗桡骨远端骨折能较好地恢复关节面平整、掌倾角及尺偏角,并发症少,较手法复位石膏固定及外固定架固定有明显的优势。     

活血止痛膏对兔骨骼肌急性钝挫伤后组织观察及IGFmRNA表达的影响

目的：通过光镜组织学观察评分、电镜超微机构观察和应用逆转录聚合酶链式反应（RT—PCR）技术对内源性胰岛素样生长因子（IGF—I、IGF一Ⅱ）mRNA的测定来探讨活血止痛膏剂对骨骼肌钝挫伤修复的作用及其可能机制。方法：将63只兔子随机分为活血止痛膏高剂量组、中剂量组、低剂量组、青鹏膏对照组、外伤对照组,每组12只,另取3只做正常对照组。采用“重物自由落体打击法”制作大白兔骨骼肌急性钝挫伤模型。分别在3天、6天、10天、13天处死大白兔,每组每个时间点处死3只兔子,每只兔子在两条后腿腓肠肌取标本,共计6个标本。结果：（1）光镜组织学观察评分：各个时间点与外伤对照组比较,青鹏膏剂组、活血止痛膏高、中剂量组（P〈0．05）;青鹏膏和活血止痛膏高剂量组优于活血止痛膏中剂量组（P〈0．05）。（2）电镜超微结构观察结果：青鹏膏组、活血止痛膏高、中剂量组较低剂量组和外伤组在3、6天可以更早更多看见激活的肌卫星细胞,在10天和13天青鹏膏组、活血止痛膏高、中剂量组肌组织趋于正常,活血止痛膏低剂量组和外伤组有瘢痕形成。（3）RT—PCR技术检测内源性胰岛素样生长因子（IGF—I、IGF一Ⅱ）mRNA的表达量：各个时间点内与外伤对照组比较,活血止痛膏高、中剂量组（P〈0．05）;活血止痛膏高剂量组优于活血止痛膏中剂量组（P〈0．05）。伤后各组IGF—I、IGF一ⅡmRNA含量在3、6、10、13天升高,其中第6天达高峰值。结论：（1）活血止痛膏可有效的改善兔骨骼肌钝挫伤后的组织学愈合过程和愈合质量。（2）活血止痛膏能促进骨骼肌钝挫伤后卫星细胞的激活,进一步促进新肌生成。（3）内源性IGF—I,IGF—II的mRNA随着兔骨骼肌钝挫伤不同修复时期,表达量也相应变化。（4）活血止痛膏对兔骨骼肌钝挫伤后的内源性IGF—I,IGF—II的mRNA表达量上调有明显的促进作用,从而有利于骨骼肌挫伤后愈合;并且该表达量与活血止痛膏有效浓度呈正相关。     

玄黄活络膏加电磁波治疗急性软组织运动损伤45例

目的观察玄黄活络膏加电磁波治疗急性软组织运动损伤的临床疗效。方法将90例患者随机分为治疗组45例、对照组45例,分别选用外用玄黄活络膏加电磁波和红花油治疗,疗程7d。结果治疗组显效32例,有效12例,无效1例,总有效率为97．78％;对照组显效21例,有效19例,无效5例,总有效率为88．89％,治疗组明显优于对照组（P〈0．05）.结论玄黄活络膏加电磁波能明显促进急性软组织运动损伤的瘀血吸收,改善局部循环情况,改善临床症状。     

高效液相色谱法测定癌痛宁巴布剂中乌头碱的含量

目的建立癌痛宁巴布剂中乌头碱的含量测定方法。方法高效液相色谱（HPLC）法,采用Kromasil C18柱（4．6mm×250mm）,流动相为甲醇-0．2％三乙胺（66：34）,测定波长为230nm,流速为1．0mL／min,柱温为30℃。结果乌头碱在0．126-0．630μg的范围内的范围内线性关系良好,r=0．9999,平均回收率为97．47％,RSD为1．2％。结论方法简便可行,重现性好．可用于癌痛宁巴布剂的质量控制。     

正交试验优选暖脐膏醇提工艺

目的优选暖脐膏处方最佳的提取工艺。方法采用L9（34）正交试验,以复方中主要药材当归中阿魏酸的含量为考察指标,以乙醇的浓度、用量、提取时间以及提取次数为考察因素,得出最佳的提取工艺。结果最终确定的最佳提取工艺为第1次加9倍量75%乙醇,回流提取90 min,第2次加6倍量75%乙醇,回流提取60 min。结论该工艺简单方便,稳定性好,可作为工业化生产的参考路线。     

奇正消痛贴治疗肘关节创伤性关节炎的临床观察

目的：观察奇正消痛贴治疗肘关节创伤性关节炎的临床疗效。方法：将80例肘关节创伤性关节炎患者随机分为试验组和对照组,每组各40例,分别给予奇正消痛贴和双氯芬酸二乙胺乳剂治疗．治疗前后分别对两组进行HSS评分。结果：试验组HSS评分由治疗前的平均（68．40±7．81）分提高到（81．48±11．08）分,平均提高了（13．08±4．14）分;对照组由（68．20±7．18）分提高到（77．70±9．55）分,平均提高了（9．50±4．21）分。两组治疗后HSS评分比较,差异有高度统计学意义（P〈0．01）。治疗组优良率（82．5％）高于对照组（45．0％）,两组疗效比较,差异有高度统计学意义（x^2=15．40,P〈0．01）。结论：奇正消痛贴能够有效地治疗肘关节创伤性关节炎,改善关节活动功能。     

益肺止喘膏穴位贴敷防治儿童哮喘复发的临床研究

目的观察应用益肺止喘膏穴位贴敷防治儿童哮喘复发的临床疗效。方法将180例哮喘患儿随机分为2组,治疗组120例予益肺止喘膏穴位贴敷,对照组60例予酮替芬口服,观察患儿治疗前后的症状、体征及发病次数的变化,同时测定免疫球蛋白、T细胞亚群、肺功能、肺阻抗血流图。结果治疗组总有效率为92．5％,显著优于对照组（73．33％）,P〈0．01;治疗组在改善症状、体征及实验室检查指标方面,亦显著优于对照组。结论益肺止喘膏穴位贴敷能增强患儿免疫力,提高肺功能,改善肺循环,对防治儿童哮喘复发有显著疗效。     

Strong and light plaster casts?

Three geometries of volar slab plaster cast for the stabilisation of wrist fractures were investigated. It was found that by moulding reinforcement ridges on the inferior surface of the slab the strength and stiffness could be doubled with only a 20% increase in weight. It was discovered that to provide the same increase in strength with a traditional cast the entire thickness of the cast would have to be doubled, with a 100% increase in weight that would be cumbersome to most users. Bending theory is presented in a simple manner to allow clinicians to understand how reinforcement mouldings can improve the strength and stiffness of plaster casts without adversely influencing weight, or cost.