论文标题:通督法内治结合AF手术治疗不稳定性屈曲型胸腰椎骨折的临床研究
Treatment of Unstable Flexing Type Thoracolumbar Vertebral Fracture with the Combination of Tongdu Method and AF Operation
论文作者 杨少锋
论文导师 姚共和,论文学位 硕士,论文专业 中医骨伤科学
论文单位 湖南中医学院,点击次数 205,论文页数 44页File Size3546k
2002-05-01论文网 http://www.lw23.com/lunwen_1065057/ 胸腰椎骨折;屈曲型;不稳定性;中西医结合;临床研究
Thoracolumbar vertebral fracture,Flexing type,Ustable,the combination of TCM and WM,The Research of Clinic
目的：屈曲型胸腰椎骨折是一种常见病、多发病，近年来我国呈上升趋势。1990年日本的统计数值就达到了38.3-58/百万/年；我国光煤炭系统2000年的调查就显示为69.42/百万/年，尤其是严重的并发症--脊髓损伤，因为迄今为止仍未找到理想的治疗方法，更是对社会和家庭的严重危害。本研究旨在探讨通督法内治结合AF手术治疗不稳定性屈曲型胸腰椎骨折的临床疗效，摸索中西医结合治疗本病的最佳治疗方案。 方法：按照严格的前瞻性临床治疗试验设计与评价的原则，将90例观察病例随机分配到治疗组和对照组1、2中，其中治疗组：通督法+AF手术治疗；对照组1：单纯AF手术治疗；对照组2：哈氏棒手术治疗。单盲对照，分别从临床症状体征改善情况、临床疗效情况、椎体高度恢复情况、脊柱后突角恢复情况、日常生活功能情况、脊髓损伤情况等方面评价临床疗效。 结果：1．通督法能有效改善临床症状。通督法+AF手术治疗组临床症状改善情况明显优于对照组1、2(P＜0.01)。2．通督法能有效改善日常生活功能，结果明显优于对照组。3．对脊髓损伤神经功能改善的初步研究发现：脊髓损伤病人术后应用通督法治疗，能有效改善脊髓神经功能，呈现优于对照组的趋势。4．AF手术创伤少、方法简便。AF手术切口小，椎旁肌肉剥离少，术中平均出血少于400ml；方法简便，缩短了手术时间。5.AF治疗能有效恢复椎体高度和纠正脊柱后突角。AF手术治疗的椎体高度恢复情况明显优于哈氏棒手术组(P＜0.01)，且恢复情况基本接近于正常椎体；脊柱后突角的恢复也较为满意，与哈氏棒治疗组形成明显差异。这是AF能在三维空间复位的作用。6．AF治疗能有效改善日常生活功能活动。远期疗效随访观察结果表明，AF手术治疗患者的日常生活功能优于哈氏棒手术治疗患者（P＜0刀1），这与AF良好的复位、短节段的固定、不需过多的植骨融合的作用有关。 结论：通督法内治结合M手术治疗不稳定性屈曲压缩型胸腰椎骨折的中西医结合疗法能有效改善临床症状体征，提高临床疗效，改善生活质量，是一值得提倡运用的临床治疗方法。
OBJECTIVErFlexsing type thoracolumbar vertebral fracture is a commone disease which increased in China in recent years. By the year 1990, the statistic number of patients of this disease in Japan came to 38.3-58 per million one year. As at 2000, the number obtained merely in coal system in China was 69.42 per million one year. This disease was harmful to the benefit of social and families especially with the spinal cord injury which was a severe complication of the vertebral fracture. Because there are still no ideal therapeutic methods of spinal cord injury. The objective of this study was to discuss the clinial effect of combination of Tongdu method and AF opration treating unstable flexing type thoracolumbar vertebral fracture of and try to find the best treating regime of this disease using with the combination of tradional Chinese medcine(TCM) and western medicine (WM) .METHODStAccording to strict prospective principle of projecting and evaluation of clinial treatment test, 90 patients were divited into the treatment group which using combination of Tongdu method and AF operation and the control group 1 and group2 which merely using AF opration in group 1 and Harlington operation in group2. The clinial effect was evaluated in improvement of clinial symptom , restoration of vertebral height , correction of kyphosis angle, condition of spinal cord injury and daily living ability.RESULTS: l.Tongdu method could improve the symptoms effectively. The improvement of the symptoms in the group with combination of Tongdu method and AF operation was more effective than that in the control group 1 and group 2(P<0.01). 2. The method of TongDu may effectively improve the daily living ablity of patients. 3.The tendency of treament with spinal cord using with TongDu method is: Tongdu method could improve neural function of spinal cord. 4.The trauma in AF operation was little and the procedure was simple. The operative incision was small. Few paravertebral muscles were stripped. The average bleeding amount in operation was less than 400 ml. The operative time was short because of simple procedure. 5.AF operation could effectively restore the vertebal height and correct kyphosis angle. The correction of kyphosis angle was satisfied. There were obvious different in AF group and Harlington group. This was owe to the ability of tridimensional replacement of AF operation. 6.AF operation may effectively improve the daily living ablity of patients. The results of following up suggested that the daily living ability of the patients in AF group was better than that in Harlington group(P<0.01). This may be related with well replacement, short segmental fixation and less bone planting fusion in AF operation.CONCLUSION: The combination of Tongdu method and AF operation treating flexing type thoracolumbar vertebal fracture could effectively improve the clinial symptom and the quality of life. It is a good therapeutic method being worth to be advocated using in clinic.
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