膏摩治疗踝关节扭伤后期患者疗效观察

目的 观察及对比以膏摩法和“消痛贴膏外敷加主动功能锻炼”两种治疗手段治疗踝关节扭伤后期患者的临床疗效及疼痛改善情况。方法 将93例患者采用随机对照的研究方法分为治疗组（膏摩疗法）和对照组（消痛贴膏外敷和主动功能锻炼）,观察并对比两组临床疗效,采用视觉模拟评分（visual analog scale,VAS）评价患踝疼痛程度。结果 两组临床疗效比较,差异具有统计学意义（P＜0.05）;治疗后两组VAS评分均较治疗前显著降低（P＜0.05）,治疗组治疗前后VAS差值显著大于对照组（P＜0.05）。结论 膏摩法和“消痛贴膏外敷加主动功能锻炼”对踝关节扭伤后疼痛均具有一定疗效,膏摩组疗效相对更优。     

栀黄止痛散治疗急性踝关节扭伤的疗效及对损伤韧带形态学的影响

目的  观察栀黄止痛散治疗急性踝关节扭伤的疗效及对损伤韧带形态学的影响。方法  将92例急性踝关节扭伤患者随机分为对照组与观察组各46例,对照组采用基础疗法联合双氯芬酸二乙胺软乳胶剂外敷,观察组采用基础疗法联合栀黄止痛散外敷,共治疗14 d。比较2组治疗前后视觉模拟评分表(VAS)疼痛评分及血清氧化应激因子水平、踝关节周径、踝关节跖屈、背伸活动度、损伤韧带厚度及踝关节功能的变化;观察2组疼痛、关节肿胀缓解时间和皮肤不良反应情况。结果  治疗后,2组VAS评分、距腓前韧带厚度与跟腓韧带厚度、踝关节周径明显下降(P < 0.05),踝关节跖屈及背伸活动度、踝与后足功能评价表评分明显改善(P < 0.05),超氧化物歧化酶(SOD)活性明显升高(P < 0.05),丙二醛(MDA)、成纤维细胞生长因子(FGF)-2、转化生长因子(TGF)-β1、基质金属蛋白酶(MMP)-9和白介素-1β(IL-1β)水平明显下降(P < 0.05),观察组优于对照组(P < 0.05)。观察组总有效率优于对照组(P < 0.05),观察组疼痛缓解时间及关节肿胀恢复时间均短于对照组(P < 0.05),2组皮肤不良反应发生率比较无统计学意义(P>0.05)。结论  栀黄止痛散治疗急性踝关节扭伤疗效优于双氯芬酸二乙胺软乳胶剂,提升抗氧化因子活性,抑制氧化应激反应,改善患侧韧带形态,促进踝关节功能恢复。      

EVALUATION OF EFFICACY AND SAFETY OF DIACEREIN IN KNEE OSTEOARTHRITIS IN CHINESE PATIENTS

OSTEOARTHRITIS ( OA) is a most commonchronic degenerative disease, its prevalence in-cidence increases with age·The disease is char-acterized by destruction of the articular cartilage and sub-chondral bone, which is one of the most common factorsleading …     

云南白药气雾剂联合复方七叶皂苷钠凝胶治疗急性踝关节扭伤

目的观察云南白药气雾剂联合复方七叶皂苷钠凝胶治疗急性踝关节扭伤的疗效。方法 83例急性踝关节扭伤患者随机分为三组:A组(云南白药气雾剂联合复方七叶皂苷钠凝胶治疗)29例,B组(云南白药气雾剂治疗)26例,C组(复方七叶皂苷钠凝胶治疗)28例,比较三组的疗效。结果 A、B、C三组的7 d显效率分别为55.17%、23.08%、25.0%,14 d的显效率分别为82.76%、46.15%、46.43%。三组7 d、14 d的显效率比较,差异均有统计学意义(P<0.05或P<0.01)。结论云南白药气雾剂联合复方七叶皂苷钠凝胶治疗急性踝关节扭伤疗效显著,优于单独治疗。     

理筋正骨手法联合易化牵伸术治疗陈旧性踝关节扭伤30例

目的 观察中医理筋正骨手法联合易化牵伸术治疗陈旧性踝关节扭伤的疗效。方法 采用随机对照的方法,将60例陈旧性踝关节扭伤患者随机分为治疗组和对照组,每组30例,治疗组采用理筋正骨手法联合易化牵伸术治疗,对照组采用电磁波治疗仪照射和针刺治疗,治疗2个疗程后分别比较患者Baird- Jackson踝关节功能评分、疼痛视觉模拟评分（visual analogue scale,VAS）以及压痛程度评分的差异。结果 治疗后2组患者VAS评分、压痛程度评分、Baird- Jackson踝关节功能评分较本组治疗前显著改善（P＜0.05）,且治疗组各评价指标改善程度显著大于对照组（P＜0.05）。结论 理筋正骨手法联合易化牵伸术可以改善陈旧性踝关节扭伤患者症状,提高临床疗效。     

七叶皂苷钠搽剂治疗急性踝关节扭伤局部肿胀的疗效分析

目的分析七叶皂苷钠搽剂治疗急性踝关节扭伤局部肿胀100例的临床疗效。方法采用随机、单盲、平行对照的方法分为两组,治疗组与对照组各50例,将七叶皂苷钠搽剂治疗组与正红花油对照组进行疗效对比。结果治疗组总有效率为96％,水肿消退的平均时间为5．5d,对照组为82％,水肿消退的平均时间为9．7d,治疗组明显优于对照组（P〈0．05）。结论七叶皂苷钠搽剂在治疗急性踝关节扭伤方面有较好的疗效。     

搜络逐瘀法治疗腰椎间盘突出症临床观察

目的:探讨搜络逐瘀法治疗腰椎间盘突出症的临床疗效。方法:120例腰椎间盘突出症患者,按随机数字表法分为对照组和观察组各60例,对照组采取双氯芬酸钠双释放肠溶胶囊及甲钴胺片治疗,观察组用肾痹汤治疗,服药3周,所有患者均经3个月随访,观察比较两组治疗前后疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分、临床疗效及不良反应发生率。结果:两组治疗后及末次随访时两组VAS及JOA评分均较治疗前显著改善(P<0.05),观察组在治疗后及末次随访时VAS及JOA评分均较对照组改善明显(P<0.05);治疗后观察组临床疗效与对照组比较差异无统计学意义(P>0.05),末次随访时观察组临床疗效明显优于对照组(P<0.05)。结论:搜络逐瘀法治疗腰椎间盘突出症能够缓解腰椎间盘突出引起的症状和体征。     

伤柏膏治疗急性踝关节外侧副韧带损伤患者疼痛的临床效果

目的 探讨伤柏膏在治疗急性踝关节外侧副韧带损伤患者疼痛的临床治疗效果.方法 选取我院单侧踝关节损伤患者50例随机分为治疗组和对照组,每组各25例,分别在入院治疗前及治疗第3,7,14天对患者进行疼痛度视觉模拟评分(VAS)和kofoed评分,同时测量患者踝关节周径,以及踝关节损伤后下肢功能自我功能评定.结果 两组患者治疗前一般临床资料差异均无统计学意义,在治疗第3,7,14天后,治疗组在VAS评分及肿胀消除上均优于对照组,差异具有统计学意义(P＜0.05);两组患者在治疗前和治疗第3天后Kofoed踝关节评分无显著性差异(P＞0.05),在治疗7,14d后,治疗组在Kofoed踝关节评分显著高于对照组(P＜0.05).在自我功能评定上,治疗前和治疗第3天,两组患者评分均无统计学差异,治疗7,14d后,治疗组评分显著高于对照组(P＜0.01).结论 伤柏膏外敷治疗能够较快改善急性踝关节外侧副韧带损伤患者的疼痛,并改善相关功能性评分.     

Clinical trial of diclofenac sodium (Naclof) eye drops on Nigerians

Twenty-eight eyes of 26 age-matched patients who had planned extracapsular cataract extraction with or without intraocular lens implantation were enrolled into a double blind randomised actively controlled study of 2 groups. Each group of 14 eyes was assigned to receive 0.1% diclofenac sodium (Naclof) eye drops or 1% prednisolone acetate eye suspension. The patients received either 0.1% Diclofenac sodium eye drops or 1.0% prednisolone acetate eye suspension four times a day as their post operative anti-inflammatory medication for a period of four weeks. No significant difference was noticed in the subjective assessment of pain and conjunctival injection in the 28 days follow-up period except day 1 in the diclofenac sodium group (0.05> p >0.01). Other measured objective variables of inflammation such as anterior chamber cells and flare showed no significant difference from the 3rd-28th postoperative days (0.05< p > 0.20). The result demonstrated that 0.1% diclofenac sodium eye drops was as effective as 1% prednisolone acetate eye suspension in the control of postoperative inflammation after cataract surgery, and could serve as a viable alternative to topical steroids in Nigerians who are steroid responders.     

Intravenous paracetamol versus intramuscular pethidine in relief of labour pain in primigravid women

Background:

Intramuscular pethidine is one of most common opioids used for labour analgesia. There are a number of concerns in the literature regarding the use of pethidine. The aim of this study is to compare analgesic efficacy of paracetamol with pethidine for labour pain in normal vaginal delivery.

Materials and Methods:

In this single-blinded, randomised control trial, 80 primigravid singleton women with full-term pregnancy candidate for normal vaginal delivery, were entered the trial and divided in to pethidine (A) and paracetamol (B) groups. At the time of admission, age and body mass index of mother and gestational age based on last day of period were recorded. In both groups, intravenous promethazine and hyoscine were administered to each patient at the first stage of delivery. From beginning of active phase of delivery, patients in group A received 50 mg intramuscular pethidine injection. At the same time patients in group B, received an intravenous solution infusion containing 1000 mg paracetamol and 300 cc of normal saline. After child birth, average labour pain was assessed using Visual Analogue Scale (VAS) by direct questioning from patient in both groups.

Results:

After patients'' selection, 19 individual omitted during study due to exclusion criteria and finally 30 patients in paracetamol group and 31 patients in pethidine group remained to enter the trial. There was no significant difference in age and BMI of mothers between both groups (P > 0.05). Maternal age and labour duration in paracetamol group had no meaningful difference with maternal age and labour duration of patients in pethidine group (P > 0.05). The average VAS pain score was significantly lower in paracetamol comparing to that of pethidine group (8.366 out of 10, 9.612 out of 10, respectively, P < 0.001).

Conclusion:

It is concluded that intravenous paracetamol is more effective than intramuscular pethidine to relief labour pain in normal vaginal delivery.     

骶管注射联合推拿疗法治疗急性腰扭伤的疗效研究

目的探讨骶管注射疗法与压痛点强刺激推拿疗法联合应用治疗急性腰扭伤的疗效。方法选择2010年1月─2011年5月广东省第二人民医院康复医学科门诊诊治的急性腰扭伤患者120例,患者对治疗方案知情同意。按随机数字表法将患者分为4组:骶管注射组、压痛点推拿组、联合治疗组及物理治疗组,每组30例。骶管注射组:骶管注射0.9%氯化钠溶液、利多卡因注射液及地塞米松混合液20 ml,共1次。压痛点推拿组:按照宣蛰人软组织外科学所介绍的腰、骶、臀及腿的压痛点检查方法及强刺激推拿手法进行治疗,两次推拿的间隔时间为3 d,共2次。联合治疗组:为骶管注射和压痛点强刺激推拿两种疗法联合应用,每次骶管注射药物后立即施行压痛点强刺激推拿1次,隔3～4 d再进行1次。物理治疗组:采用超短波加动态干扰电进行治疗,1次/d,共7次。于治疗前及治疗后即刻、1周使用改良的日本矫形外科学会(M-JOA)腰痛评分标准和疼痛视觉模拟(VAS)评分进行临床疗效评价。结果急性腰扭伤患者116例进入结果分析。治疗前,4组患者M-JOA腰痛评分和VAS评分比较,差异均无统计学意义(P>0.05)。治疗后即刻,4组患者的VAS评分比较,差异有统计学意义(P<0.05);且物理治疗组与其他3组比较,差异均有统计学意义(P<0.05);4组M-JOA腰痛评分比较,差异无统计学意义(P>0.05)。治疗后1周,4组患者的VAS评分和M-JOA腰痛评分比较,差异均有统计学意义(P<0.05);4组患者的改善率比较,差异有统计学意义(P<0.01)。结论骶管注射疗法、压痛点强刺激推拿及物理治疗均是治疗急性腰扭伤的有效方法,但骶管注射疗法和压痛点强刺激推拿联合应用具有止痛迅速、功能恢复快等优点,所以其疗效最好,建议临床优先选用。     

双氯芬酸钾治疗拔牙术后疼痛的临床观察

目的：评价双氯芬酸钾治疗拔牙后疼产能的疗效和安全性。方法：将８０例技术术后疼痛患者随机机且和对照组,每组４０例,试验组给予双氯芬酸钾５０ｍｇ,３次／ｄ;对照组给予双氯芬酸钠５０ｍｇ,口服,３次／ｄ,疗程均为３天。结果：试验组和对照组的快效率分别为５５％和１５％,治愈率分别 烽７３％,试验线的快效率和治愈率均显著高于对照组,试验组和对照组的不良反应发生率分别为５％和７．５％。结论：双氯芬酸钾用于拔牙     

强的松龙阻滞配合金黄膏外敷治疗踝关节扭伤疗效观察

目的：比较强的松龙阻滞配合金黄膏外敷较电针配合金黄膏外敷治疗踝关节扭伤的疗效差异。方法：将64例踝关节扭伤患者按就诊先后顺序随机分为治疗组和对照组,各32例。治疗组采用强的松龙阻滞配合金黄膏外敷治疗,对照组采用电针配合金黄膏外敷治疗,两组在治疗2个疗程后进行疗效评定。结果：治疗组在疼痛、肿胀、功能活动度方面明显优于对照组,治疗组临床治愈率为90．6％,总有效率为100％;对照组临床治愈率为56．2％,总有效率为90．6％,（P〈0．05）。结论：强的松龙阻滞配合金黄膏外敷治疗踝关节扭伤较电针配合金黄膏外敷治疗踝关节扭伤具有显著疗效优势。     

Analgesic effect of low gynaecological surgery under general anaesthesia

Gabapentin has been used in the treatment of neuropathic pain as well as postoperative pain with good result. This study was done to investigate the effect of gabapentin in day-case gynaecological surgery under general anaesthesia. A randomised, placebo controlled, double blind study was undertaken on 200 patients of ASA I and II, aged 20 and 50 years, body weight of 50 +/- 0.06 kg undergoing day case gynaecological surgery under general anaesthesia. Group-A (n=100) patients received oral gabapentin 300mg and group-B (n = 100) received placebo orally 2 hours before surgery. Postoperative pain was assessed by visual analogue scale (VAS) at 1st hour, 3rd hour, and 6th hour following surgery. Injection diclofenac sodium 75 mg intramuscularly was used as rescue analgesic when VAS was > 4cm or on demand. Group-A patients showed lower VAS scores than the patients in group-B at 1st, 3rd and 6th hours postoperatively (p < 0.05). Moreover the total amount of rescue analgesic required in the immediate postoperative period observed for six hours was much higher in the group-B patients than in the patients in group-A (p <0.05). To conclude, the study showed that gabapentin used in low dose has got analgesic efficacy in the patients following day-case gynaecological surgery under general anaesthesia and has also significantly reduced the total requirement of rescue analgesic in the immediate postoperative period.     

中药熏洗结合功能康复训练对踝关节骨折术后功能康复的影响

目的：探讨中药活血止痛熏洗剂结合功能康复训练对踝关节骨折术后踝关节功能康复的影响。方法：回顾分析我院2011年1月至2012年1月收治的病历资料完整的踝关节骨折并行手术治疗的患者50例,依据术后治疗方式不同分为观察组与对照组各25例,观察组患者于术后15 d开始采用活血止痛熏洗剂结合功能康复训练以促进患者踝关节功能恢复,对照组术后单纯采用功能康复训练促进患者踝关节功能康复,对比两组患者治疗前、治疗后15、30、45 d VAS疼痛评分、AOFAS踝-后足评分、肿胀消退率等指标改善情况。结果：观察组患者治疗后各时间点VAS疼痛评分、AOFAS 踝-后足评分改善均较对照组更为显著,组间比较差异有统计学意义（ P＜0．05）;两组患者治疗后15d AO-FAS 踝-后足评分比较无统计学差异（ P＞0．05）,治疗后第30、45天AOFAS踝-后足评分显著高于对照组,组间比较差异有统计学意义（ P＜0．05）。结论：活血止痛熏洗剂结合功能康复训练可有效改善踝关节骨折患者术后疼痛、肿胀及关节活动度,促进患者康复,对提高患者生活质量起积极意义。     

Efficacy of a fixed dose combination of diclofenac sodium and acetaminophen (Rhumacort) injection in postoperative pain

To evaluate the efficacy and safety of a fixed dose combination of diclofenac sodium and acetaminophen injection a study was carried out in patients suffering from acute pain. Thirty-eight adult patients undergoing orthopaedic surgery received 3ml injection of diclofenac 25mg and acetaminophen 75mg per ml by deep intramuscular route 8 hourly for 6 doses. The pain assessment was made on a 1-100 mm visual analogue scale (VAS), onset of action, extent of pain relief and maximum fall in VAS score after the first dose was assessed. Injection pentazocine lactate was administered as rescue medication in case of uncontrolled pain. At baseline the pain score on VAS was 78.55 +/- 17.12, which at the end of 1 hour was found to be 43.57 +/- 19.91. There was a statistically significant (p<0.0001, ANOVA) reduction in mean pain score starting from 15 minutes after administration of first dose and extending up to the end of study period. Complete relief was seen in 17 patients (44.74%) and the mean time for complete relief was 172.20 minutes after the first dose. Maximum fall and maximum percentage fall in VAS score during the study period was 71.71 mm and 92.76% respectively on a 0-100 mm VAS, and the time for achieving maximum fall was 172.50 minutes after the first dose of study medication. The results of this study suggest that fixed dose combination of diclofenac and acetaminophen is effective and safe for management of postoperative pain in orthopaedic surgery.     

罗非昔布和依他昔布在妇科小手术中的预先性镇痛效果

目的比较环氧化酶-2(COX-2)抑制剂罗非昔布和依他昔布应用于妇科小手术的预先性镇痛效果.方法采用随机、双盲、安慰剂对照研究,选取在日间病房行妇科人工流产吸宫术的60例患者,将其随机分成3组,每组20例,分别在术前口服安慰剂、或罗非昔布50 mg、或依他昔布120 mg.术后15、30、60min及出院时,出院后6、24h分别记录患者的视觉模拟评分(VAS),对于镇痛不足的患者予以芬太尼(恢复室内)和扑热息痛(回家后),并记录其用量.术后24 h评估患者对镇痛治疗的满意度.结果在术后60min,依他昔布组VAS低于罗非昔布组(P＜0.05);术后6 h罗非昔布组和依他昔布组VAS评分显著低于安慰剂组(P＜0.05,P＜0.01).术后24 h罗非昔布组和依他昔布组均无患者主诉腹痛.其他时间点各组间VAS差异无显著性.各组患者在恢复室内芬太尼用量无差异,但患者回家后扑热息痛的用量罗非昔布组(0.2 g/人)和依他昔布组(0.05 g/人)明显低于安慰剂组(1.21g/人)(P＜0.01),且依他昔布组用量低于罗非昔布组(P＜0.05).各组患者的恢复过程差异无显著性.术后24 h依他昔布组镇痛满意度(96±7)显著高于其他两组(P＜0.01).结论在人工流产吸宫术患者术前应用罗非昔布和依他昔布可以降低术后6 h的VAS,并减少其他镇痛药物的用量,二者之间依他昔布的效果更加明显.     

冲击波诱导双氯芬酸二乙胺乳胶剂在膝关节置换术康复中的应用

  目的  探讨基于加速康复外科理念下冲击波诱导双氯芬酸二乙胺乳胶剂外用在膝关节置换术后康复中的效果。  方法  选取上海市第一康复医院2018年1月—2020年6月骨科收治的膝关节置换术后疼痛患者80例,采用随机数字表法将患者随机分为对照组和治疗组,每组40例。对照组行常规康复治疗;治疗组除常规康复治疗外,每隔6 d行冲击波诱导双氯芬酸二乙胺乳胶剂治疗1次,共3次。观察2组患者治疗后第1、6、12天的疼痛VAS评分、SAS评分、Berg平衡评分量表、Lysholm膝关节功能评分。  结果  治疗组与对照组年龄、性别差异无统计学意义(均P＞0.05)。治疗第12天时,冲击波诱导双氯芬酸二乙胺乳胶剂治疗效果最为显著。治疗组VAS评分(2.62±1.26 vs. 3.65±2.58,P < 0.05)和焦虑量表SAS评分(42.08±2.16 vs.47.76±2.69,P < 0.05)显著低于对照组;Berg平衡量表评分(46.83±4.67 vs. 41.39±3.52,P < 0.05)和Lysholm量表评分(82.98±8.86 vs. 74.52±6.48,P < 0.05)显著高于对照组。  结论  基于加速康复外科理念下的冲击波诱导双氯芬酸二乙胺乳胶剂外用能够有效减少膝关节置换术后患者疼痛和焦虑水平,促进膝关节功能恢复。      

低强度激光照射对正畸治疗慢性牙周炎患者疼痛及牙周健康状况的影响

目的 探讨低强度激光照射对正畸治疗慢性牙周炎患者疼痛和牙周健康的影响.方法 选择2016年1月至2019年12月在合肥市口腔医院行正畸治疗的慢性牙周炎患者45例,以每位患者左、右侧2颗同名单根后牙共180颗为观察对象,将左、右侧患牙按随机号码表抽样分为观察组(90颗)及对照组(90颗).观察组在正畸加力后行低强度激光照射颊、舌侧牙槽粘膜,对照组给予安慰剂处理.比较两组激光治疗后第1、3、5、7天疼痛评分(VAS评分),第1、2、3个月复诊时VAS评分,同时比较第1、3、6个月复诊时患牙牙菌斑指数(PI)、牙龈指数(GI)、牙周探诊深度(PPD)、临床附着丧失值(CAL)、牙龈退缩(GR)情况.结果 两组不同时间点VAS评分、PI、GI、PPD、CAL、GR行重复测量方差分析,满足球形假设(P<0.05),主效应方差分析提示两组VAS评分、PI、GI差异有统计学意义(P<0.05),但两组GR、PPD、CAL差异无统计学意义(P>0.05).结论 低强度激光治疗可减轻正畸治疗的慢性牙周炎患者疼痛情况,还可以有效改善患者牙周健康状况,值得临床推广.     

改良银质针导热疗法治疗急性腰扭伤的疗效

目的观察改良银质针导热疗法治疗急性腰扭伤的疗效。方法急性腰扭伤患者随机分为银质针组和塞来昔布组,完成观察者分别为32例、30例。于治疗前、治疗后30min、1周和1个月时以视觉模拟评分（VAS）评价疼痛强度、腰椎活动度评分（ROM）评估腰椎功能并进行疗效评定。结果两组治疗后疼痛及腰椎功能较治疗前均有改善,银质针组疼痛、腰椎功能改善均优于塞来昔布组（P〈O．05）。治疗后1周时银质针组有效率为94．1％（32／34例）,塞来昔布组为87．5％（28／32例）;治疗后1个月时银质针组有效率为96．9％（31／32例）,塞来昔布组为90．0％（27／30例）。结论改良银质针导热治疗急性腰扭伤在缓解疼痛、改善腰椎功能及疗效方面均优于口服塞来昔布。