秦夏冰 文科

〔摘要〕 目的 观察内外合用接骨续筋汤对胫骨平台骨折术后膝关节功能及生活质量的影响。方法 按随机分组法将80例胫骨平台骨折患者分为观察组和对照组，每组40例，两组均行手术治疗，术后对照组予以常规治疗，观察组在对照组基础上予以口服接骨续筋汤配合中药熏洗膝关节。治疗3个月后，随访比较两组患者Lysholm评分、胫骨平台内翻角（tibial plateau-tibial shaft angle，TP-TSA）和胫骨平台后倾角（posterior slope angle， PSA）、膝关节被动活动度评定（passive range of motion， PROM）、股四头肌等长峰力矩和日常生活能力（activities of daily living， ADL）评分。结果 治疗后，两组患者的Lysholm评分、TP-TSA、PSA、膝关节PROM、股四头肌等长峰力矩和ADL值均较治疗前上调（P<0.05）;且觀察组患者的Lysholm评分、TP-TSA、PSA、膝关节PROM、股四头肌等长峰力矩和ADL值均高于对照组（P<0.05）。结论 内外合用接骨续筋汤配合手术治疗胫骨平台骨折疗效确切，可有效改善患者膝关节功能，加速膝关节功能康复，对于防治术后膝关节粘连和提高生活质量有明显的积极作用。

〔关键词〕 胫骨平台骨折;接骨续筋汤;中药熏洗;膝关节功能;Lysholm评分;关节被动活动度评定;股四头肌等长峰力矩;日常生活能力

〔中图分类号〕R274.1       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.05.018

Analysis of the Knee Joint Function and Quality of Life of Tibial Plateau Fracture Treated with Jiegu Xujin Decoction for Internal and External Use Combined with Surgery

QIN Xiabing， WEN Ke*

（Orthopedics Department， Affiliated Taihe Hospital of Hubei University of Medicine， Shiyan， Hubei 442000， China）

〔Abstract〕 Objective To observe the effect of Jiegu Xujin Decoction for internal and external combined use on knee joint function and quality of life after tibial plateau fracture. Methods According to the random grouping method， 80 cases of tibial plateau fractures were divided into observation group and control group， 40 cases in each group. Both groups were treated with surgery. The control group was treated with routine treatment after operation， and the observation group was treated with Jiegu Xujin Decoction combined with traditional Chinese medicine fumigation on the basis of the control group. After 3 months of treatment， Lysholm score， tibial plateau-tibial shaft angle （TP-TSA） and posterior slope angle （PSA）， passive range of motion （PROM）， isometric peak torque of quadriceps femoris and activities of daily living （ADL） scores were compared between the two groups. Results Compared with before treatment， Lysholm score， TP-TSA， PSA， knee PROM， isometric peak torque of quadriceps femoris and ADL value of two groups were increased after treatment （P<0.05）; compared with control group， Lysholm score， TP-TSA， PSA， knee PROM， isometric peak torque of quadriceps femoris and ADL value of observation group were increased （P<0.05）. Conclusion Jiegu Xujin Decoction for internal and external use combined with surgery in the treatment of tibial plateau fracture has definite curative effect， which can effectively improve the knee joint function of patients， accelerate the recovery of knee joint function， and play a significant positive role in preventing postoperative knee joint adhesion and improving the quality of life.

〔Keywords〕 tibial plateau fracture; Jiegu Xujin Decoction; traditional Chinese medicine fumigation and washing; knee joint function; Lysholm score; evaluation of passive activity of joint; isometric peak torque of quadriceps femoris; activities of daily living

胫骨平台是人体关键的承重部位之一，其承重力可能超过人体质量的5倍。胫骨平台骨折（fracture

of tibial plateau， FTP）约占所有骨折的1.2%，多发于遭受高能量创伤的年轻人和低能量創伤的老年人[1-2]。FTP多因直接撞击或间接压力引起的强烈外翻和内翻应力合并轴向载荷，导致胫骨平台劈裂、压缩或塌陷及膝关节韧带、半月板损伤等骨骼和软组织损伤，出现关节僵硬、疼痛及畸形等以膝关节功能受限为主的临床表现[3]。目前，多采取手术复位固定配合术后康复训练治疗[4]，但术后康复训练患者依从性差、早期恢复欠佳，易致膝关节周围软组织纤维化，导致关节活动部分受限，严重降低患者生活质量[5]。……