清热利湿法对足踝部软组织缺损皮瓣修复术后影响.docVIP

清热利湿法对足踝部软组织缺损皮瓣修复术后影响 　　[摘要] 目的 观察清热利湿法对足踝部软组织缺损皮瓣修复术后的影响。 方法 将2013年1月～2014年10月于山东中医药大学附属医院骨科住院的60例符合纳入标准的足踝部软组织缺损患者按照随机数字表法分为两组，每组30例。对照组采用常规皮瓣转移手术，治疗组在采用同样术式的基础上术后口服皮瓣消肿颗粒。比较两组术前、术后各项血液流变学指标（全血黏度、全血高切黏度、全血中切黏度、全血低切黏度、血浆黏度、红细胞聚集指数和变形指数）；评判术后皮瓣肿胀程度和肿胀疗效；术后应用美国足踝外科协会（AOFAS）踝关节功能评估系统评判踝关节功能。 结果 两组术后各项血液流变学指标均较术前明显改善（P 0.05或P 0.01），且治疗组较对照组下降更为明显，差异有统计学意义（P 0.05）。治疗组术后皮瓣肿胀程度及肿胀疗效均明显优于对照组，差异均有高度统计学意义（均P 0.01）。治疗组术后6个月踝关节功能优良率明显高于对照组，差异有统计学意义（P 0.05）。 结论 清热利湿方药可有效消除足踝部软组织缺损皮瓣修复术后皮瓣的肿胀程度，缩短肿胀时间，减少静脉危象的发生，提高皮瓣成活率，改善皮瓣质量。 　　[关键词] 清热利湿法；足踝部；软组织缺损；皮瓣修复术；血液流变学 　　[中图分类号] R658.3；R622.12 [文献标识码] A [文章编号] 1673-7210（2015）09（a）-0112-04 　　[Abstract] Objective To observe the effect of heatness-clearing and wetness-removing therapy on soft tissue defect of foot and ankle after skin flap prothesis. Methods Sixty cases of patients with soft tissue defect of foot and ankle who were met with the inclusion standard admitted to Department of Orthopaedics of Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2013 to October 2014 were divided into two groups according to the random number table， with 30 cases in each group. The conventional flap operation was implemented in the control group and the flap swelling particles were taken in the treatment group on the basis of the same surgery. The hemodynamic indexes （whole blood viscosity， whole high blood viscosity， whole blood middle shear viscosity， whole blood low shear viscosity， plasma viscosity， red cell assembling index and deformation index） before and after operation between the two groups were compared. The swelling degree of skin flap and swelling efficacy after surgery were assessed. The function of ankle joint after operation was evaluated by scoring system of American orthopedic foot and ankle society （AOFAS）. Results The hemodynamic indexes after operation of the two groups were all improved significantly compared with before operation （P 　　[Key words] Heatness-clearing and wetness