中西医结合治疗腕关节骨折术后周围软组织粘连1例

“Traditional Chinese medicine (Acupuncture)(Akupunktura) and western medicine combined to treat a patient of around joint soft tissue adhesion after carpal fractures (case report)” Dr. Xiu Wei 1089 Budapest, Vajda Peter u, 43a

Abstract: After near the joint bone fracture, incision reduction often associated around the joint the soft tissue adhesion and even the joint activity is limited, and the closed reduction of fractures in patients with soft tissue injury or tearing, causing tissue edema?effusion also led later the soft tissue adhesionaround joints. I had one patient who suffered from right carpal fractures, open reduction operation with external cast immobilization after operation and immobilization caused by adhesions around the forearm and carpal area, her carpal activities is severely limited, treatment using cooperation of traditional Chinese medicine – that is, traditional Chinese acupuncture(akupunktura) and acupunctural drug injection and Western medicine, with medical gymnastic rehabilitation therapy, and achieved a very satisfactory effect.

Case report: The female patient, In July, 2010 she was robbed and fall down,with right carpal distal radius intra-articular comminuted fracture. Treated with open reduction and internal fixation, she was discharged from the hospital with external plaster cast .But 3 – 4 weeks after because of the fracture place re-dislocation, she had to have the second operation, using external fixator to treat this dislocation.  After removing the external fixation, her carpal movement was severely limited. Then she got rehabilitation treatment such as medical gymnastics, physiotherapy in the hospital. From Oct. 2010 – Feb.2011 more than four month continuous rehabilitation treatment, she had no significant change in her carpal movement. The patient is right-hand user, she could not use her right hand to put food in her mouth, could not clean the anus with right hand, could not do the house works. The patient was very suffering. The doctor also suggested that she should start to train using her left hand. Whe the patient came to me, by examination, her right carpal movement: Dorsalflexion 20 degree, volarflexion 0 degree, radial and ulnar deviation 0 degree, forearm supination and pronation 0 degree. Because of the long time fixation and limited mobility of the forearm and wrist, also Sudeck syndrome performed by RTG. After two courses of treatment in 3 Months with traditional Chinese acupuncture(akupunktura) and Western medicine, the patient had great improvement, the movement in her carpal and forearm close to normal, she can eat and do housework with her right hand, the function almost like normal. Her right carpal and forearm movement: Dorsalflexion 50 degree, volarflexion 60 degrees, radial deviation 20 degree, ulnar deviation 40 degree, forearm supination 70 degree, pronation 60 degree. The patient is very satisfied, and after 1 year follow up, her carpal movement is almost totalyl normal. Method: Discussion: Around joint soft tissue adhesion, the  pathological changes are slow circulation and stasis in the venous and lymphatic tube, tissue edema.  Exudation of serous fibrin, can get formation of adhesions, and even the muscles contracture in the area of joint capsule, synovialplica as well as muscles and ligaments. During the treatment, stimulate the acupuncture points can play promoting blood circulation and removing blood stasis and smoothing flow of the meridians, while acupuncture injection with medicine both give the drug effects and acupuncture(akupunktura) effect. Plus medical gymnastics, physiotherapy, those methods together play multi-function, to harmony the body in good situation, to soften the scar tissue and free the adhesions. pentoxifylline can expand the peripheral blood vessels, to promote the local blood circulation, and to improve the nutrition of the joints and surrounding soft tissues. Glucosamine in the body is decomposed into amino acid, can be converted into galactose, can be converted into chondroitin, can promote to produce proteoglycans and collagen, Supply the synovial fluid, lubricate the joints, and provide the necessary materials to the cartilage in healing of the injured joints. In human body, 1/3 of total protein  is consist of by Collagen, they generate connective tissue and Constitute the body skeleton, Determines the elasticity of the skin, such as bones, blood vessels, ligaments, and contribute to the healing human wounds. Calcitonin directly inhibits osteoclast absorbing the bone, to reduce the bone releasing calcium, to promote the bone absorbing calcium from the blood, so the serum calcium becomes low. Calcium gluconate supplies calcium, together with Calcitonin often use in the treatment of osteoporosis.

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