【作者】 于小中；

【导师】 林清坚；

【作者基本信息】 福建中医学院 ， 中医骨伤科学， 2003， 硕士

【摘要】 背景 幻肢痛（Phantom Limb Pain，PLP）是指大多数6岁以上截肢患者常感到截肢肢体仍然完整存在，且幻肢处于某种强迫体位或痉挛性抽搐而产生的疼痛。幻肢痛至今尚无一种令人满意的治疗方法。本课题将纳米相陶瓷应用于PLP的研究，是我系对纳米相陶瓷在中医骨伤科学应用系列研究的组成部分。 目的 观察纳米相陶瓷远红外线对截肢术后幻肢痛的治疗效果，初步探讨其治疗机理。 方法 58例入选病人随机分为两组，采用单盲的方法，A组为治疗组（30例），采用残端相对侧外贴纳米相陶瓷片两片，大小3×7cm²，弹力绷带包扎。B组为对照组（28例），采用残端手法按摩拍打，中频电疗，每天两次，每次20分钟，在治疗结束后残端弹力绷带包扎。两组治疗均为4周。分别在治疗前、后检测以下指标：①SF-MPQ疼痛问卷评分表。②残肢皮肤微循环。③残肢表面弹性。④外周血前列腺素E₂水平。⑤假肢代偿功能（小腿假肢病人）。 结果 1、治疗组30例治愈16例（53.3％），总有效率为86.7％，对照组的治愈9例（37.1％），总有效率64.3％，治疗组疗效明显优于对照组（P＜0.01）。 2、治疗组皮肽微循环的各项指标改善优于对照组，其中管袢数两组治疗后比较13.73士0.87 Vs 10.18士1.12，P（0.05。 3、皮肤弹性治疗前治疗组为2.11士0.27，对照组为2.21士0.40（P）0.05），治疗后治疗组为3.72士0.60，对照组为2.92士0.43，治疗组优于对照组（P<0 .01）。 4、外周血PGEZ治疗后两组均有下降，但治疗组优于对照组（P<0 .001）。 5、治疗组在步速和步长的提高优于对照组，有显著性差异（P<0 .01），但治疗后两组行走能力组间比较没有统计学意义（P>0.05）。 结论 1、用纳米相陶瓷片能够有效治疗截肢术后幻肢痛，促进患者功能的康复，是一种有效、简便、经济、无毒副作用的治疗方法，值得临床推广应用。 2、纳米相陶瓷远红外线具有改善微循环，提高残端皮肤弹性的作用。 3、纳米相陶瓷对PLP的治疗可能是通过抑制前列腺素的合成和释放，促进周围神经损伤的修复以及提高脑内p一内啡肤、脑啡肤等内源性阿片样物质，具体的机制尚需要今后进一步研究。更多还原

【Abstract】 BackgroundPhantom limb pain (PLP) is an experience of patients after limb amputated ,who has the feeling that the lost limb still exist and is pained. It often occurs in patient over six years old. PLP is a common complication after amputation . And there is no satisfactory treatment now. Nanophase ceramics has a radiative of far-infrared under room temperature. This study is to apply the nanophase ceramics for the treatment of PLP. ObjectiveThis study is to observe the clinic therapeutic effect of far-infrared ray from nanophase ceramics on phantom limb pain and preliminarily to explore the therapeutic mechanism of far-infrared from nanophase ceramics to PLP. MethodsFifty-eight cases with PLP after amputation were randomly divided into treatment group (30 cases) and control group (28 cases). The treatment group was treated with far-infrared radiation from nanophase ceramics plus dressing elastic bandage. The patients of control group accepted the treatment by mid-frequency current therapy , manipulation and dressing elastic bandage. The varieties of five indexes were compared before and after treatment: (1)Short-form of Me Gill pain questionnair (SF-MPQ );(2)the skin microcirculation of the stump;(3)the eladticity of the stump;(4) level of plasma PGE2 ;(5)the compensatory function of artificial limb (patients with crus amputated).Result(1) 16 cases (53.3%) in the treatment group were cured ,the overall effective rate was 86.7%. 9 cases (37.1%) in the control group were cured ,the overall effective rate was 64.3%.The difference between two group was significant(P<0.01).(2)The improvement of microcirculation of treatment group was better than that of control group(13.73 ± 0.87 Vs 10.18 ± 1.12, P<0.01).(3)The stump skin elasticity of two groups was significantly different from the baselines after treatment. But treatment group was significantly different from the control group(P<0.01).(4)Level of PGE2 in two groups reduced after treatment. But the level of plasma PGE2 in the treatment group reduced more significantly than that in the control group (PO.01) .(5)Step velocity and step length in the treatment group after treatment was 88.69 ±5.51 and 67.97 ±3.82 respectively, which was obviously higher than that in the control group, 68.07 ± 7.28 and 58.08 ± 2.47, respectively (P<0.05). The ambulation ability in two groups was insignificant after treatment. Conclusion(l)The far-infrared radiation from nanophase ceramics has effective therapeatic action to PLP. It is a convenient effective methods.(2)Far-infrared from nanophase ceramics can ameliorate microcirculation, intenerate scar and improve the artificial limb compensatory function.(3)The therapeutic mechanism of far-infrared from nanophase ceramics to PLP is likely to inhibit the synthesis and release of PG, renovate of injured peripheral nerve and evoke the ascension of the levels of B -endorphin, enkephalin in brain.更多还原