电针缓解人工膝关节置换术术后疼痛及改善活动受限的研究
发布时间：2018-07-16 09:38
【摘要】：目的：通过观察电针(electroacupuncture,EA)对人工膝关节置换术(total knee arthroplasty,TKA)术后疼痛评分(visual analogue score,VAS)及关节活动度(range of motion,ROM)的影响,探讨电针治疗对缓解TKA术后疼痛及改善关节活动度的意义。 方法：采用莆田学院附属医院骨科2012.12至2013.10期间收住入院的32例(男性6例,女性26例)重度膝关节骨性关节炎患者,按住院号随机分组,住院号尾数00-50之间的16例患者设为电针组,住院号在51-99之间的16例患者设为对照组。患者均同意本次研究,手术由同一组手术医生完成,其中2例行全麻(电针组1例,对照组1例),30例行腰硬联合麻醉,术中止血带时间为30±5分钟,手术时间为120±20分钟。两组术后均行常规口服口服塞来昔布200mg bid、持续静脉镇痛、持续被动功能锻炼(continuous passive motion,CPM),术后24±2小时拔除引流管,鼓励麻醉消退后即行双侧膝关节、踝关节及各趾主动运动。术后镇痛泵由麻醉师按同一配方配制,术后3d去除镇痛泵。电针组于术后第1(拔除引流管后)、2、3、5、7、10、12、14d换药后行电针治疗半小时,对照组无特殊治疗,电针由同一个专业的针灸科医师使用同一品牌针灸针、电针仪、选取同一组穴位操作。观察两组术后第3、7、10、14d关节活动度及疼痛程度变化。疼痛程度采用视觉模拟评分法(visual analogue score, VAS)评价,关节活动度采用仰卧位下患者最大主动屈膝角度,测量由同一医生操作。试验数据用X±S表示,使用SPSS17.0成组t检验(Independent Samples Test)及两样本秩和检验(Mann-Whitney Test)统计分析,P0.05为显著性差异。 结果：电针治疗能够明显降低膝关节骨性关节炎患者人工膝关节置换术术后早期疼痛程度,改善术后早期活动度。电针组VAS在术后第3d及术后第7d明显低于对照组(P0.05),但于术后14日时两组无明显区别(P0.05),表明该手术在术后第14天(常为拆线出院时间)疼痛程度已较轻。电针组关节早期活动度明显高于对照组(P0.05),但随着疼痛程度减轻,术后第7、10、14d活动度两组无明显区别(P0.05)。 结论：1、电针能显著缓解人工膝关节置换术术后尤其是术后早期疼痛程度,增加患者满意度,鼓励患者积极行功能锻炼；2、电针能改善人工膝关节置换术后近期关节活动度,有利于患者及早进行功能锻炼、提高生活水平和增强康复信心。
[Abstract]:Objective: to observe the effect of electroacupuncture (EA) on (visual analogue score (visual analogue score) and motion degree (range of motionless ROM) after (total knee arthroplasty (TKA), and to explore the significance of electroacupuncture in relieving pain and improving joint motion after TKA. Methods: 32 patients (6 males and 26 females) with severe knee osteoarthritis admitted from 2012.12 to 2013.10 in Orthopaedics Department affiliated Hospital of Putian University were randomly divided into two groups according to the number of hospitalization. Sixteen patients with hospital number from 00 to 50 were divided into electroacupuncture group and 16 patients with hospitalization number between 51 and 99 were set up as control group. All the patients agreed to this study. The operation was performed by the same group of surgeons. Two patients were treated with general anesthesia (electroacupuncture group 1 case, control group 1 case) and 30 cases with combined spinal-epidural anesthesia. The operative tourniquet time was 30 卤5 minutes and the operative time was 120 卤20 minutes. The two groups were given routine oral celecoxib 200mg after operation, continuous intravenous analgesia, continuous passive exercise of (continuous passive motion.After 24 卤2 hours after operation, drainage tubes were removed to encourage bilateral knee joint, ankle joint and toe active movement after anesthesia subsided. The postoperative analgesic pump was prepared by anesthesiologist according to the same formula, and the analgesic pump was removed 3 days after operation. The electroacupuncture group was treated with electroacupuncture for half an hour on the first day after operation (after pulling out the drainage tube). The electroacupuncture group was treated with electroacupuncture for half an hour, and the control group had no special treatment. The electroacupuncture group was operated by the same brand acupuncture needle and electroacupuncture instrument using the same brand acupuncture needle and electroacupuncture instrument. The range of motion and the degree of pain were observed on the 3rd day 10 ~ (th) and 14 ~ (th) day after operation in the two groups. The degree of pain was evaluated by visual analogue score (visual analogue score,), and the joint motion was measured by the same doctor with the largest active flexion angle in supine position. The test data were expressed by X 卤S, and statistically analyzed by SPSS 17.0 (Independent samples Test) and Mann-Whitney Test (Mann-Whitney Test) (P0.05). Results: electroacupuncture can significantly reduce the early pain and improve the early postoperative activity in patients with knee osteoarthritis. The VAS in the electroacupuncture group was significantly lower than that in the control group on the 3rd day and the 7th day after operation (P0.05), but there was no significant difference between the two groups on the 14th day after operation (P0.05). The early motion of joints in the electroacupuncture group was significantly higher than that in the control group (P0.05), but with the relief of the pain, there was no significant difference between the two groups (P0.05). Conclusion electroacupuncture can significantly relieve postoperative pain, increase patients' satisfaction, and encourage patients to take active functional exercise after artificial knee arthroplasty. Electroacupuncture can improve the degree of joint movement in the near future after artificial knee arthroplasty. It is helpful for patients to do functional exercise as early as possible, to improve their living standard and to enhance their confidence in rehabilitation.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R274.9
本文编号：2125979
[Abstract]:Objective: to observe the effect of electroacupuncture (EA) on (visual analogue score (visual analogue score) and motion degree (range of motionless ROM) after (total knee arthroplasty (TKA), and to explore the significance of electroacupuncture in relieving pain and improving joint motion after TKA. Methods: 32 patients (6 males and 26 females) with severe knee osteoarthritis admitted from 2012.12 to 2013.10 in Orthopaedics Department affiliated Hospital of Putian University were randomly divided into two groups according to the number of hospitalization. Sixteen patients with hospital number from 00 to 50 were divided into electroacupuncture group and 16 patients with hospitalization number between 51 and 99 were set up as control group. All the patients agreed to this study. The operation was performed by the same group of surgeons. Two patients were treated with general anesthesia (electroacupuncture group 1 case, control group 1 case) and 30 cases with combined spinal-epidural anesthesia. The operative tourniquet time was 30 卤5 minutes and the operative time was 120 卤20 minutes. The two groups were given routine oral celecoxib 200mg after operation, continuous intravenous analgesia, continuous passive exercise of (continuous passive motion.After 24 卤2 hours after operation, drainage tubes were removed to encourage bilateral knee joint, ankle joint and toe active movement after anesthesia subsided. The postoperative analgesic pump was prepared by anesthesiologist according to the same formula, and the analgesic pump was removed 3 days after operation. The electroacupuncture group was treated with electroacupuncture for half an hour on the first day after operation (after pulling out the drainage tube). The electroacupuncture group was treated with electroacupuncture for half an hour, and the control group had no special treatment. The electroacupuncture group was operated by the same brand acupuncture needle and electroacupuncture instrument using the same brand acupuncture needle and electroacupuncture instrument. The range of motion and the degree of pain were observed on the 3rd day 10 ~ (th) and 14 ~ (th) day after operation in the two groups. The degree of pain was evaluated by visual analogue score (visual analogue score,), and the joint motion was measured by the same doctor with the largest active flexion angle in supine position. The test data were expressed by X 卤S, and statistically analyzed by SPSS 17.0 (Independent samples Test) and Mann-Whitney Test (Mann-Whitney Test) (P0.05). Results: electroacupuncture can significantly reduce the early pain and improve the early postoperative activity in patients with knee osteoarthritis. The VAS in the electroacupuncture group was significantly lower than that in the control group on the 3rd day and the 7th day after operation (P0.05), but there was no significant difference between the two groups on the 14th day after operation (P0.05). The early motion of joints in the electroacupuncture group was significantly higher than that in the control group (P0.05), but with the relief of the pain, there was no significant difference between the two groups (P0.05). Conclusion electroacupuncture can significantly relieve postoperative pain, increase patients' satisfaction, and encourage patients to take active functional exercise after artificial knee arthroplasty. Electroacupuncture can improve the degree of joint movement in the near future after artificial knee arthroplasty. It is helpful for patients to do functional exercise as early as possible, to improve their living standard and to enhance their confidence in rehabilitation.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R274.9
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