腹针与CPM训练在TKA术后早期康复管理中的疗效对比观察

发布时间：2018-01-11 15:39

本文关键词：腹针与CPM训练在TKA术后早期康复管理中的疗效对比观察　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:本研究通过观察腹针疗法与CPM训练对TKA术后患者的临床疗效,从而客观对比腹针疗法与CPM机训练,找出各自的优势,最终优化组合TKA术后早期康复治疗措施,探索出一种疗效肯定,操作简便的TKA术后科学化的中西医综合康复方案,有利于临床推广,并探讨其作用机制。方法:本实验采用前瞻性随机对照研究,利用随机数字表法,在广东省中医院骨科从2013年8月至2015年12月收治的行TKA手术的患者中选取符合本研究纳入标准的96例进行随机分组,分为CPM组32例、腹针组32例和对照组32例,其中对照组有7例脱落,其它患者均顺利完成实验,收集到有效病例89例。三组患者均给予常规的早期康复训练,CPM组在早期康复训练的基础上联合CPM机训练,腹针组在早期康复训练的基础上联合腹针治疗。整个研究过程CPM组一共接受12次CPM机训练,腹针组一共接受12次腹针针刺治疗。用HSS膝关节功能评分量表、VAS视觉疼痛评分和关节被动活动角度(ROM)对三组患者术后3天、7天、12天的HSS总分、疼痛、关节活动度共三个方面的评分结果进行比较。统计方法,对数据先进行基线分析,计数数据组与组之间比较时采用卡方检验,符合正态分布以及方差齐性的特点的计量数据组内比较采用配对t检验,三组组间比较时采用方差分析。不符合正态分布或者方差齐性的特点时,懫用秩和检验进行分析。成果:本研究纳入的89例患者,男女比例11:78,左、右侧手术比例33:56,原发性单膝关节炎45例,原发性双膝关节炎44例,年龄波动在47-85之间。入组前三组患者的基线情况包括年龄、性别、术前诊断、手术部位、术前HSS评分、术前ROM评分、术前VAS评分组间进行比较,差异无统计学意义(P0.05),具有可比性。治疗完成后,对照组、CPM组、腹针组治疗后相比治疗前在3天、7天、12天VAS、ROM、HSS评分方面均提高(P0.05)。CPM组3天、7天、12天在VAS、ROM、HSS评分方面较对照组高(P0.05),在ROM、HSS评分方面较腹针组高(P0.05),腹针组7天、12天在VAS方面较对照组高(P0.05)。腹针组在术后3天的VAS评分方面与对照组比较没有统计学意义,这可能与样本量少,或者针刺的疗效累积效果不够造成的,这就要求以后的研究中增加样本量。所有完成本次研究的患者在试验全过程中没有出现不良事件。结论:早期康复对TKA患者术后疼痛、ROM、HSS功能方面都有明显的改善作用,其中CPM训练在疼痛、ROM、HSS功能方面疗效优于早期康复疗法,在ROM、HSS功能方面疗效优于腹针疗法,腹针治疗7天、12天在疼痛方面疗效优于早期康复疗法。总之,腹针与CPM机训练有利于全膝置换术后患膝功能的恢复。三种治疗方案有可靠的安全性。
[Abstract]:Objective: to observe the clinical effect of abdominal acupuncture therapy and CPM training on patients after TKA, so as to find out the respective advantages of abdominal acupuncture therapy and CPM machine training. Finally, the combination of early rehabilitation measures after TKA surgery was optimized to explore a scientific comprehensive rehabilitation scheme of traditional Chinese and western medicine after TKA surgery, which was beneficial to clinical popularization. Methods: the prospective randomized controlled study and the random digital table method were used in this study. From August 2013 to December 2015, 96 TKA patients who were admitted to Department of Orthopaedics, Guangdong Hospital of traditional Chinese Medicine, were randomly divided into two groups. The patients were divided into CPM group (n = 32), abdominal acupuncture group (n = 32) and control group (n = 32). All the three groups were given routine early rehabilitation training combined with CPM machine training on the basis of early rehabilitation training. Abdominal acupuncture group combined with abdominal acupuncture therapy on the basis of early rehabilitation training. CPM group received 12 CPM machine training in the whole course of the study. The abdominal acupuncture group received 12 times of abdominal acupuncture treatment. HSS knee function scale was used to evaluate the visual pain score and the angle of passive motion of joints in the three groups 3 days after operation and 7 days after operation. After 12 days of HSS score, pain and joint motion were compared in three aspects. Statistical method, the data were first baseline analysis, counting data group and group comparison using chi-square test. The matched t test was used in the comparison of the measurement data according to the characteristics of normal distribution and homogeneity of variance, and the analysis of variance was used in the comparison among the three groups, when it did not accord with the characteristics of normal distribution or homogeneity of variance. Results: the ratio of male to female was 11: 78, the ratio of left and right operation was 33: 56, and the primary arthritis of one knee was 45 cases. The baseline data of the first three groups included age, sex, preoperative diagnosis, site of operation and preoperative HSS score. There was no significant difference in preoperative ROM score and preoperative VAS score between the two groups (P 0.05). After the treatment, the control group was treated with CPM. The score of VASROMU HSS in abdominal acupuncture group was significantly higher than that in control group (3 days, 7 days and 12 days, respectively). In CPM group, the score of VAS-ROMU HSS was increased in 3 days and 7 days and 12 days in VAS-ROM. The score of HSS was higher than that of control group (P 0.05), the score of HSS was higher than that of abdominal acupuncture group (P 0.05), and that of abdominal acupuncture group was 7 days. On the 12th day, the VAS was higher than that in the control group (P 0.05). There was no significant difference in VAS score between the abdominal acupuncture group and the control group on the 3rd day after operation, which may be less than the sample size. Or the cumulative effect of acupuncture is not enough. All the patients who completed this study had no adverse events in the whole course of the trial. Conclusion: early rehabilitation is effective for postoperative pain in patients with TKA. The function of HSS was improved obviously, and CPM training was better than early rehabilitation therapy in ROM. HSS function is better than abdominal acupuncture therapy, abdominal acupuncture treatment for 7 days and 12 days in pain effect is better than early rehabilitation therapy. Abdominal acupuncture and CPM machine training are beneficial to the recovery of knee function after total knee replacement.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.9

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