红花化瘀汤薰蒸联合理筋手法在膝骨关节炎全膝关节置换术后康复中的应用

Clinical application of HONGHUAHUAYU decoctions steaming combined with sinew adjusting manipulation in the postoperative rehabilitation of total knee arthroplasty in patients with knee osteoarthritis

目的：探讨红花化瘀汤薰蒸联合理筋手法在膝骨关节炎全膝关节置换术后康复中的应用价值.方法：膝骨关节炎全膝关节置换术后患者72例,男29例,女43例;年龄59～78岁,中位数69.5岁;左侧24例,右侧33例,双侧15例;病程5～10年,中位数6.5年.随机分为2组,每组36例;观察组采用红花化瘀汤薰蒸联合理筋手法进行康复治疗;对照组单纯采用理筋手法进行康复治疗;共治疗1个月.分别于术前、术后1个月、术后6个月,测量2组患者患膝关节活动度,并依据美国特种外科医院膝关节评分标准对患膝进行评分.结果：手术前后不同时间点间患膝关节活动度比较,差异有统计学意义（F=45.809,P=0.000）,存在时间效应;2组患者间患膝关节活动度比较,差异有统计学意义（F=6.768,P=0.000）,存在分组效应;术前2组患者间患膝关节活动度比较,差异无统计学意义（92.250°±11.560°,90.140°±11.090°;t=1.131,P=1.000）;术后1个月,观察组患膝关节活动度优于对照组（115.159°±6.534°,100.884°±9.024°;t=7.650,P=0.000）;术后6个月,2组患者间患膝关节活动度比较,差异无统计学意义（122.614°±4.999°,117.558°±7.018°;t=2.709,P=0.108）;时间因素与分组因素存在交互效应（F=11.344,P=0.000）.手术前后不同时间点间患膝评分比较,差异有统计学意义（F=10.359,P=0.002）,存在时间效应;2组患者间患膝评分比较,差异有统计学意义（F=3.218,P=0.002）,存在分组效应;术前2组患者间患膝评分比较,差异无统计学意义[（37.318±10.108）分,（38.256±13.093）分;t=0.557,P=1.000];术后1个月,观察组患膝评分高于对照组[（85.250±4.309）分,（76.140±6.364）分;t=5.411,P=0.000）;术后6个月,2组患者间患膝评分比较,差异无统计学意义[（88.273±4.321）分,（87.280±4.435）分;t=0.383,P=1.000）;时间因素与分组因素存在交互效应（F=9.725,P=0.000）.结论：采用红花化瘀汤薰蒸联合理筋手法对膝骨关节炎全膝关节置换术后患者进行康复治疗,可促进患膝功能恢复,近期疗效优于单纯理筋手法.

Objective ： To explore the clinical value of HONGHUAHUAYU decoctions steaming combined with sinew adjusting manipu- lation in the postoperative rehabilitation of total knee arthroplasty in patients with knee osteoarthritis. Methods：Seventy-two patients with knee osteoarthritis treated with total knee arthroplasty were randomly divided into 2 groups ,36 cases in each group. The patients consisted of 29 males and 43 females,and ranged in age from 59 to 78 years（ Median = 69.5 yrs） and ranged in disease course from 5 to 10 years（ Medi- an = 6.5 yrs）. The osteoarthritis located in left knee for 24 patients and right knee for 33 patients and both knee for 15 patients. Patients in observation group were treated with HONGHUAHUAYU decoctions steaming combined with sinew adjusting manipulation, while patients in control group were treated only with sinew adjusting manipulation. The total disease course was 1 month. The knee range of motion（ROM） was measured before the surgery and at 1 and 6 months after the surgery, and the knee performance was evaluated according to the Hospital for Special Surgery（HSS） knee performance score. Results：There was statistical difference in the knee ROM between different time points （ F = 45. 809, P = 0. 000）, in other words, there was time effect. There was statistical difference in knee ROM between the 2 groups （ F = 6. 768,P = 0. 000）, in other words, there was group effect. Before the surgery, there was no statistical difference in knee ROM between the 2 groups（92. 250° ＋/- 11. 560° vs 90. 140° ＋/- 11. 090°,t = 1. 131 ,P = 1. 000）. At one month after the surgery,the knee ROM of observa- tion group was larger than that of control group （ 115. 159 ° ＋/-6. 534 ° vs 100. 884° ＋/-9. 024°, t = 7. 650,P = 0.000）. At six months after the surgery,there was no statistical difference in knee ROM between the 2 groups （ 122. 614° ＋/-4. 999° vs 117. 558° ＋/-7. 018°, t = 2. 709, P = 0. 108 ）. There was interaction between time factor and grouping factor（ F = 11. 344, P = 0.000）. There was statistical difference in the HSS scores between different time points （ F = 10. 359, P = 0. 002） ,in other words, there was time effect. There was statistical differ- ence in the HSS scores between the 2 groups （F = 3. 218, P = 0. 002）, in other words, there was group effect. Before the surgery, there was no statistical difference in the HSS scores between the 2 groups（37. 318 ＋/- 10. 108 vs 38. 256 ＋/- 13. 093 points,t =0. 557 ,P = 1. 000）. At one-month after the surgery, the HSS scores of observation group was larger than that of control group （85. 250 ＋/-4. 309 vs 76. 140 ＋/- 6. 364 points,t = 5. 411 ,P=0. 000）. At six months after the surgery, there was no statistical difference in the HSS scores between the 2 groups （ 88. 273 ＋/- 4. 321 vs 87. 280 ＋/- 4. 435 points, t = 0. 383, P = 1. 000）. There was interaction between time factor and grouping fac- tor（F = 9. 725 ,P = 0. 000）. Conclusion：The therapy of HONGHUAHUAYU decoctions steaming combined with sinew adjusting manipula- tion can promote the recovery of knee function after the total knee arthroplasty in patients with knee osteoarthritis, and it is better than the monotherapy of sinew adjusting manipulation in the short-term curative effect.