电针联合三七消肿止痛散外敷在全膝关节置换术后快速康复中的应用

Application of electroacupuncture combined with external application of Sanqi Xiaozhong Zhitong San(三七消肿止痛散) in rapid rehabilitation after total knee arthroplasty

目的:探讨电针联合三七消肿止痛散外敷在全膝关节置换术后快速康复中的应用价值。方法:2015年6月至2016年6月,选择接受单侧全膝关节置换术的膝骨关节炎患者60例,随机分为观察组和对照组,每组30例。对照组单纯进行基础治疗,包括血栓通注射液静脉滴注、迈之灵片口服、低分子肝素钙注射液皮下注射;观察组在此基础上采用电针联合三七消肿止痛散外敷治疗。分别于术前、术后第7天、术后第14天测量2组患者患膝关节活动度,采用疼痛视觉模拟评分(visual analoguc score,VAS)评价患膝疼痛情况;分别于术前、术后第14天采用美国特种外科医院(hospital for special surgery,HSS)膝关节评分评价患膝关节功能恢复情况;并观察并发症发生情况。结果:2组患者术后切口均甲级愈合。手术前后不同时间点间膝关节活动度的差异有统计学意义,即存在时间效应(F=365.649,P=0.000);2组患者膝关节活动度总体比较,组间差异有统计学意义,即存在分组效应(F=28.432,P=0.000);术前、术后第14天,2组患者膝关节活动度的组间差异无统计学意义(87.167°±3.601°,88.600°±5.512°,t=-2.959,P=0.238;119.833°±6.497°,119.000°±6.214°,t=0.258,P=0.614);术后第7天,观察组膝关节活动度大于对照组(107.700°±7.474°,95.667°±7.858°,t=36.933,P=0.000);时间因素与分组因素存在交互效应(F=14.018,P=0.000)。手术前后不同时间点间膝关节VAS评分的差异有统计学意义,即存在时间效应(F=644.220,P=0.000);2组患者膝关节VAS评分总体比较,组间差异有统计学意义,存在分组效应(F=18.625,P=0.000);术前、术后第14天2组患者膝关节VAS评分的组间差异无统计学意义[(8.433±1.278)分,(8.067±1.172)分,t=1.158,P=0.252;(1.467±1.008)分,(1.400±0.894)分,t=0.271,P=0.787];术后第7天,观察组VAS评分低于对照组[(4.700±1.207)分,(6.633±1.066)分,t=6.573,P=0.000];时间因素与分组因素存在交互效应(F=13.644,P=0.000)。术前2组患者膝关节HSS评分比较,组间差异无统计学意义[(42.733±8.525)分,(42.333±9.087)分;t=0.176,P=0.861]。术后第14天,2组患者膝关节HSS评分均较术前提高[86.967±4.979)分,(42.733±8.525)分,t=-24.050,P=0.000;(86.333±5.403)分,(42.333±9.087)分,t=-23.433,P=0.000];但组间比较,差异无统计学意义[(86.967±4.979)分,(86.333±5.403)分;t=0.472,P=0.639]。术后2组各并发肌间静脉血栓1例,经患肢抬高制动和低分子肝素钙注射液皮下注射处理后血栓消失。均无感染、关节脱位、假体松动等并发症发生。2组患者并发症发生率比较,组间差异无统计学意义(χ~2=0.000,P=1.000)。结论:膝骨关节炎全膝关节置换术后,在活血、抗凝、消肿等药物治疗的基础上采用电针联合三七消肿止痛散外敷治疗,可更快地减轻患膝疼痛和恢复膝关节活动度,安全可靠。

Objective：To explore the applied value of electroacupuncture combined with external application of Sanqi Xiaozhong Zhi- tong San （三七消肿止痛散, SQXZZTS） in rapid rehabilitation after total knee arthroplasty （TKA）. Methods ： Sixty patients with knee osteo- arthritis（KOA） who were treated with unilateral TKA were selected from June 2015 to June 2016 and randomly divided into observation group and control group ,30 cases in each group. All patients were treated with intravenous drip of Xueshuantong（血栓通 ）injection, oral ap- plication of Aeseuven forte tablets and subcutaneous injection of low - molecular - weight heparins calcium injection（LMWHC）. Moreover,the patients in observation group were treated with electroacupuncture combined with external application of SQXZZTS. The range of motion （ROM）of knee was measured and the knee pain was evaluated by using visual analoguc score（VAS） before the surgery and at 7 and 14 days after the surgery respectively. The knee joint function recovery was also evaluated by using Hospital for Special Surgery （HSS） scores before the surgery and at 14 days after the surgery respectively. Furthermore, the complications were recorded. Results：All patients got pri- mary healing in the operative incisions. There was statistical difference in the ROM of knee between different timepoints before and after the surgery, in other words, there was time effect （ F = 365. 649,P = 0.000）. There was statistical difference in the ROM of knee between the 2 groups in general,in other words,there was group effect（F =28. 432,P =0. 000）. There was no statistical difference in the ROM of knee between the 2 groups before the surgery and at 14 days after the surgery respectively（87. 167 ＋/-3. 601 vs 88. 600 ＋/-5. 512 degrees, t = - 2. 959, P = 0.238 ; 119. 833 ＋/- 6. 497 vs 119. 000 ＋/- 6. 214 degrees, t = 0. 058, P = 0. 614 ）. The ROM of knee was greater in ob- servation group compared to control group at 7 days after the surgery（ 107. 700 ＋/- 7. 474 vs 95. 667 ＋/- 7. 858 degrees, t = 36. 933, P = 0. 000）. There was interaction between time factor and group factor （F = 14. 018, P = 0. 000）. There was statistical difference in the knee VAS scores between different timepoints before and after the surgery, in other words, there was time effect（ F = 644. 220, P = 0.000）. There was statistical difference in the knee VAS scores between the 2 groups in general,in other words,there was group effect （ F = 18. 625,P = 0. 000 ）. There was no statistical difference in the knee VAS scores between the 2 groups before the surgery and at 14 days after the surgery respectively （ 8. 433 ＋/- 1. 278 vs 8. 067 ＋/- 1. 172 points, t = 1. 158, P = 0. 252 ; 1. 467 ＋/- 1. 008 vs 1. 400 ＋/- 0. 894 points, t = 0. 271, P = 0. 787）. The knee VAS scores were lower in observation group compared to control group at 7 days after the surgery（4. 700 ＋/- 1. 207 vs 6. 633 ＋/- 1. 066 points, t = 6. 573, P = 0.000）. There was interaction between time factor and group factor （ F = 13. 644, P = 0.000）. There was no statistical difference in the knee HSS scores between the 2 groups before the surgery（42. 733 ＋/- 8. 525 vs 42. 333 ＋/- 9. 087 points,t =0. 176,P =0. 861 ）. The knee HSS scores increased in both of the 2 groups at 14 days after the surgery（86. 967 ＋/-4. 979 vs 42. 733 ＋/- 8. 525 points, t = - 24. 050,P = 0. 000 ;86. 333 ＋/- 5. 403 vs 42. 333 ＋/- 9. 087 points, t -- - 23. 433, P = 0.000） ,while there was no statistical difference in the knee HSS scores between the 2 groups （86. 967 ＋/-4. 979 vs 86. 333 ＋/-5. 403 points,t = 0. 472,P = 0. 639 ）. The intermuscular venous thrombosis was found in both of the 2 groups after the surgery, 1 case in each group. The thrombus disap- peared after treating with raising and braking the affected limbs and subcutaneous injection of LMWHC. No complications such as infection, joint dislocation,prosthesis loosening occurred. There was no statistical difference in complication incidences between the 2 groups （X2 = 0. 000, P = 1. 000）. Conclusion ： On the basis of treatment with activating blood drug, anticoagulation drug and detumescence drug, applica- tion of electroacupuncture combined with external application of SQXZZTS can alleviate the knee pain and restore the knee ROM more quickly after TKA for treatment of KOA, and it is safe and reliable.