推拿配合持续冰敷对全膝关节置换术后康复及预防下肢深静脉血栓形成的效果

Effect of Massage Combined with Continuous Ice on Rehabilitation and Prevention of Deep Venous Thrombosis of Lower Extremities After Total Knee Arthroplasty

目的:探讨推拿配合持续冰敷对全膝关节置换术(TKA)患者术后康复及预防下肢深静脉血栓(DVT)形成的效果。方法:选取2014年1月至2016年10月北京军区北戴河疗养院收治的行TKA治疗的骨关节炎患者98例,随机分为对照组和观察组,每组49例,对照组行常规围手术期药物治疗及持续被动运动训练,观察组同时行推拿配合持续冰敷。检测并比较2组手术前后凝血功能变化;评价2组膝关节功能及疼痛程度;检测2组股静脉血流峰度及平均速度;统计DVT发生情况。结果:与术前比较,术后2组D-D及FIB先升高后降低,PT、APTT先降低后升高(P<0.05或P<0.01);观察组术后14 d FIB、PT、APTT已基本恢复至术前(P>0.05)。与术前比较,术后3~6个月2组膝关节功能优良率呈逐渐上升趋势(P<0.01),且观察组优良率明显高于对照组(P<0.05)。术后14 d 2组股静脉血流峰值及平均速度较术前明显升高,且观察组明显高于对照组(P<0.01)。术后3 d及术后14 d 2组VAS评分较术后1 d均明显降低,且观察组显著低于对照组(P<0.01)。观察组术后DVT发生率(4.08%)明显低于对照组(18.37%)(P<0.05)。结论:TKA术后给予推拿配合持续冰敷可有效促进术后膝关节功能恢复,预防DVT形成,降低术后疼痛程度,效果显著。

Objective ：To investigate the effect of massage combined with continuous ice on rehabilitation and prevention of deep vein thrombosis （DVT） in patients with total knee arthroplasty （TKA）. Methods：A total of 98 patients with osteoarthritis were treated with TKA,control group （n =49） was givenroutinely perioperative drug therapy and continuous passive exercise training, The observation group （ n = 49 ） was simultaneously punched with continuous ice. The changes of coagulation function before and after operation were detected and compared, the knee function and the degree of pain were evaluated, the peak wave velocity and mean velocity of 2 groups were measured, DVT occurrences was statisticsed. Results：Compared with preoperative, D-D and FIB in- creased first and then decreased, and PT and ALOFT decreased first and then increased （ P 〈 0. 05 or P 〈 0. 01 ） ; the levels of FIB, PT and APTF in observation group 14 days after surgery were basically restored to preoperative （P 〉 O. 05 ）. Compared with preop- erative, the excellent rate of knee function was gradually increasing from 3 months to 6 months after operation （ P 〈 0. 01 ）, and the excellent rate of observation group was significantly higher than that of control group （P 〈 0. 05 ）.. The peak and mean velocity of femoral vein blood flow were significantly higher than those before operation, and the observation group was significantly higher than the control group （ P 〈 0. 01 ）. The VAS score of 3 d and 14 d after surgery were significantly lower than those of control group （ P 〈0. O1 ）. The incidence of DVT in observation group was significantly lower than that in control group （ 18. 37% ） （ P 〈 0.05 ） Conclusion：TKA postoperative massage with continuous ice can effectively promote postoperative knee function recovery, preven- tion of DVT formation, reduce the degree of postoperative pain, the effect is significant~