腓股肌穴位康复按摩对老年髋关节置换术后血液流变学和临床疗效的影响

Effect of Rehabilitation Massage at Peroneal Muscle Points on Hemorheology in Elderly Patients with Hip Replacement

目的探讨腓股肌穴位康复按摩在老年髋部骨折中的应用,并分析这种干预方式对血液流变学的影响。方法纳入本院2015年3月至2017年3月间收治的老年髋部骨折患者82例进行前瞻性研究,随机将其分成观察组与对照组各41例。两组均行髋关节置换术治疗,对照组于术后予以常规干预,观察组在对照组基础上采用腓股肌穴位康复按摩干预,穴位包括血海、足三里、阴陵泉、阳陵泉、承山、三阴交。利用中医证候积分量表评估两组术后下肢症状,观察干预前、干预3 d及干预7 d的血液流变学变化情况,采用关节角度测量仪测定两组踝关节背屈角度、踝关节跖屈角度,并记录术后并发症发生率。结果观察组总有效率为95.12%,高于对照组的80.49%,差异有统计学意义(P<0.05);观察组干预7 d后的粗肿、胀痛积分较同时段对照组更低,组间比较差异有统计学意义(P<0.01);观察组干预7 d的全血低切粘度、全血中切粘度、全血高切粘度、血浆粘度均低于同时段对照组,差异有统计学意义(P<0.01);观察组干预7 d的踝关节背屈角度及跖屈角度较同时段对照组更高,两组比较差异有统计学意义(P<0.01);观察组术后下肢沉静脉血栓(deepvein thrombosis,DVT)发生率为4.88%,低于对照组的21.95%,组间比较差异有统计学意义(P<0.05)。结论腓股肌穴位康复按摩能促进老年髋部骨折患者血液流变学的改善,进一步改善下肢不适症状,降低DVT的发生,值得临床推广。

Objective To study the application of the peroneal acupoint rehabilitation massage in the elderly hip and analyze the effect of this intervention on hemorheology. Methods A prospective study was carried out in 82 with hip fractures in our hospital from March 2015 to March 2017. The patients were randomly divided fracture patients nto the observation group and control group, 41 cases in each group. The two groups were given hip replacement. The control group was received with conventional intervention after operation. The observation group was treated with rehabilitation massage at peroneal muscle points （Xuehai, Zusanli, Yinlingquan, Chengshan, Sanyinjiao）. The symptoms of lower limbs in two groups were evaluated by TCM syndrome integral scale. The changes of hemorheology were observed before intervention, and after intervention for 3 d and 7 d. The ankle dorsiflexion angle and ankle plantar flexion angle in the two groups were measured by the joint angle measuring instrument, and the incidence of postoperative complications was recorded. Results The total effective rate of the observation group was 95.12%, which was higher than that of the control group （80.49%）, and the difference was statistically significant （P〈0.05）. The gross swelling and distending pain scores of the observation group after 7 d were lower than those of the control group, and there was a significant difference between the groups （P〈0.01）. The low, medium and high shear viscosity of the whole blood, and plasma viscosity in the observation group after intervention for 7 d were lower than the control group, the difference was statistically significant （P〈0.01）. The angle of ankle dorsiflexion and the metatarsal flexion angle after treatment for 7 d in the observation group were higher than those in the same period control group, and the difference between the two groups was statistically significant （P〈0.01）. The incidence of deepvein thrombosis （DVT） in the observation group was 4.88%, lower than 21.95% in the control group, and the difference between the two groups was statistically significant （P〈0.05）. Conclusion The peroneal acupoint rehabilitation massage can promote the improvement of hemorheology in the elderly patients with hip fracture, further improve the discomfort of the lower limb and reduce the occurrence of DVT, which is worthy of clinical promotion.