冷冻疗法在全膝关节置换术后患者中的应用研究进展

Research progress of cryotherapy in patients with total knee arthroplasty

全膝关节置换术(total knee arthroplasty,TKA)主要应用于膝关节骨性关节炎、类风湿性关节炎等终末期膝关节炎,可恢复下肢力线,重建膝关节功能。但是,TKA术后存在引流量增多、隐性失血量增加、疼痛、肿胀、关节僵硬等问题。冷冻疗法(简称冷疗)是指体外冰水持续作用于皮肤表面,通过热传导使肌肉组织及关节腔内温度降低,进而刺激交感神经,引起血管反应性收缩。TKA患者术后给予冷疗可缓解疼痛、减少出血量、减轻肿胀、促进膝关节功能康复等。目前临床对冷疗的时间、温度、频率等具体实施细节仍未明确。长时间冷疗或温度过低冷疗可导致皮肤冻伤、神经麻痹、伤口感染等并发症的发生,低温度亦有可能降低患者的舒适感,引发睡眠质量差等问题。该文就冷疗在TKA后患者中的应用研究进展作一综述。

Total knee arthroplasty(TKA) is mainly used in knee osteoarthritis, rheumatoid arthritis and other end-stage knee arthritis,which can restore the lower limb alignment and reconstruct the knee joint function. However, some problems that may ooccur after TKA include increasing drainage fluid and the hidden recessive blood loss, pain, swelling and ankylosis. Cryotherapy refers to using ice on the skin surface in vitro, which makes temperature of the muscle tissues and articular reduce because of conduction of heat, and then stimulates the sympathetic nerve and produces vasoconstriction. Cryotherapy can relieve pain, reduce bleeding and swelling, and promote joint function rehabilitation in TKA patients. So far, it is not clear what the proper treatment time, temperature and frequency of cryotherapy are. Some complications like skin frostbite, paralysis and wound infection may occur if the cryotherapy is performed for a long time or at a low temperature. Low temperatures may also reduce the patients′ comfort and cause poor quality of sleep. The research progress of cryotherapy in patients with TKA is reviewed in this paper.