手足同名经交叉取穴电针治疗全膝关节置换后疼痛

Effect of crossing acupoints of the same name of hands and feet on pain after total knee arthroplasty

背景:全膝关节置换后疼痛的程度可达到中重度,电针作为治疗全膝关节置换后疼痛的有效措施已经广泛应用于临床。目的:探讨手足同名经交叉取穴电针治疗对膝骨关节炎全膝关节置换后疼痛的影响。方法:选择膝骨关节炎拟行单侧全膝关节置换的82例患者,用简单随机化法分为对照组和治疗组(n=41)。对照组置换后予以常规镇痛方案,治疗组置换后在常规镇痛方案上联合运用手足同名经交叉取穴电针治疗。干预时间为置换后第1-5天,记录并评价两组患者压痛阈值、目测类比评分、自控静脉镇痛泵按压次数、额外使用镇痛药剂量、美国特种外科医院膝关节评分、医院用焦虑抑郁量表评分、不良事件发生情况等。此次临床试验于2020-05-05经上海中医药大学附属光华医院伦理委员会审批通过,伦理批准号:2020-k-40。试验参与者对试验方案和过程均知情同意,并签署临床试验知情同意书。结果与结论:(1)治疗3,5 d,治疗组压痛阈值高于对照组(P<0.05);(2)治疗3,5 d,治疗组活动时目测类比评分低于对照组(P<0.05);(3)术后48 h,治疗组自控静脉镇痛泵按压次数低于对照组(P<0.05);(4)治疗5 d,治疗组额外使用镇痛药剂量低于对照组(P<0.05);(5)治疗3,5 d,治疗组美国特种外科医院评分高于对照组(P<0.05);(6)治疗后3,5 d,治疗组医院用焦虑抑郁量表评分低于对照组(P<0.05);(7)治疗5d,两组不良事件和针刺异常情况发生相比差异无显著性意义(P>0.05);(8)提示手足同名经交叉取穴电针治疗能缓解膝骨关节炎患者全膝关节置换后的疼痛,促进置换后膝关节功能恢复,减少镇痛药物的使用,安全有效。

BACKGROUND:The degree of pain after total knee arthroplasty has reached moderate and severe.Electroacupuncture as an effective measure for thetreatment of pain after total knee arthroplasty has been widely used in clinic.OBJECTIVE:To explore the effect of electroacupuncture on pain after total knee arthroplasty in patients with knee osteoarthritis based on crossing acupoints of the same name of hands and feet.METHODS:In a randomized controlled design,82 patients with knee osteoarthritis scheduled for unilateral total knee arthroplasty were randomly divided into control group(n=41)and treatment group(n=41).The control group was given the routine postoperative analgesia program,and the treatment group was treated with electroacupuncture combined with the method of crossing acupoints of the same name of hands and feet on the routine analgesia scheme.The intervention time was from the first day to the fifth day after operation.The tenderness threshold,visual analogue scale score,pressing times of patientcontrolled analgesia pump,additional use of analgesics,Hospital for special surgery score of knee joint,hospital anxiety and depression scale score,and adverse events were recorded and evaluated.The clinical trial was approved by the Ethics Committee of Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine on May 5,2020.Ethics approval number:2020-k-40.The trial participants had informed consent to the trial scheme and process,and signed an informed consent form for the clinical trial.RESULTS AND CONCLUSION:(1)After 3 and 5 days of treatment,the tenderness threshold of the treatment group was higher than that of the control group(P<0.05).(2)After 3 and 5 days of treatment,the visual analogue scale score of the treatment group was lower than that of the control group(P<0.05).(3)After 48 hours of treatment,the number of pressing times of patient-controlled analgesia pump in the treatment group was lower than that of the control group(P<0.05).(4)After 5 days of treatment,the dose of extra analgesics in the treatment group was lower than that in the control group(P<0.05).(5)After 3 and 5 days of treatment,the Hospital for special surgery score of the treatment group was higher than that of the control group(P<0.05).(6)After 3 and 5 days of treatment,the hospital anxiety and depression scale score of the treatment group was lower than that of the control group(P<0.05).(7)After 5 days of treatment,there was no significant difference in adverse events and abnormal acupuncture between the two groups(P>0.05).(8)It is concluded that electroacupuncture combined with the method of crossing acupoints of the same name of hands and feet can reduce the pain after total knee arthroplasty in patients with knee osteoarthritis,promote the rehabilitation of knee joint function and reduce the use of analgesics,which is safe and effective.