中医外治法在全膝关节置换术围手术期镇痛中的应用

Application of External Treatments of TCM in Perioperative Analgesia of Total Knee Arthroplasty

全膝关节置换术(total knee arthroplasty,TKA)围手术期镇痛常用的中医外治法有:针刺、理筋推拿手法、耳穴压豆、中药外敷等。针刺镇痛的机制,可分为中枢机制和外周机制,在全膝关节置换术围手术期镇痛方面,当属电针、腕踝针、耳针疗效显著,其余也有如平衡针法、腹针等。TKA术后功能锻炼基础上辅助艾灸治疗,一定程度上能减轻膝关节疼痛,开始早期主动直腿抬高训练,有助于缩短下床活动时间,提高下肢肌肉力量,促进患膝运动功能恢复。理筋推拿手法通过综合各类推、拿、按、摩、[扌衮]等手法,结合患者疾病、症状的辨证分析,疏理局部病灶筋络,促进局部血液运行,标本兼顾缓解患处疼痛。针刺、艾灸不仅可以镇痛,理筋推拿、点穴不仅能缓解疼痛、改善关节功能活动,还能调节疼痛时诱发的情绪。随着人们对疼痛认识的深入和医学模式的转变,疼痛研究也需要转变模式,即从传统“伤害性感受”的单一研究模式向“疼痛-情绪-认知”的多维度研究模式转变。

External treatments of TCM commonly used for perioperative analgesia of total knee arthroplasty(TKA) include acupuncture,tendon-regulating massage,pressing beans at ear points,external application of Chinese medicinals,etc.The mechanism of acupuncture analgesia can be divided into central mechanism and peripheral mechanism.In the perioperative analgesia of TKA,electroacupuncture,wrist ankle acupuncture and ear acupuncture have significant effects.The rest also include balance acupuncture and abdominal acupuncture,etc.On the basis of functional exercise after TKA,assisted moxibustion treatment can reduce knee joint pain to a certain extent,and early active straight leg lifting training can help to shorten the time of getting out of bed,improve the muscle strength of lower limbs,and promote the recovery of motor function of the affected knee.Muscle regulating massage by integrating various massage,such as pushing,holding,pressing,rubbing,rolling and other techniques,combined with the dialectical analysis of patients′ diseases and symptoms,can clear the tendons and collaterals of local lesions,promote local blood circulation,and relieve the pain of the affected parts by treating manifestation and root cause concurrently.Acupuncture and moxibustion can relieve pain.Tendon-regulating massage and acupoint-pointing can not only relieve pain and improve joint function,but also regulate the emotion induced by pain.With the deepening of people′s understanding of pain and the change of medical model,pain research also needs to change the model,that is,from the traditional single research model of "nociception" to the multi-dimensional research model of "pain-emotion-cognition".