电针联合塞来昔布治疗全膝关节置换术后疼痛的疗效观察

Efficacy Observation of Electroacupuncture Combined with Celecoxib in the Treatment of Pain after Total Knee Arthroplasty

目的观察电针辅助治疗全膝关节置换术(TKA)后疼痛的临床疗效。方法采用单中心、随机对照、单盲的研究方法。将126例TKA患者根据统计软件产生的随机数字分为两组(每组63例)。术后给予口服塞来昔布镇痛的基础上,治疗组给予电针干预,对照组给予假针干预,治疗穴位为术侧的伏兔、足三里、阴陵泉和阳陵泉。治疗时间在术后第3、4、5、6、7天,每天1次。治疗前和治疗后记录患者数字疼痛评分(NRS)、压力痛阈值(PPT)、改良版30s坐站试验(m30s STS)、抑郁自评量表(SDS)、额外镇痛次数和不良事件的发生情况。结果最终纳入统计120例患者,治疗组和对照组各60例。与本组治疗前比较,两组在术第4、5、6、7天NRS降低(P<0.05),PPT值升高(P<0.05);m30s STS增加(P<0.05),SDS均降低(P<0.05)。与对照组同期比较,治疗组术后第4、5、6、7天NRS降低,PPT值增高(P<0.05),m30sSTS增加(P<0.05),SDS降低(P<0.05)。治疗期间治疗组额外镇痛次数显著较少(P<0.05)。两组均无不良事件发生。结论电针联合塞来昔布能降低患者TKA术后的疼痛强度,缓解不良情绪,促进关节功能的早期恢复,疗效优于假针治疗。

Objective To observe the clinical efficacy of electroacupuncture adjuvant for pain following total knee arthroplasty(TKA). Methods A single-center, single-blinded, randomized sham-acupuncture controlled trial method was used. A total of 126 patients underwent TKA were randomly assigned to the treatment group and the control group using statistical software, 63 cases in each group. All patients took celecoxib after operative analgesia as conventional Western medical conventional analgesia. Patients in the treatment group additionally received electroacupuncture intervention [EA at Futu(ST32), Zusanli(ST36), Yinlingquan(SP9), Yanglingquan(GB34) on the surgical side], while those in the control group additionally received shamacupuncture. The course of intervention in both groups were on postoperative day 3(D3), postoperative day 4(D4), postoperative day 5(D5), postoperative day 6(D6), postoperative day 7(D7), once per day. The numerical rating scale(NRS), value of pressure pain threshold(PPT), number of modified 30 sit-to-stand(m30s STS), self-rating depression scale(SDS) score, extra analgesia times, and adverse events were recorded.Results A final of 120 patients were included in statistical analysis, 60 cases in each group. Compared with before treatment in the same group, NRS decreased(P<0.05), PPT increased(P<0.05), m30s STS increased(P<0.05) and SDS decreased(P<0.05) at D4, D5, D6, and D7 in the two groups(P<0.05). Compared with the control group, NRS decreased(P<0.05), PPT increased(P<0.05), m30s STS increased(P<0.05), and SDS decreased(P<0.05) at D4, D5, D6, and D7 in the treatment group(P<0.05). The number of extra analgesia significantly decreased in the treatment group(P<0.05). No adverse events occurred in both groups during the treatment period. Conclusion Electroacupuncture combined with celecoxib reduced the pain intensity following TKA, relieved bad mood, and promoted early recovery of joint function, with better efficacy than shamacupunture.