腕踝针配合耳穴埋针对老年髋部骨折置换术后疼痛及功能恢复的影响

Effects of wrist-ankle acupuncture combined with thumbtack needle at auricular points on pain and functional recovery after hip arthroplasty in elderly hip fracture patients

目的 观察腕踝针配合耳穴埋针对老年髋部骨折置换术后疼痛及功能恢复的影响。方法 将89例硬膜外麻醉下行全髋关节置换术的髋部骨折患者,随机分为联合组(30例)、单纯耳穴组(29例)和对照组(30例)。对照组进行加速康复外科方案,单纯耳穴组在对照组基础上加用耳穴治疗,联合组在单纯耳穴组基础上加用腕踝针。在术前24 h、术后0.5 h、术后6 h、术后24 h、术后72 h以及术后7 d后采用数字评价量表(numerical rating scale,NRS)评估其疼痛程度;在术前24 h以及术后7 d观察Harris评分;在术后6 h以及术后7 d检测血清白细胞介素-6(interleukin-6, IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α)、P物质(substance P, SP)、前列腺素E2(prostaglandin E2, PGE2)以及C-X-C趋化因子配体10(chemokine C-X-C ligand 10, CXCL10)水平。结果 3组术后各时间节点NRS评分均低于术前(P<0.05);3组术后0.5 h和术后6 h NRS评分比较,差异无统计学意义(P>0.05);术后24 h联合组NRS评分低于对照组(P<0.05),与单纯耳穴组比较差异无统计学意义(P>0.05);术后72 h和术后7 d,联合组NRS评分低于其余两组,差异有统计学意义(P<0.05)。3组术后7 d Harris评分均高于术前(P<0.05);联合组高于对照组(P<0.05),与单纯耳穴组比较差异无统计学意义(P>0.05)。3组术后6 h血清IL-6、TNF-α、SP、PGE2和CXCL10水平比较差异无统计学意义(P>0.05);3组术后7 d血清IL-6、TNF-α、SP、PGE2和CXCL10水平低于术后6 h(P<0.05),联合组均低于其余两组(P<0.05)。联合组CXCL10与Harris评分呈负相关(P<0.05);与NRS评分及血清TNF-α、SP、PGE2水平呈正相关(P<0.05)。结论 腕踝针配合耳穴埋针能减轻疼痛评分,降低炎症因子、疼痛介质以及CXCL10的水平,从而保证后期功能锻炼的效果,利于髋关节的功能恢复。

Objective To observe the effect of wrist-ankle acupuncture combined with thumbtack needle at auricular points on pain as well as functional recovery after hip arthroplasty in elderly hip fracture patients. Method Eighty-nine patients with hip fracture who underwent total hip arthroplasty under epidural anesthesia were randomly assigned to a combination group(30 cases), an auricular acupoint alone group(29 cases), and a control group(30 cases).The control group underwent an accelerated rehabilitation surgical program. The auricular acupoint alone group was treated with thumbtack needle in addition to the treatment used in the control group. The combination group was treated with wrist-ankle acupuncture in addition to the treatment used in the auricular acupoint alone group. Their pain level was assessed using the numerical rating scale(NRS) 24 h before, 0.5 h after, 6 h after, 24 h after, 72 h after, and 7 d after surgery;Harris score was observed 24 h before surgery as well as 7 d after surgery;Serum levels of interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), substance P(SP), prostaglandin E2(PGE2), as well as chemokine C-X-C ligand 10(CXCL10) were measured 6 h as well as 7 d after surgery. Result In all three groups, the NRS score at each timepoints after surgery was lower than that before surgery(P<0.05);There was no significant difference in NRS score among the three groups at 0.5 h and 6 h after surgery(P>0.05);The NRS score in the combination group were lower than that in the control group at 24 h after surgery(P<0.05) and was not significantly different from that in the auricular acupoint alone group(P>0.05);At 72 h and 7 d after surgery, the NRS score in the combination group was lower than that in the other two groups, with statistically significant differences(P<0.05). In all three groups, the Harris score at 7 d after surgery was higher than that before surgery(P<0.05);It was higher in the combination group than in the control group(P<0.05), but was not significantly different from that in the auricular acupoint alone group(P>0.05). There was no significant difference in the serum levels of IL-6, TNF-α, SP, PGE2, and CXCL10 among the three groups at 6 h after surgery(P>0.05);The serum levels of IL-6, TNF-α, SP, PGE2, and CXCL10 in the three groups at 7 d after surgery were lower than those at 6 h after surgery(P<0.05), and they were lower in the combination group than in the other two groups(P<0.05). CXCL10 in the combination group was negatively correlated with Harris score(P<0.05);but was positively correlated with NRS score and serum TNF-α, SP, PGE2 levels(P<0.05).Conclusion The combination of wrist-ankle acupuncture and thumbtack needle at auricular points can reduce pain score and decrease the levels of inflammatory factors, pain mediators as well as CXCL10, thus guaranteeing the effect of later functional exercise and favoring the functional recovery of hip joint.