加速康复联合补肾活血方在前交叉韧带重建围手术期的临床应用

Clinical application of enhanced recovery after surgery combined with Bushen Huoxue Decoction in the perioperative period of anterior cruciate ligament reconstruction

目的:探讨加速康复联合补肾活血方在前交叉韧带(ACL)损伤后重建围手术期的临床疗效。方法:选取2021年5月—2022年10月常州市武进中医医院骨伤科住院治疗的40例ACL损伤患者,采用随机数字法分为传统治疗组和加速康复组,传统治疗组采用传统关节镜下ACL单束重建术,加速康复组患者在传统治疗组基础上,于围手术期使用加速康复方案联合补肾活血方。比较两组患者首次屈膝90°时间、首次下床时间及住院时间,术前、术后1个月及术后6个月VAS、IKDC评分,术后1个月、6个月移植物成熟度及术后相关不良事件。结果:40例患者均有效随访,两组患者术后均未发生感染、关节僵硬、重建韧带再次断裂等相关不良事件。加速康复组首次屈膝90°时间、住院时间及下床时间均短于传统治疗组,差异有统计学意义(P<0.01);术前两组VAS、IKDC评分比较,差异无统计学意义(P>0.05),术后1个月、6个月两组VAS、IKDC评分均较术前改善,差异有统计学意义(P<0.05);术后1个月加速康复组VAS评分显著低于传统治疗组,术后1个月、6个月IKDC评分显著高于传统治疗组,差异有统计学意义(P<0.05);术后1个月及6个月加速康复组移植物胫骨段及股骨段成熟度均明显高于传统治疗组,差异有统计学意义(P<0.05,P<0.01)。结论:加速康复联合补肾活血方能够有效促进ACL损伤患者术后康复,改善膝关节功能,缓解膝关节疼痛,并发症较少,安全性高,值得临床推荐。

Objective:To investigate the clinical effect of enhanced recovery after surgery combined with Bushen Huoxue Decoction in the perioperative period of anterior cruciate ligament(ACL)reconstruction after the injury.Methods:A total of 40 patients with ACL injury who were hospitalized in the Orthopedics Department of Wujin Hospital of Traditional Chinese Medicine of Changzhoue from May 2021 to October 2022 were selected and divided into the traditional treatment group and the enhanced recovery after surgery group according to the random number method.Patients in the traditional treatment group were treated with traditional arthroscopic single-bundle ACL reconstruction,and patients in the enhanced recovery after surgery group were treated with enhanced recovery after surgery plan combined with Bushen Huoxue Decoction on the basis of the traditional treatment group.The time of first 90°knee flexion,first ambulation time,length of hospital stay,VAS and IKDC scores before operation,1 month and 6 months after operation,graft maturity at 1 month and 6 months after operation,and postoperative related adverse events were compared between the two groups.Results:All the 40 patients were followed up effectively.There were no adverse events such as infection,joint stiffness,and re-rupture of the reconstructed ligament in the two groups.The time of first 90°knee flexion,length of hospital stay and ambulation time in enhanced recovery after surgery group were shorter than those in traditional treatment group,and the differences were statistically significant(P<0.05).There was no statistical significance in VAS and IKDC scores between the two groups before operation(P>0.05).At 1 month and 6 months after operation,the VAS and IKDC scores of the two groups were significantly improved when compared with those before operation,and the difference was statistically significant(P<0.05).The VAS score of enhanced recovery after surgery group was significantly lower than that of traditional treatment group at 1 month after operation,and the IKDC score was significantly higher than that of traditional treatment group at 1 month and 6 months after operation,with statistical significance(P<0.05).The graft maturity of tibia segment and femur segment of in enhanced recovery after surgery group was significantly higher than that in traditional treatment group at 1 month and 6 months after operation,and the difference was statistically significant(P<0.05).Conclusion:Enhanced recovery after surgery combined with Bushen Huoxue Decoction can effectively promote the postoperative rehabilitation of patients with ACL injury,improve knee function and relieve knee pain,with fewer complications and high safety.It is worthy of clinical recommendation.