通络止痛方导入联合关节松动在全膝关节置换术加速康复中的应用

Application of Tongluo Zhitong Decoction Combined with Joint Loosening in Accelerated Rehabilitation of Total Knee Arthroplasty

目的:探讨通络止痛方导入联合关节松动在全膝关节置换术(TKA)后加速康复中的应用价值。方法:采取回顾性研究,选择2023年1月至2023年9月收治的75例行全膝关节置换术患者临床资料作为研究对象,根据治疗方法分为对照组(37例,术后采取关节松动治疗)和观察组(38例,在对照组基础上采取通络止痛方导入治疗)。两组患者均连续治疗1周,并随访12周。比较两组患者不同时点(治疗前及治疗后1周、6周、12周)疼痛视觉模拟量表(VAS)评分、膝关节肿胀程度、膝关节活动度及术后恢复情况(美国膝关节协会评分(AKSS)、Fugl-Meyer评估表(FMA)评分、徒手肌力评定量表(MMT)评分);记录并比较两组患者治疗期间不良反应发生情况。结果:总有效率观察组高于对照组,差异有统计学意义(P<0.05);观察组术后至初次下床活动时间(21.02±4.74)h短于对照组(32.45±6.91)h,差异有统计学意义(P<0.05);治疗后1周、6周及12周两组患者VAS评分、膝关节肿胀程度较治疗前降低,并呈下降趋势,观察组各项指标(VAS评分为(3.75±0.88)分、(2.49±0.75)分和(1.77±0.35)分,膝关节肿胀程度为(43.76±3.19)mm、(41.55±3.06)mm和(40.88±2.78)mm)低于对照组(VAS评分为(4.97±0.67)分、(3.75±0.64)分和(2.39±0.61)分,膝关节肿胀程度为(45.19±3.63)mm、(43.53±2.14)mm和(42.17±2.03)mm),差异有统计学意义(P<0.05);治疗后1周、6周及12周两组患者膝关节活动度、AKSS临床评分、功能评分及FMA评分、MMT评分较治疗前升高,并呈上升趋势,观察组高于对照组,差异有统计学意义(P<0.05);两组患者治疗期间均未发生不良反应。结论:通络止痛方导入联合关节松动能够缓解全膝关节置换术患者术后疼痛,改善膝关节活动度,提升膝关节功能,消除术后患膝肿胀。

Objective:To explore the application value of Tongluo Zhitong decoction combined with joint mobilization in accelerated rehabilitation after total knee arthroplasty(TKA).Methods:A retrospective study was conducted to select the clinical data of 75 patients undergoing TKA from January 2023 to September 2023 as the research objects.According to the treatment methods,they were divided into control group(37 cases,treated with joint loosening after operation)and observation group(38 cases,treated with Tongluo Zhitong decoction on the basis of the control group).Both groups were treated continuously for 1 week and followed up for 12 weeks.The levels of pain(visual analogue scale(VAS)score),swelling degree of knee joint,range of motion of knee joint and postoperative recovery(American Knee Society Score(AKSS),Fugl-Meyer Assessment(FMA)score and Manual Muscle Test(MMT)score)were compared between the two groups at different time points(before treatment,1 week,6 weeks and 12 weeks after treatment).The incidence of adverse reactions during treatment was recorded and compared between the two groups.Results:The total effective rate of the observation group was higher than that of the control group(P<0.05).The first time of getting out of bed in the observation group was(21.02±4.74)h,which was shorter than that in the control group(32.45±6.91)h(P<0.05).The VAS scores and knee joint swelling degree of the two groups at 1 week,6 weeks and 12 weeks after treatment were lower than those before treatment,and showed a downward trend.The observation group(VAS scores were(3.75±0.88)points,(2.49±0.75)points and(1.77±0.35)points,knee joint swelling degree were(43.76±3.19)mm,(41.55±3.06)mm and(40.88±2.78)mm)was lower than the control group(VAS scores were(4.97±0.67)points,(3.75±0.64)points and(2.39±0.61)points,knee joint swelling degree were(45.19±3.63)mm,(43.53±2.14)mm and(42.17±2.03)mm)(P<0.05).At 1 week,6 weeks and 12 weeks after treatment,the knee joint activity,AKSS clinical score,functional score,FMA and MMT scores of the two groups were higher than those before treatment,and showed an upward trend.The observation group was higher than the control group,and the two groups were compared at time points,groups and interactions(P<0.05).No adverse reactions occurred during the treatment in the two groups.Conclusion:The introduction of Tongluo Zhitong decoction combined with joint loosening can effectively relieve postoperative pain in TKA patients,improve knee joint mobility,improve knee joint function,and eliminate postoperative knee swelling.