全膝关节置换术后持续与间断冰敷方法临床效果的比较

The effectiveness and safety of continuous and intermittent ice compression therapy after total knee arthroplasty:a prospective cohort study

目的：比较全膝关节置换术后持续48 h冰敷与间断冰敷的疗效差异。方法80例全膝关节置换术后患者随机纳入试验组与对照组，各40例。试验组给予术后48 h持续冰敷，对照组每冰敷2 h间断30 min。比较2组患者疼痛评分（VAS）、额外止痛药物使用情况及大小腿肿胀、引流量、关节活动度等情况。结果试验组术后3d内患者疼痛轻于对照组患者（前3dZ值分别为-2.722、-3.359、-2.039，P＜0.05）。试验组使用镇痛药次数少于对照组（Z=-2.559，P＜0.05）。术后1 d试验组大腿腿围较术前肿胀（1.84±1.11）cm，明显小于对照组的（3.30±1.69）cm（t=4.565，P＜0.01）；小腿腿围较术前肿胀（0.94±0.89）cm，明显小于对照组的（1.46±0.91）cm（t=2.627，P=0.01）。术后3 d试验组患者大腿腿围较术前肿胀（3.09±1.39）cm，明显小于对照组的（4.09±1.71）cm（t=2.869，P＜0.01）。结论膝关节置换术后持续48 h冰敷镇痛效果优于间断冰敷，不影响患者早期恢复及下地活动，安全可靠，值得推广。

Objective To compare the effectiveness and safety of continuous and intermittent ice compression therapy following total knee arthroplasty surgery. Methods Eighty patients were divided into two groups receiving continuous or intermittent 30 minutes every 2 two hours within 48 hours after the operation. The subjective pain (VAS score), additional pain-killer use, swelling of extremity, drainage, range of motion were observed and compared. Results Patients in the observation group had less pain than those in the control group (Z values in the first 3 postoperative day was-2.722,-3.359,-2.039, respectively, P<0.05). Less pain-killers were required in the experimental group (Z=-2.559, P<0.05). The postoperative swelling by the thigh circumferences in the first day in the observation group was (1.84 ± 1.11) cm, which was milder than the (3.30 ± 1.69) cm of the control group (t=4.565, P<0.01). So was it in the calf circumferences, (0.94 ± 0.89 ) cm vs. (1.46 ± 0.91) cm (t=2.627, P=0.01). Within the first 3 days after the operation, this mildness still existed in aspect of thigh circumferences, which was (3.09±1.39) cm in the observation group vs the (4.09 ± 1.71) cm in the control group, t=2.869, P < 0.01. Conclusions Continuous ice compression therapy has better effects than intermittent 48 hours after total knee replacement, with functional training and exercise not disturbed. It is considered safe and assured, and is therefore recommended.