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艾灸、穴位贴敷联合快速康复干预对老年全膝关节置换术后下肢疼痛、下肢肌力、膝关节功能的影响
田春燕,张玉叶
江苏省海安市中医院骨伤科海安 226600;江苏省苏州大学附属第二医院骨科苏州 215000
摘要:
目的:观察用艾灸、穴位贴敷联合快速康复干预对老年全膝关节置换术后下肢疼痛、下肢肌力、膝关节功能的影响。方法:选择我院收治的120 例老年全膝关节置换术后患者为研究对象,按照随机数字表法分为对照组和观察组患者各60 例。对照组患者接受术后常规治疗,并给予康复训练指导;观察组患者在对照组基础上给予艾灸、穴位贴敷联合快速康复外科干预措施,两组均连续干预4 周。比较两组患者术后恢复时间、住院时间,评价术后下肢痛感、下肢肌力、膝关节功能,监测术后机体炎症状态。结果:观察组患者术后恢复更快,患者的主动屈曲到90°时间、首次下床时间、直腿抬高时间、住院时间与对照组相比显著缩短(P <0.05) ;观察组患者术后下肢疼痛较对照组明显减轻,术后2、3、5 d 的下肢疼痛VAS 评分均显著低于对照组(P <0.05) ;观察组患者术后下肢肌力较对照组明显增强,术后2、3、5 d 的下肢肌力评分均显著高于对照组(P <0.05) ;观察组患者术后膝关节功能改善较对照组明显减轻,膝关节功能随着时间延长而提高更明显,术后1 周、术后1、3、6 个月同一时间点比较,以观察组患者的膝关节功能HSS 评分显著高于对照组(P <0.05) ;观察组患者术后炎症反应较对照组明显减轻,术后细胞炎症因子水平升高程度较对照组降低,组间同一时间对比,术后3 天、术后7 天的血清中炎症因子肿瘤坏死因子-α(TNF-α)、C 反应蛋白(CRP)、环氧合酶(COX-2)水平均显著低于对照组(P <0.05)。结论:艾灸、穴位贴敷联合快速康复干预利于促进全膝关节置换术后老年患者的康复,能有效减轻术后下肢痛感,改善下肢肌力,提高膝关节功能,减轻术后机体炎症反应,值得进行临床推广。
关键词:  全膝关节置换术  穴位贴敷  快速康复外科  老年  膝关节功能
DOI:10.3969/j.issn.1007-6948.2020.04.023
投稿时间:2019-10-15
基金项目:苏州市科教兴卫青年科技项目(KJXW2016073)
Effects of Moxibustion and Acupoint Application Combined with Rapid Rehabilitation Intervention on Lower Limb Pain, Lower Limb Muscle Strength and Knee Function after Total Knee Arthroplasty in Elderly Patients
TIAN Chun-yan,ZHANG Yu-ye
Department of Orthopedics, Hai' an Hospital of Traditional Chinese Medicine, Haian, (226600), China
Abstract:
Objective To observe the effects of moxibustion and acupoint application combined with rapid rehabilitation intervention on lower limb pain, lower limb muscle strength and knee function after total knee arthroplasty in the elderly. Methods 120 elderly patients admitted to our hospital after total knee replacement were selected as the study objects, and were divided into the control group and the observation group according to the random number table method. Patients in the control group received conventional postoperative treatment and were given rehabilitation training guidance. On the basis of the control group, patients in the observation group were given moxibustion and acupoint application combined with rapid rehabilitation surgery intervention measures and both groups were received continuous intervention for 4 weeks. Postoperative recovery time and length of hospital stay were counted, postoperative lower limb pain, lower limb muscle strength and knee function were evaluated and postoperative body inflammation was monitored. Results Patients in the observation group recovered faster after surgery,and the time of active buckling to 90?, the time of ?rst getting out of bed, the time of straight leg elevation and the time of hospitalization were signi?cantly shorter than those in the control group (P<0.05). Compared with the control group, the postoperative lower limb pain in the observation group was signi?cantly reduced and the lower limb pain VAS score of 2d, 3d and 5d after surgery was significantly lower than those of the control group (P<0.05). The lower limb muscle strength of the observation group signi?cantly enhanced compared with that of the control group. The lower limb muscle strength score of the observation group was signi?cantly higher than that of the control group at 2d, 3d and 5d after surgery (P<0.05). Compared with the control group, the improvement of knee function in the observation group was signi?cantly reduced after surgery and the improvement of knee function was more obvious with the extension of time. Compared with the same time point of 1 week, 1 month, 3 months and 6 months after surgery, the HSS scores of knee function in the observation group was signi?cantly higher than those in the control group (P<0.05). Compared with the control group, the postoperative inflammatory response of the patients in the observation group signi?cantly reduced and the level of postoperative in?ammatory cytokines decreased. Compared with the control group, the serum levels of Tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and cyclooxygenase-2 (COX-2) signi?cantly decreased on the 3rd day and 7th day after operation (P<0.05). Conclusion Moxibustion and acupoint application combined with rapid rehabilitation intervention is beneficial to the rehabilitation of the elderly patients after total knee replacement, which can effectively reduce postoperative lower limb pain, improve lower limb muscle strength, improve knee function and reduce postoperative body in?ammatory response. It is worthy of clinical promotion.
Key words:  Total knee arthroplasty  acupoint application  rapid rehabilitation surgery  the elderly  knee joint function

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