電針緩解人工膝關(guān)節(jié)置換術(shù)術(shù)后疼痛及改善活動受限的研究
發(fā)布時間：2018-07-16 09:38
【摘要】：目的：通過觀察電針(electroacupuncture,EA)對人工膝關(guān)節(jié)置換術(shù)(total knee arthroplasty,TKA)術(shù)后疼痛評分(visual analogue score,VAS)及關(guān)節(jié)活動度(range of motion,ROM)的影響,探討電針治療對緩解TKA術(shù)后疼痛及改善關(guān)節(jié)活動度的意義。 方法：采用莆田學(xué)院附屬醫(yī)院骨科2012.12至2013.10期間收住入院的32例(男性6例,女性26例)重度膝關(guān)節(jié)骨性關(guān)節(jié)炎患者,按住院號隨機(jī)分組,住院號尾數(shù)00-50之間的16例患者設(shè)為電針組,住院號在51-99之間的16例患者設(shè)為對照組�；颊呔獗敬窝芯�,手術(shù)由同一組手術(shù)醫(yī)生完成,其中2例行全麻(電針組1例,對照組1例),30例行腰硬聯(lián)合麻醉,術(shù)中止血帶時間為30±5分鐘,手術(shù)時間為120±20分鐘。兩組術(shù)后均行常規(guī)口服口服塞來昔布200mg bid、持續(xù)靜脈鎮(zhèn)痛、持續(xù)被動功能鍛煉(continuous passive motion,CPM),術(shù)后24±2小時拔除引流管,鼓勵麻醉消退后即行雙側(cè)膝關(guān)節(jié)、踝關(guān)節(jié)及各趾主動運(yùn)動。術(shù)后鎮(zhèn)痛泵由麻醉師按同一配方配制,術(shù)后3d去除鎮(zhèn)痛泵。電針組于術(shù)后第1(拔除引流管后)、2、3、5、7、10、12、14d換藥后行電針治療半小時,對照組無特殊治療,電針由同一個專業(yè)的針灸科醫(yī)師使用同一品牌針灸針、電針儀、選取同一組穴位操作。觀察兩組術(shù)后第3、7、10、14d關(guān)節(jié)活動度及疼痛程度變化。疼痛程度采用視覺模擬評分法(visual analogue score, VAS)評價,關(guān)節(jié)活動度采用仰臥位下患者最大主動屈膝角度,測量由同一醫(yī)生操作。試驗(yàn)數(shù)據(jù)用X±S表示,使用SPSS17.0成組t檢驗(yàn)(Independent Samples Test)及兩樣本秩和檢驗(yàn)(Mann-Whitney Test)統(tǒng)計分析,P0.05為顯著性差異。 結(jié)果：電針治療能夠明顯降低膝關(guān)節(jié)骨性關(guān)節(jié)炎患者人工膝關(guān)節(jié)置換術(shù)術(shù)后早期疼痛程度,改善術(shù)后早期活動度。電針組VAS在術(shù)后第3d及術(shù)后第7d明顯低于對照組(P0.05),但于術(shù)后14日時兩組無明顯區(qū)別(P0.05),表明該手術(shù)在術(shù)后第14天(常為拆線出院時間)疼痛程度已較輕。電針組關(guān)節(jié)早期活動度明顯高于對照組(P0.05),但隨著疼痛程度減輕,術(shù)后第7、10、14d活動度兩組無明顯區(qū)別(P0.05)。 結(jié)論：1、電針能顯著緩解人工膝關(guān)節(jié)置換術(shù)術(shù)后尤其是術(shù)后早期疼痛程度,增加患者滿意度,鼓勵患者積極行功能鍛煉；2、電針能改善人工膝關(guān)節(jié)置換術(shù)后近期關(guān)節(jié)活動度,有利于患者及早進(jìn)行功能鍛煉、提高生活水平和增強(qiáng)康復(fù)信心。
[Abstract]:Objective: to observe the effect of electroacupuncture (EA) on (visual analogue score (visual analogue score) and motion degree (range of motionless ROM) after (total knee arthroplasty (TKA), and to explore the significance of electroacupuncture in relieving pain and improving joint motion after TKA. Methods: 32 patients (6 males and 26 females) with severe knee osteoarthritis admitted from 2012.12 to 2013.10 in Orthopaedics Department affiliated Hospital of Putian University were randomly divided into two groups according to the number of hospitalization. Sixteen patients with hospital number from 00 to 50 were divided into electroacupuncture group and 16 patients with hospitalization number between 51 and 99 were set up as control group. All the patients agreed to this study. The operation was performed by the same group of surgeons. Two patients were treated with general anesthesia (electroacupuncture group 1 case, control group 1 case) and 30 cases with combined spinal-epidural anesthesia. The operative tourniquet time was 30 鹵5 minutes and the operative time was 120 鹵20 minutes. The two groups were given routine oral celecoxib 200mg after operation, continuous intravenous analgesia, continuous passive exercise of (continuous passive motion.After 24 鹵2 hours after operation, drainage tubes were removed to encourage bilateral knee joint, ankle joint and toe active movement after anesthesia subsided. The postoperative analgesic pump was prepared by anesthesiologist according to the same formula, and the analgesic pump was removed 3 days after operation. The electroacupuncture group was treated with electroacupuncture for half an hour on the first day after operation (after pulling out the drainage tube). The electroacupuncture group was treated with electroacupuncture for half an hour, and the control group had no special treatment. The electroacupuncture group was operated by the same brand acupuncture needle and electroacupuncture instrument using the same brand acupuncture needle and electroacupuncture instrument. The range of motion and the degree of pain were observed on the 3rd day 10 ~ (th) and 14 ~ (th) day after operation in the two groups. The degree of pain was evaluated by visual analogue score (visual analogue score,), and the joint motion was measured by the same doctor with the largest active flexion angle in supine position. The test data were expressed by X 鹵S, and statistically analyzed by SPSS 17.0 (Independent samples Test) and Mann-Whitney Test (Mann-Whitney Test) (P0.05). Results: electroacupuncture can significantly reduce the early pain and improve the early postoperative activity in patients with knee osteoarthritis. The VAS in the electroacupuncture group was significantly lower than that in the control group on the 3rd day and the 7th day after operation (P0.05), but there was no significant difference between the two groups on the 14th day after operation (P0.05). The early motion of joints in the electroacupuncture group was significantly higher than that in the control group (P0.05), but with the relief of the pain, there was no significant difference between the two groups (P0.05). Conclusion electroacupuncture can significantly relieve postoperative pain, increase patients' satisfaction, and encourage patients to take active functional exercise after artificial knee arthroplasty. Electroacupuncture can improve the degree of joint movement in the near future after artificial knee arthroplasty. It is helpful for patients to do functional exercise as early as possible, to improve their living standard and to enhance their confidence in rehabilitation.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R274.9
本文編號：2125979
[Abstract]:Objective: to observe the effect of electroacupuncture (EA) on (visual analogue score (visual analogue score) and motion degree (range of motionless ROM) after (total knee arthroplasty (TKA), and to explore the significance of electroacupuncture in relieving pain and improving joint motion after TKA. Methods: 32 patients (6 males and 26 females) with severe knee osteoarthritis admitted from 2012.12 to 2013.10 in Orthopaedics Department affiliated Hospital of Putian University were randomly divided into two groups according to the number of hospitalization. Sixteen patients with hospital number from 00 to 50 were divided into electroacupuncture group and 16 patients with hospitalization number between 51 and 99 were set up as control group. All the patients agreed to this study. The operation was performed by the same group of surgeons. Two patients were treated with general anesthesia (electroacupuncture group 1 case, control group 1 case) and 30 cases with combined spinal-epidural anesthesia. The operative tourniquet time was 30 鹵5 minutes and the operative time was 120 鹵20 minutes. The two groups were given routine oral celecoxib 200mg after operation, continuous intravenous analgesia, continuous passive exercise of (continuous passive motion.After 24 鹵2 hours after operation, drainage tubes were removed to encourage bilateral knee joint, ankle joint and toe active movement after anesthesia subsided. The postoperative analgesic pump was prepared by anesthesiologist according to the same formula, and the analgesic pump was removed 3 days after operation. The electroacupuncture group was treated with electroacupuncture for half an hour on the first day after operation (after pulling out the drainage tube). The electroacupuncture group was treated with electroacupuncture for half an hour, and the control group had no special treatment. The electroacupuncture group was operated by the same brand acupuncture needle and electroacupuncture instrument using the same brand acupuncture needle and electroacupuncture instrument. The range of motion and the degree of pain were observed on the 3rd day 10 ~ (th) and 14 ~ (th) day after operation in the two groups. The degree of pain was evaluated by visual analogue score (visual analogue score,), and the joint motion was measured by the same doctor with the largest active flexion angle in supine position. The test data were expressed by X 鹵S, and statistically analyzed by SPSS 17.0 (Independent samples Test) and Mann-Whitney Test (Mann-Whitney Test) (P0.05). Results: electroacupuncture can significantly reduce the early pain and improve the early postoperative activity in patients with knee osteoarthritis. The VAS in the electroacupuncture group was significantly lower than that in the control group on the 3rd day and the 7th day after operation (P0.05), but there was no significant difference between the two groups on the 14th day after operation (P0.05). The early motion of joints in the electroacupuncture group was significantly higher than that in the control group (P0.05), but with the relief of the pain, there was no significant difference between the two groups (P0.05). Conclusion electroacupuncture can significantly relieve postoperative pain, increase patients' satisfaction, and encourage patients to take active functional exercise after artificial knee arthroplasty. Electroacupuncture can improve the degree of joint movement in the near future after artificial knee arthroplasty. It is helpful for patients to do functional exercise as early as possible, to improve their living standard and to enhance their confidence in rehabilitation.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R274.9
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