【摘要】：目的:本研究通過觀察人工全膝關(guān)節(jié)置換術(shù)(TKA)后患者的VAS評分、關(guān)節(jié)活動度及相關(guān)血清指標(biāo),評價(jià)龍發(fā)傷科七味片加減敷臍治療人工全膝關(guān)節(jié)置換術(shù)后疼痛的臨床療效,初步探討其作用機(jī)制,為此技術(shù)應(yīng)用推廣提供臨床依據(jù)。方法:本課題選取2015年10月至2016年12月期間就治于泉州市正骨醫(yī)院,診斷為晚期膝關(guān)節(jié)骨性關(guān)節(jié)炎,且首次行人工全膝關(guān)節(jié)置換術(shù)的70例患者為研究對象,根據(jù)診斷、納入、排除標(biāo)準(zhǔn),參照隨機(jī)數(shù)字表將病人隨機(jī)分成兩組,分別為治療組和對照組,每組各35例。治療組病人術(shù)后連續(xù)兩周予中藥敷臍治療;對照組術(shù)后連續(xù)兩周予生理鹽水敷臍治療。比較兩組患者術(shù)前及術(shù)后第1、2、3、5、7、10、14天的VAS疼痛評分,術(shù)前及術(shù)后第1、3、7、14天的膝關(guān)節(jié)主動活動度,術(shù)前及術(shù)后第7、14天進(jìn)行膝關(guān)節(jié)HSS功能評分。術(shù)前1天及術(shù)后第1、3、7、14天抽靜脈血查血常規(guī)、血沉、CRP。在術(shù)后第14天,采用HSS功能評分進(jìn)行總療效的評定。并在整個療程中進(jìn)行安全性記錄及分析。最后所得數(shù)據(jù)采用軟件SPSS 20.0進(jìn)行統(tǒng)計(jì)分析,設(shè)定P0.05具有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.本研究共納入70例患者,其中治療組脫落2例,對照組脫落2例,最后共66例完成了臨床觀察,脫落率為5.71%。2.治療組與對照組的VAS評分、膝關(guān)節(jié)活動度、HSS評分、白細(xì)胞計(jì)數(shù)、血沉、CRP在治療前后自身對比均有統(tǒng)計(jì)學(xué)差異(P0.05)。兩組間VAS評分在術(shù)后第1、2、14天無統(tǒng)計(jì)學(xué)差異(P0.05),在術(shù)后第3、5、7、10天有統(tǒng)計(jì)學(xué)差異(P0.05)。關(guān)節(jié)活動度在術(shù)后第1、14天無統(tǒng)計(jì)學(xué)差異(P0.05),在術(shù)后第3、7天有統(tǒng)計(jì)學(xué)差異(P0.05)。HSS評分在術(shù)后第7、14天有統(tǒng)計(jì)學(xué)差異(P0.05)。白細(xì)胞計(jì)數(shù)、血沉、CRP在術(shù)后第1、14天無統(tǒng)計(jì)學(xué)差異(P0.05),在術(shù)后3、7天有統(tǒng)計(jì)學(xué)差異(P0.05)。3.治療組2例患者在治療過程中出現(xiàn)臍部皮膚發(fā)紅、瘙癢,診斷過敏反應(yīng),不良事件的發(fā)生率為5.71%;對照組無發(fā)生不良反應(yīng)。結(jié)論:中藥敷臍可減輕人工全膝關(guān)節(jié)置換術(shù)后的疼痛程度及改善術(shù)后活動度,對促進(jìn)患者早期康復(fù)鍛煉具有重要意義,其臨床效果滿意,可進(jìn)一步在臨床中推廣應(yīng)用。
[Abstract]:Objective: to evaluate the clinical effect of the treatment of pain after total knee arthroplasty (TKA) by observing the VAS score, the range of joint motion and the related serum indexes after total knee arthroplasty (TKA). The mechanism of its action was preliminarily discussed, and the clinical basis for its application and popularization was provided. Methods: from October 2015 to December 2016, 70 patients who were diagnosed as advanced knee osteoarthritis and underwent total knee arthroplasty for the first time from October 2015 to December 2016 in Quanzhou Zhenggu Hospital were selected as the study objects. The patients were randomly divided into treatment group and control group with 35 cases in each group. The patients in the treatment group were treated with traditional Chinese medicine for two weeks, while the patients in the control group were treated with normal saline for two weeks. The VAS pain score of the patients before and after operation was compared with that of the patients before and after the operation. The active motion of the knee joint was measured on the 1st day and the 3rd day after the operation. The knee joint HSS function score was performed before and after the operation on the 714 days. Venous blood samples were taken 1 day before operation and 714 days after operation for examination of blood routine, erythrocyte sedimentation rate, CRP. On the 14th day after operation, HSS functional score was used to evaluate the total curative effect. Safety records and analysis were performed during the whole course of treatment. Finally, the data were analyzed by software SPSS 20.0, set P0.05 has statistical significance. Results: 1. A total of 70 patients were included in the study, including 2 cases in the treatment group and 2 cases in the control group, and 66 cases completed the clinical observation. The abscission rate was 5.71. 2. The VAS score, knee motion, HSS score, white blood cell count, ESR and CRP were significantly different between the treatment group and the control group before and after treatment (P0.05). There was no significant difference in VAS score between the two groups on the 214th day after operation (P0.05), but there was statistical difference on the 3rd and 5th day after operation (P0.05). There was no significant difference in joint motion on the 1st day after operation (P0.05), but there was a statistical difference on the 3rd day (P0.05). (P0.05). HSS score was significantly different on the 7th day (P0.05). White blood cell count, erythrocyte sedimentation rate and CRP had no statistical difference on the 1st day after operation (P0.05), but on the 7th day after operation, there were statistical differences (P0.05). In the treatment group, 2 cases had redness and itching of umbilical skin during the treatment, and the incidence of adverse events was 5.71, while in the control group, there were no adverse reactions. Conclusion: the application of traditional Chinese medicine can relieve the pain after total knee arthroplasty and improve the postoperative activity. It is of great significance to promote the early rehabilitation and exercise of the patients, and its clinical effect is satisfactory. It can be further popularized and applied in clinical practice.
【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】：2017
【分類號】：R687.4

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