Broderick Barry J, Kennedy Cian, Breen Paul P, Kearns Stephen R, Olaighin Gearóid
School of Engineering and Informatics, National University of Ireland Galway, University Road, Ireland.
Annu Int Conf IEEE Eng Med Biol Soc. 2010;2010:5823-6. doi: 10.1109/IEMBS.2010.5627491.
Neuromuscular electrical stimulation (NMES) is a potential deep vein thrombosis (DVT) preventative measure that is often over-looked. NMES could be used postoperatively in conjunction with pharmacological prophylaxis to further reduce the incidence rate of DVT following orthopaedic surgery. However, the use of NMES in the recovery period following orthopaedic surgery on patients with metallic hip/knee implants has not been tested to date. The presence of a metallic implant may interfere with the NMES generated electric field causing hypersensitivity at the implant site. This may essentially limit the use of NMES postoperatively. Consequently, patient tolerance of NMES must be assessed before any treatment can be administered. Five hip replacement patients and 5 knee replacement patients participated in this study that were at least 3 weeks post-op. NMES was applied to the calf muscles of each patient using skin surface electrodes and the stimulation intensity was slowly increased. Comfort was assessed by asking the patient to indicate the stimulation intensity corresponding to 4 thresholds: when they first felt the stimulus sensation (sensory threshold), when a muscle contraction was observed (motor threshold), when stimulation became uncomfortable (pain threshold) and when the stimulation became unbearable (pain tolerance). Patients also indicated their overall comfort level on a visual analogue scale and completed a short verbal interview detailing their experience of the NMES treatment. Results indicated that the presence of a metallic implant did not give rise to hypersensitivity to NMES. Patients found the application of calf muscle NMES comfortable and acceptable as a treatment. We conclude that use of NMES on postoperative orthopaedic patients can be safely considered as a DVT prevention method.
神经肌肉电刺激（NMES）是一种潜在的深静脉血栓形成（DVT）预防措施，但常常被忽视。NMES可在术后与药物预防联合使用，以进一步降低骨科手术后DVT的发生率。然而，迄今为止，在接受金属髋关节/膝关节植入物的骨科手术患者的恢复期使用NMES尚未得到测试。金属植入物的存在可能会干扰NMES产生的电场，导致植入部位出现超敏反应。这可能从根本上限制NMES在术后的使用。因此，在进行任何治疗之前，必须评估患者对NMES的耐受性。五名髋关节置换患者和五名膝关节置换患者参与了这项研究，他们均已术后至少3周。使用皮肤表面电极对每位患者的小腿肌肉施加NMES，并缓慢增加刺激强度。通过要求患者指出对应于4个阈值的刺激强度来评估舒适度：当他们首次感觉到刺激感时（感觉阈值）、当观察到肌肉收缩时（运动阈值）、当刺激变得不舒服时（疼痛阈值）以及当刺激变得无法忍受时（疼痛耐受）。患者还在视觉模拟量表上指出他们的总体舒适度，并完成了一次简短的口头访谈，详细描述了他们接受NMES治疗的经历。结果表明，金属植入物的存在并未导致对NMES的超敏反应。患者认为对小腿肌肉施加NMES作为一种治疗方法是舒适且可接受的。我们得出结论，对于术后骨科患者，使用NMES可以安全地被视为一种DVT预防方法。
