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早期电针结合加速康复外科(ERAS)对全膝关节置换术后患者疼痛感知和功能障碍的影响。

Effect of Early Electroacupuncture Combined with Enhanced Recovery after Surgery (ERAS) on Pain Perception and Dysfunction in Patients after Total Knee Arthroplasty (TKA).

机构信息

Department of Rehabilitation Medicine, Guizhou Orthopedics Hospital, Guiyang 550001, China.

Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China.

出版信息

Biomed Res Int. 2022 May 9;2022:6560816. doi: 10.1155/2022/6560816. eCollection 2022.

Abstract

OBJECTIVE

A retrospective case-control study was performed to observe the effect and clinical significance of early electroacupuncture combined with enhanced recovery after surgery (ERAS) on pain perception and dysfunction after total knee arthroplasty (TKA).

METHODS

About 100 patients who diagnosed with TKA from February 2019 to April 2021 were enrolled in our hospital. The patients were arbitrarily assigned into control group and study group. The former group was cured with electroacupuncture in the early stage, and the latter group was intervened on the basis of early electroacupuncture combined with the concept of ERAS. The curative effect, the time of getting out of bed for the first time after operation, the time of postoperative rehabilitation, postoperative rehabilitation cost, pain score and knee joint function score, range of motion (ROM) of knee joint, low shear of whole blood viscosity, plasma viscosity, fibrinogen level, and postoperative complications were compared.

RESULTS

There exhibited no statistical difference in clinical data. In terms of the treatment effects, there were 27 cases of markedly effective, 22 cases of effective, and 1 case of ineffective in the study group, and the total effective rate was 98.00%; in the control group, 15 cases were markedly effective, 28 cases were effective, and 13 cases were ineffective, and the total effective rate was 86.00%. Compared to the control group, the total effective rate of the study group was higher ( < 0.05). And the first time to get out of bed and the postoperative rehabilitation time in the study group were lower. Compared to the control group (10113.42 ± 524.83) yuan, the postoperative rehabilitation cost in the study group (12401.71 ± 530.77) yuan was higher. In terms of the scores of VAS and HSS, there exhibited no remarkable difference before treatment ( > 0.05). After treatment, the VAS score lessened and the HSS score augmented the study group VAS score (1.76 ± 0.28); the score in the control group was lower compared to the control group (3.45 ± 0.36), and HSS scoring (83.48 ± 11.23) points higher compared to the control group (65.82 ± 10.44) points ( < 0.05). The ROM of knee joint augmented successively at the 1st, 2nd, 4th, and 8th week after treatment comparison between groups, the ROM of the knee joint in the study group at the 1st, 2nd, 4th, and 8th week was (49.47 ± 3.60)°, (64.38 ± 5.32)°, (86.93 ± 6.72)°, and (104.20 ± 9.11)°, is higher compared to the control group (46.53 ± 3.41)°, (61.52 ± 5.20)°, (78.42 ± 6.45)°, and (98.77 ± 8.67)° ( < 0.05). One day after operation, there exhibited no remarkable difference in whole blood viscosity low shear, plasma viscosity, and fibrinogen level ( > 0.05). However, there exhibited no remarkable difference in plasma viscosity and fibrinogen level at 1 day and 7 days after operation ( > 0.05). Seven days after operation, the whole blood viscosity, plasma viscosity, and fibrinogen in the study group were lower ( < 0.05). The probability of postoperative complications was compared. In the study group, there were 2 cases of limb swelling and pain, 1 case of joint stiffness, and no swelling and pain complicated with deep venous thrombosis, and the total incidence was 6.00%. In the control group, there were 5 cases of limb swelling and pain, 3 cases of joint stiffness, and 3 cases of swelling and pain complicated with deep venous thrombosis, with a total incidence of 22.00%. The incidence of adverse reactions in the study group was lower (  = 5.317 < 0.05).

CONCLUSION

Early electroacupuncture combined with ERAS is of positive significance to the patients after TKA, which can reduce the pain, enhance the function of the knee joint, and promote the ROM of the knee joint, and can effectively shorten the first time out of bed and postoperative rehabilitation time and reduce whole blood viscosity low shear, plasma viscosity, and fibrinogen level, but the overall rehabilitation cost is high, and clinical application should be combined with the actual situation of patients.

摘要

目的

回顾性病例对照研究旨在观察早期电针联合加速康复外科(ERAS)对全膝关节置换术(TKA)后疼痛感知和功能障碍的影响和临床意义。

方法

选取 2019 年 2 月至 2021 年 4 月在我院诊断为 TKA 的患者约 100 例。将患者随机分为对照组和研究组。前者采用早期电针治疗,后者在早期电针的基础上结合 ERAS 理念进行干预。比较两组的疗效、术后首次下床时间、术后康复时间、术后康复费用、疼痛评分和膝关节功能评分、膝关节活动度(ROM)、全血低切黏度、血浆黏度、纤维蛋白原水平及术后并发症。

结果

两组临床资料比较差异无统计学意义。研究组治疗效果显著 27 例,有效 22 例,无效 1 例,总有效率为 98.00%;对照组显著有效 15 例,有效 28 例,无效 13 例,总有效率为 86.00%。与对照组相比,研究组总有效率更高(<0.05)。且研究组首次下床时间和术后康复时间均较低。与对照组(10113.42±524.83)元相比,研究组术后康复费用(12401.71±530.77)元较高。治疗前 VAS 和 HSS 评分差异无统计学意义(>0.05)。治疗后,研究组 VAS 评分降低,HSS 评分升高,研究组 VAS 评分(1.76±0.28);对照组评分低于对照组(3.45±0.36),HSS 评分(83.48±11.23)分高于对照组(65.82±10.44)分(<0.05)。治疗后第 1、2、4、8 周,两组膝关节 ROM 逐渐增加,治疗后第 1、2、4、8 周研究组膝关节 ROM 分别为(49.47±3.60)°、(64.38±5.32)°、(86.93±6.72)°、(104.20±9.11)°,高于对照组(46.53±3.41)°、(61.52±5.20)°、(78.42±6.45)°、(98.77±8.67)°(<0.05)。术后第 1 天,两组全血低切黏度、血浆黏度、纤维蛋白原水平差异无统计学意义(>0.05)。但术后第 1 天和第 7 天两组血浆黏度和纤维蛋白原水平差异无统计学意义(>0.05)。术后第 7 天,研究组全血黏度、血浆黏度、纤维蛋白原均较低(<0.05)。比较术后并发症发生率。研究组肢体肿胀疼痛 2 例,关节僵硬 1 例,无深静脉血栓形成伴肿胀疼痛,总发生率为 6.00%。对照组肢体肿胀疼痛 5 例,关节僵硬 3 例,深静脉血栓形成伴肿胀疼痛 3 例,总发生率为 22.00%。研究组不良反应发生率较低(=5.317<0.05)。

结论

早期电针联合 ERAS 对 TKA 后患者具有积极意义,能减轻疼痛,增强膝关节功能,促进膝关节活动度,有效缩短首次下床时间和术后康复时间,降低全血低切黏度、血浆黏度和纤维蛋白原水平,但整体康复费用较高,临床应用应结合患者实际情况。

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