目的:探讨术后加速康复(ERAS)模式下,术前中药泡洗联合穴位按压对单侧全膝关节置换术(TKA)后疼痛情况及功能恢复的影响。方法:选取2018年1月至2019年4月山东中医药大学附属医院关节骨科收治的首次行单侧TKA患者216例,根据随机数字表法分为对照组和观察组各108例。所有患者均应用ERAS方法进行围手术期管理,对照组采用传统皮肤准备法,观察组在对照组的基础上于术前3 d进行中药泡洗联合穴位按压。观察比较两组患者术后膝关节疼痛情况,镇痛药使用次数,膝上、下肿胀程度,美国特种外科医院(HSS)膝关节评分、膝关节主动活动度(ROM),感染、血栓、伤口愈合不良等并发症发生情况。结果:术后1 d、3 d、7 d观察组视觉模拟评分法(VAS)评分均低于对照组(P<0.05),观察组住院期间镇痛药使用次数均低于对照组(P<0.05);术后1 d、3 d、7 d观察组膝上肿胀值和膝下肿胀值均低于对照组(P<0.05);术后3 d、7 d、12 d观察组HSS膝关节评分、ROM均高于对照组(P<0.05);观察组并发症总发生率低于对照组(P<0.05)。结论:术前中药泡洗联合穴位按压可以减轻单侧TKA患者术后疼痛及肢体肿胀,减少镇痛药物使用,同时减少术后并发症,实现患者术后快速康复。

Objective:To explore the effect of preoperative Chinese medicine soaking combined with acupoint pressing on pain and functional recovery of unilateral total knee arthroplasty(TKA) under enhanced recovery after surgery(ERAS) mode. Methods:A total of 216 patients with unilateral TKA admitted to department of joint orthopaedics,Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2018 to April 2019 were selected and divided into the control group(108 cases) and the observation group( 108 cases) according to the random number table method. All patients were managed by the ERAS method in the perioperative period.The control group received traditional skin preparation method,and the observation group was treated with traditional Chinese medicine soaking combined with acupoint pressing 3 days before the operation on the basis of the treatment of the control group. The postoperative knee pain,the number of analgesics usage,the degree of swelling,the American hospital for special surgery(HSS) knee joint score,the knee active range of motion(ROM),and the occurrence of complications,including infection,thrombosis,poor wound healing,etc.were observed and compared. Results:After operation 1 d,3 d,and 7 d,the visual analogue scale(VAS)scores of the observation group were lower than those of the control group(P<0.05),and the number of analgesics usage in the observation group during hospitalization was lower than that of the control group(P<0.05). After operation 1 d,3 d,and 7 d,the observation group's above-knee swelling value and below-knee swelling value were lower than those of the control group(P<0.05). After operation 3 d,7 d,and 12 d,the HSS knee score and ROM of the observation group were higher than those of the control group(P<0.05).The total incidence of complications in the observation group was lower than that in the control group(P<0.05). Conclusions:Preoperative Chinese medicine soaking combined with acupoint pressing for unilateral TKA preoperative skin preparation can significantly relieve postoperative pain and swelling in patients,reduce the use of analgesics,promote functional recovery,and reduce the probability of complications,and achieve rapid recovery of patients after surgery.