穴位按摩联合温灸在全膝关节置换术后多模式消肿中的临床疗效  

Clinical efficacy of multi-pattern detumescence after total knee arthroplasty treated with acupoint massage and mild moxibustion

作　　者：陈巧玲[1] 黄双英[1] 陈小丽[1] 封蕾[1] 朱旭霞[1] 

机构地区：[1]浙江中医药大学附属第一医院骨伤科,杭州310006

出　　处：《中国针灸》2016年第5期471-475,共5页Chinese Acupuncture & Moxibustion

基　　金：浙江省中医药管理局科技计划资助项目:2014ZA027

摘　　要：目的：探讨穴位按摩、温灸配合常规消肿对行全膝关节置换术患者肿胀、疼痛的临床效果。方法：将120例行全膝关节置换术后膝骨关节炎患者随机分为观察组和对照组,各60例。对照组,在全膝关节置换术后给予常规消肿治疗,包括弹力绷带加压包扎、术肢抬高、膝关节制动、局部冰敷、气压泵间歇性充气加压、主动的踝泵和股四头肌舒缩锻炼、持续被动活动机械锻炼、使用弹力袜、口服利伐沙班片10mg,每日1次,连续21~24d。观察组在对照组常规消肿基础上,于术后1h行穴位按摩足三里、三阴交,以酸胀为度,每天2次;术后48h于足三里、三阴交联合温灸干预,以患者有温热且无灼痛感为宜,每天1次,持续干预至术后第7d。观察两组患者术前、术后肢体肿胀情况及疼痛评分（VAS法）和美国特种外科医院（HSS）膝关节功能评分变化。结果：术后第1、3、5、7、14d,观察组术后肢体肿胀发生率明显低于对照组（P〈0.05,P〈0.01）;术后第1、3、5、7d,观察组疼痛VAS评分均低于对照组（均P〈0.05）;术后第7、14d观察组HSS膝关节功能评分均优于对照组（均P〈0.05）。结论：穴位按摩联合温灸应用于全膝关节置换术后可以减少下肢肿胀的发生率,减轻疼痛,促进膝关节功能恢复,优于单纯常规消肿治疗。Objective To discuss the clinical effect on swelling and pain after total knee arthroplasty treated with acupoint massage,mild moxibustion and routine detumescence.Methods One hundred and twenty patients of knee osteoarthritis（KOA）after total knee arthroplasty（TKA）were randomized into an observation group and a control group,60 cases in each one.In the control group,after TKA,the routine detumescence was applied,including elastic bandage compression,the operated limb raising exercise,knee joint braking,local ice compress,intermittent pneumatic compression,active ankle pumping and quadriceps contraction exercise,continuous passive mechanical exercise,using stretch socks,oral administration of rivaroxaban tablets,10 mg,once a day,continuously for 21 to 24 days.In the observation group,on the basis of the routine detumescence as the control group,1 h after operation,acupoint massage was done at Zusanli（ST 36）and Sanyinjiao（SP 6）till soreness and distension presented,twice a day;48 h after operation,mild moxibustion was intervened at Zusanli（ST 36）and Sanyinjiao（SP 6）,avoiding burning pain,once a day,continuously till the 7th day after operation.Before and after operation,the limb swelling condition and the scores of visual analogue scale（VAS）and HSS（hospital for special surgery）knee joint function were observed in the patients of the two groups.Results On the 1st,3rd,5th,7th and 14 th days after operation,the swelling incidence in the observation group was apparently lower than that in the control group（P〈0.05,P〈0.01）.On the 1st,3rd,5th and 7th days after operation,the scores of VAS in the observation group were lower than those in the control group（all P〈0.05）.On the 7th and 14 th days after operation,the scores of HSS in the observation group were better than those in the control group（all P〈0.05）.Conclusion The combined intervention of acupoint massage and mild moxibustion reduces the incidence of lower limb swelling,alleviates pain and promotes knee joint funct

关 键 词：置换 膝 穴位按摩 温灸 肿胀 随机对照试验 

分 类 号：R246.2[医药卫生—针灸推拿学]