伤科活血方联合屈膝体位对全膝关节置换术后失血及功能康复的影响研究  

Effect of Shangke Huoxue Prescription Combined with Knee-flexion Position on Blood Loss and Functional Rehabilitation in Patients after Total Knee Arthroplasty

作　　者：吴子光 郑炜宏[2] 何君源[2] 彭键勇 黄治华 唐剑邦[2] WU Zi-Guang;ZHENG Wei-Hong;HE Jun-Yuan;PENG Jian-Yong;HUANG Zhi-Hua;TANG Jian-Bang(Graduate School of Guangzhou University of Chinese Medicine,Guangzhou 510006 Guangdong,China;Zhongshan Hospital of Traditional Chinese Medicine,Zhongshan 528400 Guangdong,China)

机构地区：[1]广州中医药大学研究生院,广东广州510006 [2]中山市中医院,广东中山528400

出　　处：《广州中医药大学学报》2022年第2期277-284,共8页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：广东省中医药局科研项目(编号:20181272)。

摘　　要：【目的】探讨全膝关节置换术(TKA)患者口服伤科活血方联合应用60°屈膝位对于术后出血量、关节活动度及功能康复的影响。【方法】将90例初次行单侧TKA治疗的原发性退行性膝骨关节炎患者随机分为屈曲位联合伤科活血方组(Ⅰ组)、屈曲位组(Ⅱ组)和伸直位组(Ⅲ组),每组各30例。3组患者术后均向关节腔注射氨甲环酸并夹闭引流管2 h,Ⅰ组患者术后取屈髋、屈膝60°、抬高下肢30 cm的体位,并于术前5 d(手术当天暂停服用)和术后14 d给予口服伤科活血方治疗;Ⅱ组患者术后取屈髋、屈膝60°、抬高下肢30 cm的体位;Ⅲ组患者术后取单纯伸直体位。比较3组患者的术中出血量、术后48 h引流量、总失血量和隐性失血量情况,观察3组患者术前、术后患肢小腿周径、关节活动度(ROM)、疼痛视觉模拟量表(VAS)评分、美国纽约康奈尔大学特种外科医院(HSS)膝关节功能评分的变化情况及术后并发症发生情况。【结果】(1)Ⅰ组患者的术后总失血量、隐性失血量低于Ⅱ组、Ⅲ组,Ⅱ组患者的总失血量、隐性失血量低于Ⅲ组,差异均有统计学意义(P<0.05);但3组患者的术中出血量和48 h引流量比较,差异均无统计学意义(P>0.05)。(2)Ⅰ组患者在术后7 d和14 d的患肢膝关节ROM均明显高于Ⅱ组和Ⅲ组,在术后14 d的患肢小腿周径均明显小于Ⅱ组和Ⅲ组,差异均有统计学意义(P<0.05)。(3)术后7 d,Ⅰ组和Ⅲ组患者的患肢膝关节VAS评分低于Ⅱ组,术后14 d,Ⅰ组患者的患肢膝关节VAS评分低于Ⅱ组和Ⅲ组,差异均有统计学意义(P<0.05)。(4)Ⅰ组患者在术后14 d和3个月的患肢膝关节HSS评分均明显高于Ⅱ组和Ⅲ组,差异均有统计学意义(P<0.05)。(5)Ⅱ组患者术后肌间静脉血栓(MCVT)发生率明显高于Ⅰ组、Ⅲ组,差异均有统计学意义(P<0.05)。【结论】伤科活血方联合60°屈曲膝关节治疗,可有效减少TKA术后隐性失血量及总失血量Objective To investigate the effect of oral use of Shangke Huoxue Prescription combined with 60° kneeflexion position on postoperative blood loss,knee joint range of motion(ROM)and functional rehabilitation in the patients after total knee arthroplasty(TKA). Methods Ninety patients with primary degenerative knee osteoarthritis who received unilateral TKA for the first time were randomly divided into knee-flexion position combined with Shangke Huoxue Prescription(groupⅠ),knee-flexion position group(groupⅡ)and knee-extension position group(group Ⅲ),with 30 patients in each group. After TKA,the patients in the 3 groups all were given intra-articular cavity injection of tranexamic acid and the clamp of drainage tube for 2 hours. Additionally,the post-operative limb of group Ⅰwas set in the position of hip flexion,knee flexion of 60°and elevation of the lower limb by 30 cm,and was given oral use of Shangke Huoxue Prescription 5 days before surgery(suspension of administration on the day of surgery)and 14 days after surgery. The post-operative limb of groupⅡ was set in the same position as the group Ⅰ,and that of group Ⅲ was set in the position of hip flexion and knee extension. The intraoperative blood loss, volume of the drainage 48 h after surgery, total blood loss and hidden blood loss of the 3 groups were compared. The calf circumference of the affected limb,knee jiont range of motion(ROM),visual analogue scale(VAS)pain scores,and knee function scores of Cornell University Hospital for Special Surgery(HSS)before and after surgery as well as the incidence of postoperative complications in the three groups were observed. Results(1)The postoperative total blood loss and hidden blood loss in groupⅠ were lower than those in groupⅡ and groupⅢ,and the total blood loss and hidden blood loss in the group Ⅱ were lower than those in the group Ⅲ,the differences being statistically significant(P<0.05). However, there were no significant differences in the intraoperative blood loss and 48-h drainage vo

关 键 词：膝骨关节炎 全膝关节置换术 伤科活血方 术后失血量 屈膝体位 关节活动度 功能康复 

分 类 号：R274.9[医药卫生—中西医结合] R687.4[医药卫生—中医骨伤科学]