中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (36): 5798-5803.doi: 10.12307/2021.345

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手足同名经交叉取穴电针治疗全膝关节置换后疼痛

马成豪1,黄  海1,吕若楠1,覃祚海1,王  浩1,聂智兴2,韩大鹏2,欧阳桂林2   

  1. 1上海中医药大学,上海市   201203; 2上海中医药大学附属光华医院,上海市   200052
  • 收稿日期:2021-01-06 修回日期:2021-01-08 接受日期:2021-02-22 出版日期:2021-12-28 发布日期:2021-09-17
  • 通讯作者: 欧阳桂林,博士,主任医师,硕士生导师,上海中医药大学附属光华医院,上海市 200050
  • 作者简介:马成豪,男,1993年生,河南省许昌县人,汉族,上海中医药大学在读硕士,主要从事骨与关节病防治的研究工作。
  • 基金资助:
    上海市长宁区卫生健康委员会医学重点(特色)专科计划(20191003),项目负责人:欧阳桂林

Effect of crossing acupoints of the same name of hands and feet on pain after total knee arthroplasty

Ma Chenghao1, Huang Hai1, Lü Ruonan1, Qin Zuohai1, Wang Hao1, Nie Zhixing2, Han Dapeng2, Ouyang Guilin2   

  1. 1Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; 2Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200052, China
  • Received:2021-01-06 Revised:2021-01-08 Accepted:2021-02-22 Online:2021-12-28 Published:2021-09-17
  • Contact: Ouyang Guilin, MD, Chief physician, Master’s supervisor, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200052, China
  • About author:Ma Chenghao, Master candidate, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
  • Supported by:
    Medical Key (Characteristic) Specialist Plan of Shanghai Changning District Health Committee, No. 20191003 (to OYGL)

摘要:


文题释义:

手足同名经交叉取穴法:是以《黄帝内经》缪刺和巨刺理论为基础,结合对应取穴法、同名经配穴法形成的一种复合取穴方法,采用与膝关节近端穴位同名经脉的手肘部的对应穴对患者进行治疗,临床上主要用于治疗肢体、关节的扭挫伤及疼痛。
全膝关节置换:是将人工膝关节假体固定在正常骨质上替代病变的关节,以重建患者膝关节的正常功能。适用于各种原因造成的膝关节病变致顽固性疼痛,经一定时间保守治疗无效的患者,如膝关节骨关节炎、类风湿性关节炎、创伤性关节炎等。

背景:全膝关节置换后疼痛的程度可达到中重度,电针作为治疗全膝关节置换后疼痛的有效措施已经广泛应用于临床。
目的:探讨手足同名经交叉取穴电针治疗对膝骨关节炎全膝关节置换后疼痛的影响。
方法:选择膝骨关节炎拟行单侧全膝关节置换的82例患者,用简单随机化法分为对照组和治疗组(n=41)。对照组置换后予以常规镇痛方案,治疗组置换后在常规镇痛方案上联合运用手足同名经交叉取穴电针治疗。干预时间为置换后第1-5天,记录并评价两组患者压痛阈值、目测类比评分、自控静脉镇痛泵按压次数、额外使用镇痛药剂量、美国特种外科医院膝关节评分、医院用焦虑抑郁量表评分、不良事件发生情况等。此次临床试验于2020-05-05经上海中医药大学附属光华医院伦理委员会审批通过,伦理批准号:2020-k-40。试验参与者对试验方案和过程均知情同意,并签署临床试验知情同意书。

结果与结论:①治疗3,5 d,治疗组压痛阈值高于对照组(P < 0.05);②治疗3,5 d,治疗组活动时目测类比评分低于对照组(P < 0.05);③术后48 h,治疗组自控静脉镇痛泵按压次数低于对照组(P < 0.05);④治疗5 d,治疗组额外使用镇痛药剂量低于对照组(P < 0.05);⑤治疗3,5 d,治疗组美国特种外科医院评分高于对照组(P < 0.05);⑥治疗后3,5 d,治疗组医院用焦虑抑郁量表评分低于对照组(P < 0.05);⑦治疗5 d,两组不良事件和针刺异常情况发生相比差异无显著性意义(P > 0.05);⑧提示手足同名经交叉取穴电针治疗能缓解膝骨关节炎患者全膝关节置换后的疼痛,促进置换后膝关节功能恢复,减少镇痛药物的使用,安全有效。

https://orcid.org/0000-0002-5272-0873 (马成豪) 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 膝关节, 骨关节炎, 全膝关节置换, 疼痛, 电针, 同名经

Abstract: BACKGROUND: The degree of pain after total knee arthroplasty has reached moderate and severe. Electroacupuncture as an effective measure for the treatment of pain after total knee arthroplasty has been widely used in clinic.  
OBJECTIVE: To explore the effect of electroacupuncture on pain after total knee arthroplasty in patients with knee osteoarthritis based on crossing acupoints of the same name of hands and feet.
METHODS:  In a randomized controlled design, 82 patients with knee osteoarthritis scheduled for unilateral total knee arthroplasty were randomly divided into control group (n=41) and treatment group (n=41). The control group was given the routine postoperative analgesia program, and the treatment group was treated with electroacupuncture combined with the method of crossing acupoints of the same name of hands and feet on the routine analgesia scheme. The intervention time was from the first day to the fifth day after operation. The tenderness threshold, visual analogue scale score, pressing times of patient-controlled analgesia pump, additional use of analgesics, Hospital for special surgery score of knee joint, hospital anxiety and depression scale score, and adverse events were recorded and evaluated. The clinical trial was approved by the Ethics Committee of Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine on May 5, 2020. Ethics approval number: 2020-k-40. The trial participants had informed consent to the trial scheme and process, and signed an informed consent form for the clinical trial.  
RESULTS AND CONCLUSION: (1) After 3 and 5 days of treatment, the tenderness threshold of the treatment group was higher than that of the control group (P < 0.05). (2) After 3 and 5 days of treatment, the visual analogue scale score of the treatment group was lower than that of the control group (P < 0.05). (3) After 48 hours of treatment, the number of pressing times of patient-controlled analgesia pump in the treatment group was lower than that of the control group (P < 0.05). (4) After 5 days of treatment, the dose of extra analgesics in the treatment group was lower than that in the control group (P < 0.05). (5) After 3 and 5 days of treatment, the Hospital for special surgery score of the treatment group was higher than that of the control group (P < 0.05). (6) After 3 and 5 days of treatment, the hospital anxiety and depression scale score of the treatment group was lower than that of the control group (P < 0.05). (7) After 5 days of treatment, there was no significant difference in adverse events and abnormal acupuncture between the two groups (P > 0.05). (8) It is concluded that electroacupuncture combined with the method of crossing acupoints of the same name of hands and feet can reduce the pain after total knee arthroplasty in patients with knee osteoarthritis, promote the rehabilitation of knee joint function and reduce the use of analgesics, which is safe and effective.

Key words: knee joint, osteoarthritis, total knee arthroplasty, pain, electroacupuncture, homonymous meridian

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