中国组织工程研究

中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (15): 2330-2336.doi: 10.12307/2022.585

• 人工假体 artificial prosthesis • 上一篇    下一篇

推拿预防全膝关节置换后下肢深静脉血栓发生

赵  翅1，许  辉2，康冰心3，阿欣雨1，解  骏4，5，孙松涛4，5，沈  军4，5，肖涟波4，5，施  杞6，7   

  1. 1上海中医药大学，上海市   201203；2河南中医药大学，河南省郑州市   450003；3河南中医药大学第一附属医院，河南省郑州市   450099；4上海中医药大学附属光华医院，上海市   200050；5上海市中医药研究院中西医结合关节炎研究所，上海市   200050；6上海中医药大学附属龙华医院，上海市   200003；7上海中医药大学脊柱病研究所，上海市   200003
  • 收稿日期:2021-08-17 修回日期:2021-09-18 接受日期:2021-10-18 出版日期:2022-05-28 发布日期:2022-01-05
  • 通讯作者: 肖涟波，硕士，主任医师，博士生导师，上海中医药大学附属光华医院，上海市 200050
  • 作者简介:赵翅，女，1991年生，河南省郑州市人，汉族，上海中医药大学在读博士，主要从事中医骨伤科学研究工作。
  • 基金资助:
    上海市卫计委中西医结合康复诊疗能力提升项目[ZY(2018-2020)-FWTX-6023]，项目负责人：肖涟波；上海市临床重点专科建设项目(shslczdzk04801)，项目负责人：肖涟波；上海市长宁区科学技术委员会项目(CNKW2020Y23)，项目负责人：解骏；上海中医药大学研究生创新培养专项(Y2021009)，项目负责人：赵翅

Tuina prevents deep venous thrombosis of the lower limbs after total knee arthroplasty

Zhao Chi1, Xu Hui2, Kang Bingxin3, A Xinyu1, Xie Jun4, 5, Sun Songtao4, 5, Shen Jun4, 5, Xiao Lianbo4, 5, Shi Qi6, 7   

  1. 1Shanghai University of Traditional Chinese Medicine; 2Henan University of Chinese Medicine; 3The First Affiliated Hospital of Henan University of Chinese Medicine; 4Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine; 5Arthritis Research Institute of Integrated Traditional Chinese and Western Medicine; 6Longhua Hospital Affiliated to Shanghai University of Chinese Medicine; 7Institute of Spinal Diseases, Shanghai University of Chinese Medicine
  • Received:2021-08-17 Revised:2021-09-18 Accepted:2021-10-18 Online:2022-05-28 Published:2022-01-05
  • Contact: Xiao Lianbo, Master, Chief physician, Doctoral supervisor, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200050, China; Arthritis Research Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai 200050, China
  • About author:Zhao Chi, MD candidate, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
  • Supported by:
    Integrated Traditional Chinese and Western Medicine Rehabilitation, Diagnosis and Treatment Capacity Improvement Project of Shanghai Health and Family Planning Commission, No. ZY(2018-2020)-FWTX-6023 (to XLB); Shanghai Key Clinical Specialist Construction Project, No. shslczdzk04801 (to XLB); Shanghai Changning District Science and Technology Commission Project, No. CNKW2020Y23(to XJ); Shanghai University of Traditional Chinese Medicine’s Graduate Innovative Training Project, No. Y2021009 (to ZC)

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摘要：

文题释义：
全膝关节置换：是使用人工生物材料制成的膝关节假体替代膝关节中已被破坏的骨和软骨的一种外科手术，是缓解终末期膝骨关节炎所致膝关节疼痛和功能受限的主要手段。
下肢深静脉血栓：是指血液非正常的凝结在下肢深静脉内所引起的疾病，以下肢肿胀、疼痛及功能障碍为主要临床表现，常因患者术后血液回流受阻出现。下肢深静脉血栓脱落可引起肺动脉栓塞，更甚者危及患者生命。

背景：随着人工生物材料的更新及手术技术的进步，全膝关节置换已成为治疗重度膝关节骨关节炎的可靠方法，可有效解决膝关节骨关节炎患者的关节疼痛、关节僵硬，矫正关节畸形，恢复关节功能。但是，全膝关节置换后患者膝关节创口面积大，血液循环环境遭到破坏，血流缓慢凝滞易致机体形成高凝状态诱发深静脉血栓，严重影响手术疗效及患者满意度，甚则有发展为致死性肺栓塞的可能，是全世界关节外科专家共同关注的临床难题。
目的：观察推拿预防膝关节骨关节炎患者全膝关节置换后下肢深静脉血栓的有效性。
方法：采用随机对照设计，收集上海中医药大学附属光华医院关节矫形外科及关节外科收治的98例拟择期行全膝关节置换的膝关节骨关节炎患者(均为初次单膝置换)，进行简单随机化分组：推拿组(n=49)和对照组(n=49)。对照组术后第1天开始予口服利伐沙班片治疗，推拿组术后第1天开始在口服利伐沙班片基础上给予点按下肢输穴治疗。干预时长设定为14 d，记录两组患者股总静脉瘀滞指数、下肢深静脉血栓发生率、D-二聚体值、压痛阈值、美国膝关节协会评分、大腿及小腿周径差值、不良事件发生情况等。试验方案于2020-05-16通过上海中医药大学附属光华医院伦理委员会审批(伦理批准号：2020-K-43)。参与试验患者对试验方案及过程均知情同意，并在试验开始前签署了《知情同意书》。该试验于2020-06-04在中国临床试验注册中心注册(http://www.chictr.org.cn/listbycreater.aspx，ChiCTR2000033537)。
结果与结论：①干预第14天，推拿组股总静脉瘀滞指数低于对照组(P < 0.05)；②干预第14天，推拿组下肢深静脉血栓发生率低于对照组，但差异无显著性意义(P > 0.05)；③干预第14天，推拿组D-二聚体值低于对照组(P < 0.05)；④干预第14天，推拿组膝关节外侧点、内侧点压痛阈值高于对照组(P < 0.05)；⑤干预第14天，推拿组美国膝关节协会评分高于对照组(P < 0.05)；⑥干预第14天，推拿组大、小腿周径差值低于对照组(P < 0.05)；⑦干预期间两组均未发生不良事件；⑧结果表明，推拿可改善下肢股总静脉瘀滞状态，降低D-二聚体值，缩小大、小腿周径差值，改善关节疼痛，促进关节功能康复，安全可靠。

https://orcid.org/0000-0003-4226-6002 (肖涟波) 

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, 全膝关节置换, 推拿, 点按, 输穴, 下肢深静脉血栓, D-二聚体

Abstract: BACKGROUND: With the update of artificial biomaterials and surgical techniques, total knee arthroplasty has become a reliable surgical method for the treatment of severe knee osteoarthritis. It can effectively relieve joint pain and stiffness, correct joint deformity, and restore joint function in patients with knee osteoarthritis. However, total knee arthroplasty can produce a large wound in such patients, and destroy the blood circulation environment. The blood flow is then slow and coagulated, forming a hypercoagulable state in the body and further inducing deep vein thrombosis, which seriously impacts surgical efficacy and patient satisfaction. Serious patients have the risk of developing fatal pulmonary embolism, which is a clinical problem concerned by joint surgical experts all over the world.  
OBJECTIVE: To observe the efficacy of Tuina in preventing lower extremity deep venous thrombosis after total knee arthroplasty for knee osteoarthritis.
METHODS:  Using a randomized controlled design, 98 patients with knee osteoarthritis scheduled for primary unilateral total knee arthroplasty were randomly divided into Tuina group and control group (n=49 per group). The control group was treated with oral rivaroxaban tablets after operation, and the Tuina group was treated with Tuina on the basis of oral rivaroxaban tablets. The intervention time was set from the 1st day to the 14th day after operation. The femoral vein stasis index, the incidence of deep venous thrombosis, D-dimer value, pressure pain thresholds, American Knee Society Score, thigh and calf circumference difference, and adverse events were recorded. The clinical trial protocol was approved by the Ethics Committee of Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine on May 16, 2020 (approval No.2020-K-43). Patients who participated in the clinical trial were fully informed of the study protocol and process. Informed consent was signed prior to the start of the clinical trial. This clinical trial was registered at Chinese Clinical Trial Registry on June 4, 2020 (http://www.chictr.org.cn/listbycreater.aspx, ChiCTR2000033537).  
RESULTS AND CONCLUSION: After 14 days of intervention, the total femoral vein stasis index in the Tuina group was significantly lower than that in the control group (P < 0.05). After 14 days of intervention, the incidence of deep venous thrombosis in the Tuina group was lower than that in the control group, but there was no significant difference between the two groups (P > 0.05). After 14 days of intervention, the D-dimer value of the Tuina group was significantly lower than that of the control group (P < 0.05). After 14 days of intervention, pressure pain thresholds at medial and lateral points of the knee joint in the Tuina group were significantly higher than those in the control group (P < 0.05). After 14 days of intervention, the American Knee Society Score of the Tuina group was significantly higher than that of the control group (P < 0.05). After 14 days of intervention, the circumference difference of thigh and calf in the Tuina group was significantly lower than that in the control group (P < 0.05). No adverse events occurred in both groups. To conclude, Tuina is safe and reliable, which can improve the lower limb femoral vein stasis state, reduce the D-dimer value, reduce thigh and calf circumference difference, improve joint pain, and promote joint function rehabilitation.

Key words: knee joint, total knee arthroplasty, Tuina, point-pressing, Shu points, lower limb deep venous, D-dimer

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