[1]李文龙,李阳阳,张海龙,等.腕踝针联合自控镇痛泵治疗全髋关节置换术后髋关节疼痛的临床研究[J].中医正骨,2016,28(10):24-28.
　LI Wenlong,LI Yangyang,ZHANG Hailong,et al.Clinical study on wrist-ankle acupuncture analgesia combined with patient-controlled analgesia for treatment of hip pain after total hip arthroplasty[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(10):24-28.
点击复制

腕踝针联合自控镇痛泵治疗全髋关节置换术后髋关节疼痛的临床研究()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期数:
2016年10期
页码:
24-28
栏目:
临床研究
出版日期:
2016-10-20

文章信息/Info

Title:
Clinical study on wrist-ankle acupuncture analgesia combined with patient-controlled analgesia for treatment of hip pain after total hip arthroplasty
作者:
李文龙1; 李阳阳1; 张海龙1; 刘又文2
1.河南中医药大学,河南 郑州 450008;
2.河南省洛阳正骨医院/河南省骨科医院,河南 洛阳 471002
Author(s):
LI Wenlong1; LI Yangyang1; ZHANG Hailong1; LIU Youwen2
1.Henan University of Traditional Chinese Medicine,Zhengzhou 450008,Henan,China 2.Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China
关键词:
关节成形术; 置换; 髋;  疼痛; 手术后;  针刺镇痛;  镇痛; 病人控制
Keywords:
arthroplasty; replacement; hip;  pain; postoperative;  acupuncture analgesia;  analgesia; patient-controlled
摘要:
目的:观察腕踝针联合自控镇痛泵(patient controlled analgesia,PCA)治疗全髋关节置换术(total hip arthroplasty,THA)后髋关节疼痛的临床疗效和安全性。方法:68例接受单侧THA手术的患者随机分为2组,腕踝针联合PCA组35例、PCA组33例。2组患者术前均接受疼痛知识宣教,术后均采用PCA镇痛48 h。腕踝针联合PCA组在此基础上从术前3 d开始行腕踝针针刺镇痛治疗,每日1次,10 d为1个疗程,共治疗1个疗程。记录术后48 h内2组患者每12 h的PCA镇痛药使用量; 分别在术后12、24、36、48 h及术后3、4、5 d采用疼痛视觉模拟量表(visual analogue scale,VAS)对2组患者髋关节疼痛情况进行评估; 观察术后48 h内2组患者不良反应发生情况; 术后2周,依据髋关节Harris评分标准评价髋关节功能。结果:2组患者髋关节疼痛VAS评分术后不同时间点间的差异具有统计学意义,即存在时间效应(F=220.239,P=0.000); 术后12、24、36、48 h时,2组髋关节疼痛VAS评分的组间差异均无统计学意义[(6.22±1.01)分,(6.15±1.13)分,t=0.273,P=0.786;(5.32±0.99)分,(5.17±1.27)分,t=0.513,P=0.610;(3.83±0.26)分,(3.92±0.34)分,t=-1.667,P=0.098;(3.06±0.28)分,(2.99±0.23)分,t=0.954,P=0.344]; 术后3、4、5 d时,腕踝针联合PCA组髋关节疼痛VAS评分低于PCA组[(3.68±0.25)分,(4.17±0.32)分,t=-7.528,P=0.000;(3.58±0.35)分,(4.03±0.26)分,t=-5.878,P=0.000;(2.96±0.48)分,(3.17±0.24)分,t=-2.244,P=0.029]; 2组间总体比较,腕踝针联合PCA组髋关节疼痛VAS评分低于PCA组,即存在分组效应(F=5.617,P=0.021); 时间因素和分组因素之间不存在交互效应(F=2.621,P=0.058)。2组患者术后不同时间点间镇痛药用量的差异具有统计学意义,即存在时间效应(F=667.298,P=0.000); 术后0～12 h、12～24 h、24～36 h、36～48 h腕踝针联合PCA组镇痛药用量均少于PCA组[(76.49±7.69)mL,(80.98±5.81)mL,t=-2.705,P=0.009;(63.51±6.10)mL,(69.98±5.37)mL,t=-4.636,P=0.000;(45.61±4.29)mL,(49.76±6.01)mL,t=-3.295,P=0.002;(41.28±3.75)mL,(43.52±3.85)mL,t=-2.430,P=0.018]; 2组间总体比较,腕踝针联合PCA组镇痛药用量少于PCA组,即存在分组效应(F=37.065,P=0.000); 时间因素和分组因素不存在交互效应(F=1.765,P=0.155)。术后2周,腕踝针联合PCA组患髋Harris评分高于PCA组[(80.37±4.56)分,(76.06±2.73)分,t=4.693,P=0.000]。术后48 h内,腕踝针联合PCA组发生恶心呕吐6例、尿潴留3例、眩晕2例、嗜睡2例,PCA组发生恶心呕吐13例、尿潴留8例、眩晕3例、嗜睡4例; 腕踝针联合PCA组不良反应发生率低于PCA组(χ2=16.147,P=0.000)。结论:对于THA术后髋关节疼痛,腕踝针联合PCA较单纯PCA镇痛效果好、镇痛药用量少,有利于髋关节功能恢复,且不良反应少。
Abstract:
Objective:To observe the clinical curative effects and safety of wrist-ankle acupuncture analgesia combined with patient-controlled analgesia(PCA)in treatment of hip pain after total hip arthroplasty(THA).Methods:Sixty-eight patients who received unilateral THA were randomly divided into combination group(35 cases)and PCA group(33 cases).All patients in both of the groups were taught pain knowledge before surgery,and then received PCA analgesia for 48 hours after surgery.Meanwhile,the patients in combination group were treated with wrist-ankle acupuncture analgesia from the third day before surgery,once a day for one course of treatment,10 days for each course.The consumption of PCA analgesics were recorded every 12 hours within 48 hours after surgery.The hip pain were evaluated by using visual analogue scale(VAS)at 12,24,36 and 48 hours and 3,4 and 5 days after surgery respectively.The incidence rates of adverse reactions were observed within 48 hours after surgery and the hip function were also evaluated according to Harris hip scoring standard.Results:There was statistical difference in hip pain VAS scores between different postoperative timepoints,in other words,there was time effect(F=220.239,P=0.000).There was no statistical difference in hip pain VAS scores between the 2 groups at 12,24,36 and 48 hours after surgery(6.22+/-1.01 vs 6.15+/-1.13 points,t=0.273,P=0.786; 5.32+/-0.99 vs 5.17+/-1.27 points,t=0.513,P=0.610; 3.83+/-0.26 vs 3.92+/-0.34 points,t=-1.667,P=0.098; 3.06+/-0.28 vs 2.99+/-0.23 points,t=0.954,P=0.344).The hip pain VAS scores were lower in combination group compared to PCA group at 3,4 and 5 days after surgery(3.68+/-0.25 vs 4.17+/-0.32 points,t=-7.528,P=0.000; 3.58+/-0.35 vs 4.03+/-0.26 points,t=-5.878,P=0.000; 2.96+/-0.48 vs 3.17+/-0.24 points,t=-2.244,P=0.029).The hip pain VAS scores were lower in combination group compared to PCA group in general,in other words,there was group effect(F=5.617,P=0.021).There was no interaction between time factor and group factor(F=2.621,P=0.058).There was statistical difference in the consumption of PCA analgesics between different postoperative timepoints,in other words,there was time effect(F=667.298,P=0.000).The consumption of PCA analgesics was less in combination group compared to PCA group at 0-12,12-24,24-36 and 36-48 hours after surgery(76.49+/-7.69 vs 80.98+/-5.81 ml,t=-2.705,P=0.009; 63.51+/-6.10 vs 69.98+/-5.37 ml,t=-4.636,P=0.000; 45.61+/-4.29 vs 49.76+/-6.01 ml,t=-3.295,P=0.002; 41.28+/-3.75 vs 43.52+/-3.85 ml,t=-2.430,P=0.018).The consumption of PCA analgesics was less in combination group compared to PCA group in general,in other words,there was group effect(F=37.065,P=0.000).There was no interaction between time factor and group factor(F=1.765,P=0.155).The Harris hip scores were higher in combination group compared to PCA group at 2 weeks after surgery(80.37+/-4.56 vs 76.06+/-2.73 points,t=4.693,P=0.000).Nausea and vomiting(6),uroschesis(3),dizziness(2)and somnolence(2)were found in combination group,while nausea and vomiting(13),uroschesis(8),dizziness(3)and somnolence(4)were found in PCA group within 48 hours after surgery.The incidence rate of adverse reactions was lower in combination group compared to PCA group(χ2=16.147,P=0.000).Conclusion:The combination therapy of wrist-ankle acupuncture analgesia and PCA has the advantages of better clinical effects and less consumption of PCA analgesics compared to the monotherapy of PCA in the treatment of hip pain after THA,and it is more conducive to the hip function recovery with less adverse reactions.

参考文献/References:

[1] 李文龙,范亚楠,张蕾蕾,等.微创全髋关节置换术直接前侧入路与外侧小切口入路的对比研究[J].中医正骨,2016,28(3):24-29.
[2] 杨玉霞,杨桦,范茹,等.直接前入路微创全髋关节置换术的围手术期护理[J].中医正骨,2016,28(3):77-78.
[3] 张飞,李奇,林荔军,等.联合多模式镇痛在全髋关节置换术后的早期疗效[J].中华关节外科杂志:电子版,2013,7(3):329-332.
[4] Cata JP,Gottumukkala V,Thakar D,et al.Effects of postoperative epidural analgesia on recurrence-free and overall survival in patients with nonsmall cell lung cancer[J].J Clin Anesth,2014,26(1):3-17.
[5] 中国人民解放军第二军医大学第一附属医院.讲座——腕踝针[J].江苏医药(中医分册),1976,(2):59-61.
[6] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:123-124.
[7] Harris WH.Traumatic arthritis of the hip after dislocation and acetabular fractures:treatment by mold arthroplasty.An end-result study using a new method of result evaluation[J].J Bone Joint Surg Am,1969,51(4):737-755.
[8] Goebel S,Steinert AF,Schillinger J,et al.Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach[J].Int Orthop,2012,36(3):491-498.
[9] Kearney M,Jennrich MK,Lyons S,et al.Effects of preoperative education on patient outcomes after joint replacement surgery[J].Orthop Nurs,2011,30(6):391-396.
[10] Devon HA,Piano MR,Rosenfeld AG.The association of pain with protein inflammatory biomarkers a review of the literature[J].Nurs Res,2014,63(1):51-62.
[11] 黄双英,童培建,吴蔚,等.腕踝针对老年全膝关节置换术后镇痛效果的疗效评价[J].中华中医药学刊,2013,31(5):1014-1016.
[12] 蔡亚红,叶富英.腕踝针镇痛作用研究进展[J].上海中医药杂志,2013,47(3):82-85.
[13] 冯涛,杨洪建.耳穴联合腕踝针对人工髋关节置换术后的镇痛作用[J].长春中医药大学学报,2015,31(3):576-579.
[14] 周友龙,张世卿,孙国胜,等.踝三针治疗腰椎间盘突出症根性痛临床观察[J].中国针灸,2006,26(12):847-850.
[15] 王浩洋,康鹏德,裴福兴,等.全髋关节置换术后多模式镇痛的有效性及安全性[J].中国矫形外科杂志,2013,21(10):976-980.

相似文献/References:

[1]邢金明.切开复位锁定钢板内固定术和人工半肩关节置换术 治疗老年肱骨近端复杂骨折的对比研究[J].中医正骨,2015,27(08):11.
　XING Jinming.A retrospective trial of open reduction and locking plate internal fixation versus artificial shoulder hemiarthroplasty for complicated proximal humeral fractures in old patients[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(10):11.
[2]赵云昌.人工股骨头置换治疗老年粉碎性股骨转子间骨折[J].中医正骨,2015,27(08):31.
[3]张明强.生物型加长柄半髋关节置换术治疗 高龄不稳定股骨转子间骨折疗效观察[J].中医正骨,2015,27(02):56.
[4]蔡云仙.围手术期耳穴按压联合平衡针疗法 在全膝关节置换术后镇痛中的应用[J].中医正骨,2015,27(06):41.
[5]喻长纯,杨明路,王战朝.不同手术方式治疗胫骨平台骨折畸形愈合的体会[J].中医正骨,2015,27(03):37.
[6]魏瑄,宋树春,王金良.术前精确测量和评估在全髋关节置换治疗 成人发育性髋关节发育不良继发骨关节炎中的价值[J].中医正骨,2015,27(01):30.
[7]鲍荣华,陈晓东,王国平,等.Wagner Cone生物型假体置换结合经股骨转子下横形截骨 治疗CroweⅣ型成人发育性髋关节发育不良[J].中医正骨,2015,27(01):33.
[8]喻长纯,杨明路,王战朝.同期髌骨脱位矫正术联合全膝关节置换术治疗 晚期膝骨关节炎合并习惯性髌骨脱位[J].中医正骨,2015,27(01):41.
[9]武理国,沈军,傅国海,等.人工肱骨头置换治疗老年肱骨近端复杂骨折[J].中医正骨,2013,25(10):70.
[10]李国梁,韩广普,闫国强,等.红花化瘀汤薰蒸联合理筋手法 在膝骨关节炎全膝关节置换术后康复中的应用[J].中医正骨,2013,25(12):31.
　Li Guoliang*,Han Guangpu,Yan Guoqiang,et al.Clinical application of HONGHUAHUAYU decoctions steaming combined with sinew adjusting manipulation in the postoperative rehabilitation of total knee arthroplasty in patients with knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2013,25(10):31.
[11]樊庆阳,任凯晶.定制3D打印切模辅助全膝关节置换术治疗 膝骨关节炎合并股骨干骨折畸形愈合[J].中医正骨,2015,27(11):37.
[12]李翰林,童培建.利福平联合用药配合保留假体清创治疗 人工关节置换术后早期感染及低毒性感染[J].中医正骨,2015,27(09):56.
[13]刘晓雅,孙永强,刘国杰.主动快速康复锻炼对全膝关节置换术后关节活动度的影响[J].中医正骨,2015,27(09):73.
[14]张维平,康两期,陈卫,等.全髋关节置换术围手术期隐性失血的研究进展[J].中医正骨,2015,27(08):61.
[15]宋兵华,孙俊英,倪增良,等.全膝关节置换术前CT测量股骨后髁角的临床意义[J].中医正骨,2015,27(07):38.
[16]王金良,孙京涛,李玲,等.骨水泥联合螺钉修复全膝关节置换术中 胫骨平台内侧骨缺损[J].中医正骨,2015,27(12):55.
[17]徐伟锋,叶健,吴连国.强骨饮对骨质疏松性股骨颈骨折患者全髋关节置换术后 血清骨代谢生化指标和骨密度的影响[J].中医正骨,2015,27(02):12.
　XU Weifeng,YE Jian,WU Lianguo.Effect of Qianggu Yin(强骨饮,QGY)on serum bone metabolism indexes and bone density after total hip arthroplasty in patients with osteoporotic femoral neck fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(10):12.
[18]张荣,王健.人工全膝关节置换术的围手术期心理护理[J].中医正骨,2015,27(05):77.
[19]齐志远,陈秀民,王在斌,等.桃红四物加黄芪汤预防人工髋膝关节置换术后 下肢深静脉血栓形成[J].中医正骨,2015,27(03):71.
[20]陆吴超,季卫锋,马镇川.关节镜下清创后持续灌洗联合中药口服治疗 全膝关节置换术后急性期感染[J].中医正骨,2015,27(01):51.

备注/Memo

备注/Memo:
基金项目:河南省研究生教育创新培养基地2015年度研究生创新基金项目
通讯作者:刘又文 E-mail:liuyouwen543@sina.com
更新日期/Last Update: 2016-10-20