[1]梁永瑛,郭艳明,周帅亮,等.经皮穴位电刺激联合常规康复疗法在全膝关节置换术后早期康复中的应用[J].中医正骨,2017,29(10):35-39,43.
　LIANG Yongying,GUO Yanming,ZHOU Shuailiang,et al.Application of transcutaneous electric acupoint stimulation combined with conventional rehabilitation therapy to early rehabilitation after total knee arthroplasty[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(10):35-39,43.
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经皮穴位电刺激联合常规康复疗法在全膝关节置换术后早期康复中的应用()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期数:
2017年10期
页码:
35-39,43
栏目:
临床研究
出版日期:
2017-10-20

文章信息/Info

Title:
Application of transcutaneous electric acupoint stimulation combined with conventional rehabilitation therapy to early rehabilitation after total knee arthroplasty
作者:
梁永瑛; 郭艳明; 周帅亮; 岑珏; 李德华; 陈含
上海市光华中西医结合医院,上海 200052
Author(s):
LIANG Yongying; GUO Yanming; ZHOU Shuailiang; CEN Jue; LI Dehua; CHEN Han
Shanghai Guanghua combinational hospital of traditional Chinese medicine and Western medicine,Shanghai 200052,China
关键词:
关节成形术; 置换; 膝;  骨关节炎; 膝;  康复;  电针;  经皮神经电刺激
Keywords:
Key words arthroplasty; replacement; knee;  osteoarthritis; knee;  rehabilitation;  electroacupuncture;  transcutaneous electric nerve stimulation
摘要:
目的:探讨经皮穴位电刺激联合常规康复疗法在全膝关节置换术后早期康复中的应用价值。方法:将80例接受单侧全膝关节置换术的膝骨关节炎患者随机分为经皮穴位电刺激联合常规康复疗法组和单纯常规康复疗法组,每组40例。常规康复治疗每天按康复计划进行; 经皮穴位电刺激每天治疗1次,每次20 min,5 d为1个疗程,疗程间隔2天,共4个疗程。分别于治疗前和治疗开始后4周,记录并比较2组患者美国膝关节协会评分(American knee society score,KSS)、美国特种外科医院(hospital for special surgery,HSS)膝关节评分以及患侧股四头肌内、外侧头运动单位电位时限和波幅。结果:①KSS膝关节评分。治疗前2组患者KSS临床评分和功能评分比较,差异均无统计学意义[(42.33±7.50)分,(45.33±7.76)分,t=1.523,P=0.133;(47.74±6.04)分,(44.93±4.93)分,t=-1.972,P=0.053]; 治疗开始后4周,经皮穴位电刺激联合常规康复疗法组KSS临床评分和功能评分均高于单纯常规康复疗法组[(71.71±4.41)分,(68.96±6.29)分,t=-2.049,P=0.045;(72.77±6.56)分,(69.53±5.61)分,t=-2.083,P=0.042],2组患者KSS临床评分和功能评分均高于治疗前(t=-18.519,P=0.000; t=-13.246,P=0.000; t=-15.379,P=0.000; t=-18.042,P=0.000)。②HSS膝关节评分。治疗前2组患者HSS膝关节评分比较,差异无统计学意义[(53.60±7.33)分,(54.07±6.97)分,t=0.250,P=0.801]; 治疗开始后4周,经皮穴位电刺激联合常规康复疗法组HSS膝关节评分高于单纯常规康复疗法组[(71.26±5.25)分,(68.03±7.06)分,t=-2.010,P=0.046],2组患者HSS膝关节评分均高于治疗前(t=-10.730,P=0.000; t=-7.713,P=0.000)。③股四头肌运动单位电位时限。治疗前2组患者股四头肌内、外侧头运动单位电位时限比较,组间差异均无统计学意义[(10.59±1.42)ms,(10.46±1.37)ms,t=-0.380,P=0.706;(12.79±1.49)ms,(12.80±1.32)ms,t=0.009,P=0.992]; 治疗开始后4周,经皮穴位电刺激联合常规康复疗法组股四头肌内侧头运动单位电位时限高于单纯常规康复疗法组[(11.89±2.16)ms,(11.02±1.47)ms,t=-2.010,P=0.049]; 2组患者股四头肌外侧头运动单位电位时限比较,差异无统计学意义[(13.99±1.41)ms,(13.49±1.35)ms,t=-1.396,P=0.168]; 2组患者股四头肌内、外侧头运动单位电位时限均高于治疗前(t=-3.024,P=0.003; t=-1.520,P=0.033; t=-3.170,P=0.002; t=-1.850,P=0.048)。④股四头肌运动单位电位波幅。治疗前2组患者股四头肌内、外侧头运动单位电位波幅比较,组间差异均无统计学意义[(362.70±19.47)μv,(365.77±21.15)μv,t=0.583,P=0.562;(388.70±20.99)μv,(381.37±14.77)μv,t=-1.570,P=0.121]; 治疗开始后4周,经皮穴位电刺激联合常规康复疗法组股四头肌内侧头运动单位电位波幅高于单纯常规康复疗法组[(397.31±19.23)μv,(386.19±23.18)μv,t=-2.022,P=0.047]; 2组患者股四头肌外侧头运动单位电位波幅比较,差异无统计学意义[(409.26±22.54)μv,(406.01±17.17)μv,t=-0.628,P=0.532]; 2组患者股四头肌内、外侧头运动单位电位波幅均高于治疗前(t=-6.925,P=0.000; t=3.565,P=0.000; t=-3.649,P=0.000; t=-5.956,P=0.000)。结论:对于接受单侧全膝关节置换术的膝骨关节炎患者,术后早期在常规康复治疗的基础上采用经皮穴位电刺激治疗,较单纯常规康复治疗更利于促进股四头肌肌力的恢复,缓解临床症状,恢复早期膝关节功能。
Abstract:
ABSTRACT Objective:To explore the applied value of transcutaneous electric acupoint stimulation(TEAS)combined with conventiona rehabilitation therapy in early rehabilitation after total knee arthroplasty(TKA).Methods:Eighty patients with knee osteoarthritis(KOA)were randomly divided into 2 groups after unilateral TKA and were treated with combination therapy of TEAS and conventional rehabilitation(group A)and monotherapy of conventional rehabilitation(group B),40 cases in each group.TEAS was performed once a day for consecutive 4 course of treatment,20 minutes at a time,5 days for each course with a 2-day rest-insertion between courses; while conventional rehabilitation was performed according to the rehabilitation plan every day.American knee society score(KSS),hospital for special surgery(HSS)knee scores and timing and wave amplitude of motor unit potential of medial and lateral heads of quadriceps femoris of affected side were recorded and compared between the 2 groups before treatment and at 4 weeks after the beginning of the treatment respectively.Results:There was no statistical difference in KSS clinical scores and function scores between the 2 groups before treatment(42.33+/-7.50 vs 45.33+/-7.76 points,t=1.523,P=0.133; 47.74+/-6.04 vs 44.93+/-4.93 points,t=-1.972,P=0.053).At 4 weeks after the beginning of the treatment,KSS clinical scores and function scores were higher in group A compared to group B(71.71+/-4.41 vs 68.96+/-6.29 points,t=-2.049,P=0.045; 72.77+/-6.56 vs 69.53+/-5.61 points,t=-2.083,P=0.042),and were higher at 4 weeks after the beginning of the treatment compared to pre-treatment in the 2 groups(t=-18.519,P=0.000; t=-13.246,P=0.000; t=-15.379,P=0.000; t=-18.042,P=0.000).There was no statistical difference in HSS knee scores between the 2 groups before treatment(53.60+/-7.33 vs 54.07+/-6.97 points,t=0.250,P=0.801).At 4 weeks after the beginning of the treatment,the HSS knee scores were higher in group A compared to group B(71.26+/-5.25 vs 68.03+/-7.06 points,t=-2.010,P=0.046),and were higher at 4 weeks after the beginning of the treatment compared to pre-treatment in the 2 groups(t=-10.730,P=0.000; t=-7.713,P=0.000).There was no statistical difference in the timing of motor unit potential of medial and lateral heads of quadriceps femoris between the 2 groups before treatment(10.59+/-1.42 vs 10.46+/-1.37 ms,t=-0.380,P=0.706; 12.79+/-1.49 vs 12.80+/-1.32 ms,t=0.009,P=0.992).At 4 weeks after the beginning of the treatment,the timing of motor unit potential of medial head of quadriceps femoris was higher in group A compared to group B(11.89+/-2.16 vs 11.02+/-1.47 ms,t=-2.010,P=0.049),and there was no statistical difference in the timing of motor unit potential of lateral head of quadriceps femoris between the 2 groups(13.99+/-1.41 vs 13.49+/-1.35 ms,t=-1.396,P=0.168).The timing of motor unit potential of medial and lateral heads of quadriceps femoris was higher at 4 weeks after the beginning of the treatment compared to pre-treatment in the 2 groups(t=-3.024,P=0.003; t=-1.520,P=0.033; t=-3.170,P=0.002; t=-1.850,P=0.048).There was no statistical difference in the wave amplitude of motor unit potential of medial and lateral heads of quadriceps femoris between the 2 groups before treatment(362.70+/-19.47 vs 365.77+/-21.15 μv,t=0.583,P=0.562; 388.70+/-20.99 vs 381.37+/-14.77 μv,t=-1.570,P=0.121).At 4 weeks after the beginning of the treatment,the wave amplitude of motor unit potential of medial head of quadriceps femoris was higher in group A compared to group B(397.31+/-19.23 vs 386.19+/-23.18 μv,t=-2.022,P=0.047).There was no statistical difference in the wave amplitude of motor unit potential of lateral head of quadriceps femoris between the 2 groups(409.26+/-22.54 vs 406.01+/-17.17 μv,t=-0.628,P=0.532).The wave amplitude of motor unit potential of medial and lateral heads of quadriceps femoris was higher at 4 weeks after the beginning of the treatment compared to pre-treatment in the 2 groups(t=-6.925,P=0.000; t=3.565,P=0.000; t=-3.649,P=0.000; t=-5.956,P=0.000).Conclusion:For patients with KOA who received unilateral TKA,the combination therapy of conventional rehabilitation and TEAS is more conducive to the recovery of muscular strength of quadriceps femoris,the remission of clinical symptom and the early recovery of knee function compared to the monotherapy of conventional rehabilitation.

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备注/Memo

备注/Memo:
基金项目:上海市长宁区卫生和计划生育委员会科研项目(20134ZY03001)
更新日期/Last Update: 2018-03-10