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中华关节外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (06) : 721 -728. doi: 10.3877/cma.j.issn.1674-134X.2022.06.011

临床论著

循环加压冷疗仪在膝关节置换术后早期康复中的应用研究
李想1, 陈严城2, 符培亮2,()   
  1. 1. 222000 连云港市第一人民医院
    2. 200003 上海,海军军医大学长征医院关节外科
  • 收稿日期:2021-10-28 出版日期:2022-12-01
  • 通信作者: 符培亮
  • 基金资助:
    连云港市第一人民医院青年英才基金(QN2202)

Study on application of consecutive compression cryotherapy in early rehabilitation following total knee arthroplasty

Xiang Li1, Yancheng Chen2, Peiliang Fu2,()   

  1. 1. The First People’s Hospital of Lianyungang, Lianyungang 222000, China
    2. Joint Division of Orthopedics Department, Changzheng Hospital, Shanghai 200003, China
  • Received:2021-10-28 Published:2022-12-01
  • Corresponding author: Peiliang Fu
引用本文:

李想, 陈严城, 符培亮. 循环加压冷疗仪在膝关节置换术后早期康复中的应用研究[J/OL]. 中华关节外科杂志(电子版), 2022, 16(06): 721-728.

Xiang Li, Yancheng Chen, Peiliang Fu. Study on application of consecutive compression cryotherapy in early rehabilitation following total knee arthroplasty[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2022, 16(06): 721-728.

目的

评价循环加压冷疗仪在全膝关节置换术(TKA)后功能康复中的疗效。

方法

从连云港市第一人民医院选取40例无其他严重疾病的膝骨关节炎患者行单侧TKA手术作为对照组,采用常规冰袋冰敷治疗;另外选取40例行单侧人工TKA患者作为实验组,采用循环加压冷疗仪治疗。主要纳入标准:美国麻醉师协会评分Ⅳ级以下,Kellgren-Lawrence(K-L)分级≥3级。排除标准:严重膝关节外翻、内翻和畸形,精神疾病,药物依赖性疾病,严重基础疾病,局部冷疗禁忌证。所有患者术后均不使用静脉自控镇痛泵(PCA)。主要观察指标包括采用视觉模拟评分法(VAS评分)评估术后膝关节静息和活动疼痛、膝关节肿胀程度(膝关节周长)以及术后活动度(ROM)。次要观察指标:吗啡总消耗量、引流量以及并发症(如恶心、呕吐)等。统计学分析包括重复测量资料的方差分析、t检验以及卡方检验或Fisher确切概率法和Mann-Whitney检验。

结果

两组患者年龄、性别、身体质量指数、心率、手术时间等方面无明显差别。与对照组相比,实验组TKA术后活动痛VAS评分在术后36 h(t =4.10,P<0.05)和48 h(t=9.65,P<0.05)较低;髌骨上缘10 cm处膝关节肿胀程度在术后36 h(t=4.24,P=0.04)和48 h(t =90.90,P<0.001)变化明显,明显低于对照组;活动度(ROM)在术后48 h明显优于对照组(t=32.70,P<0.001);引流量在术后48 h低于对照组(t=9.88,P <0.001)。皮疹、呼吸抑制、尿潴留、症状性深静脉血栓形成(DVT)等术后并发症两组差异均无统计学意义(均为P>0.05)。

结论

与冰敷相比,循环加压冷疗仪在全TKA术后应用可以从术后第2天更加有效地缓解疼痛、减轻膝关节上方肿胀以及增加ROM,促进患者术后功能康复。

Objective

To evaluate the efficacy of consecutive compression cryotherapy in functional rehabilitation following unilateral total knee arthroplasty (TKA).

Methods

The enrollment including 40 patients undergoing TKA from the First People’s Hospital of Lianyungang adopted consecutive compression cryotherapy devices as the experimental group without other serious diseases, and the other 40 patients used ice packs as the control group. Inclusion criteria: American Society of Anesthesiologists physical status was less than grade Ⅳ, Kellgren-Lawrence (K-L) grade was higher than three. Exclusion criteria: severe knee valgus deformity, varus deformity, mental illness, addiction medicine, severe underlying disease, contraindicated local cold therapy. None of the patients received the patient controlled analgesia (PCA) pump for analgesia after the surgical procedure. The main indices included the postoperative knee joint resting and activity pain assessed by visual analogue scale (VAS), degree of swelling according to the knee perimeter, and range of motion (ROM). The secondary indices were total morphine consumption, drainage, and complications, such as postoperative nausea and vomiting (PONV). The statistical methods included repeated measurement data analysis of variance, Student t test, chi square test or Fisher exact probability method analysis, and Mann Whitney U test.

Results

There was no difference in the general data for each treatment group. Compared to the control group, active pain in the experimental group was lower at 36 h (t =4.10, P<0.05), and 48 h (t=9.65, P<0.05) after the operation. The knee circumference at 10 cm above the superior patella (knee swelling) was significantly smaller than the contralateral side at 36 h (t =4.24, P=0.04), and 48 h (t=90.90, P<0.001) after the surgery in the experimental group. The ROM in the experimental group was significantly better than the control group (t=32.70, P<0.001) at 48 h, and the volume of drainage at 48 h in the experimental group were lower than that in the control group (t=9.88, P<0.001). There was no statistically significant difference between the two groups in postoperative wound healing, incidences of rash, respiratory depression, deep vein thrombosis (DVT) or urinary retention, ect (all P>0.05).

Conclusions

Compared to ice pack, consecutive compression cryotherapy could relieve pain more effectively, reduce swelling above the knee joint, and increase mobility. The cryotherapy can promote the patient′s overall functional rehabilitation after TKA.

图1 患者使用循环加压冷疗仪治疗过程。图A为循环加压冷疗仪;图B术前患肢状态;图C为使用中患肢状态;图D术后24 h患肢状态;图E术后36 h患肢状态;图F为术后48 h患肢状态
表1 一般资料比较
表2 不同冷疗方法对活动痛的影响(±s)
表3 不同冷疗方法对静息痛的影响(±s)
表4 不同方法对术后膝关节肿胀变化的影响[ cm,(±s)]
表5 不同方法对术后引流量的影响[ml,(±s)]
表6 不同方法对活动度的影响[°,(±s)]
表7 不同方法一般情况及并发症比较
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