摘要
目的 观察经皮电刺激董氏奇穴治疗膝关节前内侧骨关节炎(AMOA)单髁置换术后疼痛的临床效果.方法 将60例AMOA单髁置换术后患者随机分为观察组与对照组各30例.两组均采用多模式镇痛方案,观察组联合经皮电刺激董氏奇穴之肩中穴、建中穴、心门穴.观察并比较两组治疗前后静息及活动状态疼痛视觉模拟量表(VAS)评分、髌上10cm周径、膝关节主动及被动活动度、血清β-内啡肽(β-EP)含量、血清前列腺素E2(PGE2)含量、额外使用镇痛药物用量、患者满意度、不良反应等指标.结果 两组静息及活动状态疼痛VAS评分、髌上10 cm周径、膝关节主动及被动活动度、β-EP含量、PGE2含量均较治疗前明显改善(P＜0.05),观察组较对照组改善更显著(P＜0.05);观察组额外使用镇痛药物用量比对照组少(P＜0.05),观察组患者满意度较对照组高(P＜0.05).结论 经皮电刺激董氏奇穴能有效缓解AMOA单髁置换术后疼痛,改善膝关节肿胀及膝关节活动度,减少镇痛药物使用,提高患者满意度,其镇痛机理可能与其抑制PGE2合成及促进β-EP合成释放有关.
Abstract
Objective:To observe the clinical effect of transcutaneous electrical acupoint stimulation(TEAS)of Tung's acupoint on the treatment of pain after unicompartmental knee arthroplasty(UKA)for anteromedial osteoar-thritis(AMOA)of the knee.Methods:60 patients with knee AMOA who underwent UKA were randomly divided into observation group and control group,with 30 patients in each group.Both groups were treated with multimodal analgesia,and the observation group was treated with TEAS at specific points identified in Dr.Tung's acupuncture system,including the Jianzhong,Xinmen,and Jianzhong points.The Visual Analogue Scale(VAS)scores for pain at rest and during movement,the circumference 10 cm above the patella,range of motion(ROM)for active and passive movements of the knee joint,serum levels of beta-endorphin(β-EP),serum levels of prostaglandin E2(PGE2),the amount of additional analgesic medication used,patient satisfaction,and adverse reactions between two groups before and after treatment were compared.Results:In both groups,the VAS scores for pain at rest and during movement,the circumference 10 cm above the patella,ROM of the knee joint,β-EP levels,and PGE2 lev-els showed significant improvement compared with before treatment levels(P＜0.05),and the observation group showed more significant improvements than the control group(P＜0.05).Additionally,the observation group used less additional analgesic medication(P＜0.05)and reported higher patient satisfaction(P＜0.05)compared with the control group.Conclusion:TEAS at Dr.Tung's acupoints effectively alleviates postoperative pain following UKA for AMOA,improves knee swelling and ROM,reduces the use of analgesics,and increases patient satisfac-tion.The analgesic mechanism may be related to the inhibition of PGE2 synthesis and promotion of β-EP synthe-sis and release.
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