84年鼠女哪年财运最旺,857comvvv色九欧美激情|85PO_87国产精品欲av国产av资源

[1]梁永瑛,郭艷明,周帥亮,等.經皮穴位電刺激聯(lián)合常規(guī)康復療法在全膝關節(jié)置換術后早期康復中的應用[J].中醫(yī)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.
點擊復制

經皮穴位電刺激聯(lián)合常規(guī)康復療法在全膝關節(jié)置換術后早期康復中的應用()
分享到：

《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期數(shù):
2017年10期
頁碼:
35-39,43
欄目:
臨床研究
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; 郭艷明; 周帥亮; 岑玨; 李德華; 陳含
上海市光華中西醫(yī)結合醫(yī)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
關鍵詞:
關節(jié)成形術; 置換; 膝;  骨關節(jié)炎; 膝;  康復;  電針;  經皮神經電刺激
Keywords:
Key words arthroplasty; replacement; knee;  osteoarthritis; knee;  rehabilitation;  electroacupuncture;  transcutaneous electric nerve stimulation
摘要:
目的:探討經皮穴位電刺激聯(lián)合常規(guī)康復療法在全膝關節(jié)置換術后早期康復中的應用價值。方法:將80例接受單側全膝關節(jié)置換術的膝骨關節(jié)炎患者隨機分為經皮穴位電刺激聯(lián)合常規(guī)康復療法組和單純常規(guī)康復療法組,每組40例。常規(guī)康復治療每天按康復計劃進行; 經皮穴位電刺激每天治療1次,每次20 min,5 d為1個療程,療程間隔2天,共4個療程。分別于治療前和治療開始后4周,記錄并比較2組患者美國膝關節(jié)協(xié)會評分(American knee society score,KSS)、美國特種外科醫(yī)院(hospital for special surgery,HSS)膝關節(jié)評分以及患側股四頭肌內、外側頭運動單位電位時限和波幅。結果:①KSS膝關節(jié)評分。治療前2組患者KSS臨床評分和功能評分比較,差異均無統(tǒng)計學意義[(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]; 治療開始后4周,經皮穴位電刺激聯(lián)合常規(guī)康復療法組KSS臨床評分和功能評分均高于單純常規(guī)康復療法組[(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組患者KSS臨床評分和功能評分均高于治療前(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膝關節(jié)評分。治療前2組患者HSS膝關節(jié)評分比較,差異無統(tǒng)計學意義[(53.60±7.33)分,(54.07±6.97)分,t=0.250,P=0.801]; 治療開始后4周,經皮穴位電刺激聯(lián)合常規(guī)康復療法組HSS膝關節(jié)評分高于單純常規(guī)康復療法組[(71.26±5.25)分,(68.03±7.06)分,t=-2.010,P=0.046],2組患者HSS膝關節(jié)評分均高于治療前(t=-10.730,P=0.000; t=-7.713,P=0.000)。③股四頭肌運動單位電位時限。治療前2組患者股四頭肌內、外側頭運動單位電位時限比較,組間差異均無統(tǒng)計學意義[(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]; 治療開始后4周,經皮穴位電刺激聯(lián)合常規(guī)康復療法組股四頭肌內側頭運動單位電位時限高于單純常規(guī)康復療法組[(11.89±2.16)ms,(11.02±1.47)ms,t=-2.010,P=0.049]; 2組患者股四頭肌外側頭運動單位電位時限比較,差異無統(tǒng)計學意義[(13.99±1.41)ms,(13.49±1.35)ms,t=-1.396,P=0.168]; 2組患者股四頭肌內、外側頭運動單位電位時限均高于治療前(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股四頭肌運動單位電位波幅。治療前2組患者股四頭肌內、外側頭運動單位電位波幅比較,組間差異均無統(tǒng)計學意義[(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]; 治療開始后4周,經皮穴位電刺激聯(lián)合常規(guī)康復療法組股四頭肌內側頭運動單位電位波幅高于單純常規(guī)康復療法組[(397.31±19.23)μv,(386.19±23.18)μv,t=-2.022,P=0.047]; 2組患者股四頭肌外側頭運動單位電位波幅比較,差異無統(tǒng)計學意義[(409.26±22.54)μv,(406.01±17.17)μv,t=-0.628,P=0.532]; 2組患者股四頭肌內、外側頭運動單位電位波幅均高于治療前(t=-6.925,P=0.000; t=3.565,P=0.000; t=-3.649,P=0.000; t=-5.956,P=0.000)。結論:對于接受單側全膝關節(jié)置換術的膝骨關節(jié)炎患者,術后早期在常規(guī)康復治療的基礎上采用經皮穴位電刺激治療,較單純常規(guī)康復治療更利于促進股四頭肌肌力的恢復,緩解臨床癥狀,恢復早期膝關節(jié)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.

參考文獻/References:

[1] 李杰,李玉華.雞尾酒療法鎮(zhèn)痛對全膝關節(jié)置換術后股四頭肌肌力影響的對比性研究[J].中國臨床醫(yī)生,2014,42(7):69-70.
[2] 黃志峰,翁習生.全膝關節(jié)置換術后早期股四頭肌肌力降低肌肉主動激活障礙和肌萎縮[J].骨科動態(tài),2005(4):174-179.
[3] 張梅英,韓書環(huán),張秋華.人工全膝關節(jié)置換術后康復訓練指導[J].中國實用神經疾病雜志,2010,13(20):45-46.
[4] 梁玲玲,梅俏蕾,姜麗,等.數(shù)字多媒體對維吾爾族全膝關節(jié)置換患者功能鍛煉依從性的影響解析[J].中華現(xiàn)代護理雜志,2016,22(6):809-811.
[5] 中華醫(yī)學會骨科學分會.骨關節(jié)炎診治指南(2007年版)[J].中國矯形外科雜志,2014,22(3):287-288.
[6] INSALL JN,DORR LD,SCOTT RD,et al.Rationale of the knee society clinical rating system[J].Clin Orthop Relat Res,1989,(248):13-14.
[7] 蔣協(xié)遠,王大偉.骨科臨床療效評價標準[M].北京:人民衛(wèi)生出版社,2005:177-178.
[8] 朱明權,張炎,曹興巍,等.全膝關節(jié)置換術后功能鍛煉時機評價[J].實用醫(yī)院臨床雜志,2016,13(3):105-107.
[9] 李付元,馮世慶,周恒星,等.人工全膝關節(jié)置換術治療膝關節(jié)骨關節(jié)炎的療效觀察[J].山東醫(yī)藥,2014,54(5):71-73.
[10] 萬斌,呂征,呂天潤.人工膝關節(jié)置換術后早期主動伸屈膝關節(jié)對康復速度的影響[J].實用老年醫(yī)學,2007,21(5):323-325.
[11] 呂曉宇,郝選明.電刺激對失用性肌萎縮肌肉肌力與肌電影響的生物學效應[J].中國臨床康復,2006,10(30):34-36.
[12] SMITH TO,NICHOLS R,HARLE D,et al.Do the vastus medialis obliquus and vastus medialis longus really exist?A systematic review[J].Clin Anat,2009,22(2):183-199.
[13] 湯琦玫,居紅飛,陳遠星.PDCA循環(huán)在全膝關節(jié)置換術后患者功能鍛煉中的應用[J].江蘇醫(yī)藥,2016,42(17):1959-1960.
[14] GASTELLANO JJ,ROJAS AM,Karia R,et al.A randomized,double-blind,placebo- controlled study of neuromuscular electrical stimulation(NMES)use for recovery after elective total hip replacement surgery[J].Bull Hosp Jt Dis,2016,74(4):275-281.
[15] 鄭光新,黃迅悟,趙曉鷗,等.神經肌肉電刺激股四頭肌對全膝關節(jié)置換術后功能康復的影響[J].中國康復醫(yī)學雜志,2011,26(12):1126-1130.
[16] 孫京濤,劉宏建,魏碹,等.電針聯(lián)合三七消腫止痛散外敷在全膝關節(jié)置換術后快速康復中的應用[J].中醫(yī)正骨,2017,29(3):10-13.

相似文獻/References:

[1]邢金明.切開復位鎖定鋼板內固定術和人工半肩關節(jié)置換術 治療老年肱骨近端復雜骨折的對比研究[J].中醫(yī)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]趙云昌.人工股骨頭置換治療老年粉碎性股骨轉子間骨折[J].中醫(yī)正骨,2015,27(08):31.
[3]張明強.生物型加長柄半髖關節(jié)置換術治療 高齡不穩(wěn)定股骨轉子間骨折療效觀察[J].中醫(yī)正骨,2015,27(02):56.
[4]蔡云仙.圍手術期耳穴按壓聯(lián)合平衡針療法 在全膝關節(jié)置換術后鎮(zhèn)痛中的應用[J].中醫(yī)正骨,2015,27(06):41.
[5]喻長純,楊明路,王戰(zhàn)朝.不同手術方式治療脛骨平臺骨折畸形愈合的體會[J].中醫(yī)正骨,2015,27(03):37.
[6]魏瑄,宋樹春,王金良.術前精確測量和評估在全髖關節(jié)置換治療 成人發(fā)育性髖關節(jié)發(fā)育不良繼發(fā)骨關節(jié)炎中的價值[J].中醫(yī)正骨,2015,27(01):30.
[7]鮑榮華,陳曉東,王國平,等.Wagner Cone生物型假體置換結合經股骨轉子下橫形截骨 治療CroweⅣ型成人發(fā)育性髖關節(jié)發(fā)育不良[J].中醫(yī)正骨,2015,27(01):33.
[8]喻長純,楊明路,王戰(zhàn)朝.同期髕骨脫位矯正術聯(lián)合全膝關節(jié)置換術治療 晚期膝骨關節(jié)炎合并習慣性髕骨脫位[J].中醫(yī)正骨,2015,27(01):41.
[9]武理國,沈軍,傅國海,等.人工肱骨頭置換治療老年肱骨近端復雜骨折[J].中醫(yī)正骨,2013,25(10):70.
[10]李國梁,韓廣普,閆國強,等.紅花化瘀湯薰蒸聯(lián)合理筋手法 在膝骨關節(jié)炎全膝關節(jié)置換術后康復中的應用[J].中醫(yī)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]樊慶陽,任凱晶.定制3D打印切模輔助全膝關節(jié)置換術治療 膝骨關節(jié)炎合并股骨干骨折畸形愈合[J].中醫(yī)正骨,2015,27(11):37.
[12]李翰林,童培建.利福平聯(lián)合用藥配合保留假體清創(chuàng)治療 人工關節(jié)置換術后早期感染及低毒性感染[J].中醫(yī)正骨,2015,27(09):56.
[13]劉曉雅,孫永強,劉國杰.主動快速康復鍛煉對全膝關節(jié)置換術后關節(jié)活動度的影響[J].中醫(yī)正骨,2015,27(09):73.
[14]張維平,康兩期,陳衛(wèi),等.全髖關節(jié)置換術圍手術期隱性失血的研究進展[J].中醫(yī)正骨,2015,27(08):61.
[15]宋兵華,孫俊英,倪增良,等.全膝關節(jié)置換術前CT測量股骨后髁角的臨床意義[J].中醫(yī)正骨,2015,27(07):38.
[16]王金良,孫京濤,李玲,等.骨水泥聯(lián)合螺釘修復全膝關節(jié)置換術中 脛骨平臺內側骨缺損[J].中醫(yī)正骨,2015,27(12):55.
[17]徐偉鋒,葉健,吳連國.強骨飲對骨質疏松性股骨頸骨折患者全髖關節(jié)置換術后 血清骨代謝生化指標和骨密度的影響[J].中醫(yī)正骨,2015,27(02):12.
　XU Weifeng,YE Jian,WU Lianguo.Effect of Qianggu Yin(強骨飲,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]張榮,王健.人工全膝關節(jié)置換術的圍手術期心理護理[J].中醫(yī)正骨,2015,27(05):77.
[19]齊志遠,陳秀民,王在斌,等.桃紅四物加黃芪湯預防人工髖膝關節(jié)置換術后 下肢深靜脈血栓形成[J].中醫(yī)正骨,2015,27(03):71.
[20]陸吳超,季衛(wèi)鋒,馬鎮(zhèn)川.關節(jié)鏡下清創(chuàng)后持續(xù)灌洗聯(lián)合中藥口服治療 全膝關節(jié)置換術后急性期感染[J].中醫(yī)正骨,2015,27(01):51.

備注/Memo

備注/Memo:
基金項目:上海市長寧區(qū)衛(wèi)生和計劃生育委員會科研項目(20134ZY03001)
更新日期/Last Update: 2018-03-10