中医定向透药对前交叉韧带重建术后膝关节功能的影响

目的观察在常规康复的基础上配合中医定向透药疗法对关节镜下前交叉韧带重建术后患者的膝关节功能恢复的影响。 方法将80例在太仓市第一人民医院行关节镜下前交叉韧带重建术后的患者，分为治疗组与对照组(40例/组)。对照组接受运动功能训练和股四头肌内侧头、胫前肌处低频脉冲电刺激治疗，均隔日治疗1次；治疗组在对照组的基础上配合中医定向透药治疗，于每次功能训练和低频脉冲电刺激治疗前实施。术后4、8、12周评估两组患者的患肢膝关节主动屈伸关节活动度(AROM)范围、疼痛视觉模拟评分(VAS)评分和双侧腿围，术后半年随访患者的患肢膝关节屈曲AROM，并以Lysholm膝关节评分评估患肢功能状况。计数资料比较采用卡方检验；计量资料中符合正态分布的采用t检验，非正态分布的采用非参数检验。 结果治疗前两组患者的膝关节屈曲AROM、VAS评分和双侧腿围组间差异均无统计学意义(P>0.05)。治疗4周、治疗8周、治疗12周治疗组患膝疼痛VAS低于对照组(Z＝－2.68，P<0.05；Z＝－4.53，P<0.01；Z＝－3.84，P<0.01)；治疗4周、治疗8周两组膝关节AROM范围组间比较差异均无统计学意义(t＝－0.08、－0.92，均为P>0.05)，治疗12周、术后6月治疗组膝关节AROM范围大于对照组(t＝－3.72、－4.42，均为P<0.01)；治疗4周、8周、12周治疗组腿围差低于对照组(t＝3.68、7.14、9.70，均为P<0.01)。术后6个月时治疗组Lysholm评分优于对照组，差异具有统计学意义(Z＝1.90，P<0.01)。 结论在常规康复的基础上配合中医定向透药对关节镜下前交叉韧带重建术后患者的膝关节主动关节活动度、疼痛和肢体功能改善等具有治疗作用，值得推广应用。

Effect of Chinese medicine directed drug penetration on knee joint function after anterior cruciate ligament reconstruction

ObjectiveTo observe the effect of Chinese medicine directed drug penetration on knee joint function recovery after arthroscopic anterior cruciate ligament reconstruction on the basis of conventional rehabilitation combined with traditional Chinese medicine(TCM) directed penetration therapy. MethodsEighty patients who underwent arthroscopic anterior cruciate ligament reconstruction at the First People's Hospital of Taicang were divided into a treatment group and a control group (40 cases/group). The control group received motor function training and low-frequency pulsed electrical stimulation treatment on the medial head of the quadriceps and tibialis anterior muscles, and they were treated once every other day, and low frequency pulse electrical stimulation before treatment. The range of active knee flexion and extension joint mobility (AROM), pain visual analog scale (VAS) score and bilateral leg circumference of the affected knees of the two groups were evaluated at four, eight and 12 weeks after surgery. The AROM of the affected knee was recorded, and the functional status of the affected limb was evaluated by Lysholm knee scoring. Chi-square test was used for comparison of counting data, t test was used for normal distribution in measurement data, and non-parametric test was used for non-normal distribution. ResultsThere was no significant difference in knee flexion AROM, VAS scores and bilateral leg circumference between the two groups before treatment (P> 0.05). The VAS scores of knee pain in the treatment group after four weeks, eight weeks, and 12 weeks of the treatment were lower than those of the control group (Z=-2.68, P <0.05; Z=-4.53, P<0.01; Z =- 3.84, P<0.01). There was no statistically significant difference in knee AROM between the two groups after four and eight weeks of the treatment (t=-0.08, -0.92, both P> 0.05). At 12 weeks of the treatment and six months after the operation, the knee AROMs in the treatment group was larger than that in the control group (t= -3.72, -4.42, both P<0.01). At four weeks, eight weeks, 12 weeks the treatment group had lower leg circumference than the control group (t =3.68, 7.14, 9.70, all P<0.01). The Lysholm score of the treatment group was better than that of the control group at six months after surgery (Z =1.90, P<0.01). ConclusionOn the basis of conventional rehabilitation, combined with traditional Chinese medicine directional permeation medicine has therapeutic effects on knee joint active joint mobility, pain, and limb function improvement after arthroscopic anterior cruciate ligament reconstruction, which is worth popularizing and applying.