Study On The Clinical Effect Of Electroacupuncture On Acute Pain After Total Knee Arthroplasty And The Mechanism Of Upper Spinal Cord

Objective:1.To study the application and efficacy of acupuncture and electrotherapy after TKA denping upon the systematic review and meta-analysis.2.To observe the effect of electroacupuncture on postoperative acute pain and joint function rehabilitation after total knee arthroplasty,and provide a clinical basis for acupuncture treatment of postoperative pain and joint function rehabilitation.3.To study the supraspinal mechanism of electroacupuncture,including the specific effects of the descending pain control system,and provide a basis for the electroacupuncture analgesia mechanism.Methods:1.It is proposed to compare the clinical effects of electroacupuncture,transcutaneous electrical stimulation,acupuncture,placebo therapy and routine rehabilitation on analgesia after TKA through Bayesian network meta-analysis.And rank each treatment method.2.A randomized,single-blind,placebo-controlled clinical trial enrolled 110 subjects.In the pain assessment,the VAS scores of the electroacupuncture group were lower than those of the placebo group at 48 h and 72 h after surgery,and the pain grading ratio was also significant difference.The electroacupuncture group had fewer analgesic drugs than the placebo group.In terms of functional evaluation,the HSS score and ROM were higher at 72 h after surgery compared with the placebo group.In the evaluation of postoperative complications,the HAMA score and the nausea and vomiting score were lower;the electroacupuncture group had more reduction in the axial diameter of the knee joint than the placebo group.3.A rat model of plantar incision was established and randomly divided into electroacupuncture,placebo and control group.The first day after modeling,continuous intervention was started for three days,once a day.Record the pain behavior of rats before and 1d,2d,3d after modeling(oblique plate test,50% mechanical withdrawal threshold,thermal withdrawal latency);PAG and RVM regions of rat brain tissue were taken 3 days after modeling.The activation of ON cells and OFF cells in RVM was detected by double-label immunofluorescence;q PCR and Western Blot were used to detect the m RNA and protein levels of MOR,BDNF and Trk B in PAG and RVM,respectively,and the protein expression of p Trk B was detected.Results:1.A total of 16 studies,including 756 subjects,were included in the Bayesian mesh meta-analysis.Heterogeneity evaluation showed that the heterogeneity between the studies was not significant.Consistency test is performed and the effect amount is combined.By calculating the sorting probability,the pros and cons of the treatment measures are obtained.According to the SUCRA value,the treatment measures were ranked as follows: electroacupuncture(0.827),transcutaneous electrical stimulation(0.782),acupuncture(0.623),comfort therapy(0.225),and general rehabilitation(0.043).We can find that electroacupuncture treatment is similar to transcutaneous electrical stimulation and is better than acupuncture alone.2.Randomized,single-blind,placebo-controlled trial showed that the VAS scores of the electroacupuncture group were lower than those of the placebo group at 48 h and 72 h after surgery,and the composition ratio of pain grading was also significantly different.The electroacupuncture group used fewer analgesic drugs than the placebo group.The HSS score and ROM were higher at 72 h after operation,the HAMA score and nausea and vomiting score were lower in the electroacupuncture group than in the placebo group.The electroacupuncture group had more reduction in the circumference of the knee joint than the placebo group.3.Electroacupuncture intervention can act on RVM,activate the inhibition of OFF cells and inhibit the facilitation of ON cells;electroacupuncture can up-regulate PAG and Expression of MOR within RVM and inhibition of the BDNF/Trk B signaling pathway.Conclusion:1.The systematic review of previous studies supports the effectiveness of non-drug therapy(acupuncture and electrotherapy).Electroacupuncture,transcutaneous electrical stimulation,acupuncture is more effective than placebo and conventional rehabilitation in analgesia after TKA.The order of efficacy was electroacupuncture,transcutaneous electrical stimulation,acupuncture,comfort therapy and routine rehabilitation.2.Electroacupuncture intervention on both sides of Futu,Zusanli,Yinlingquan and Yanglingquan points can effectively reduce the acute pain of patients after TKA,and can promote early rehabilitation process,improve functional activity,reduce perioperative anxiety,Postoperative complications such as nausea and vomiting.3.Electroacupuncture stimulation can act on the spinal cord upper center,regulate the descending pain control system,promote the down-regulation and inhibit the descending facilitation to exert an analgesic effect.The molecular mechanism in the medulla oblongata promotes the expression of μ opioid receptor and inhibits BDNF/Trk B signaling pathway.