| BACKGROUND:In this article, we will talk about two concepts. The first one is arthritis of knee, which is the chronic disease. It can deteriorate the subchondral bone, synovial membrane, and other soft tissue could support the knee. There are many reasons that cause the arthritis of knee, among of them, we can summarize two main pathogenesis, the primary and the secondary. The former one includes the trauma, the congenital and genetically elements, the infectious and noninfectious element etc., and we can easily diagnose this disease with these pathogenesis. But the secondary will take more efforts to diagnose, which is due to the unknown reason, such as age, sex, genetic, weight etc.Another concept is the total knee arthroplasty, which is the final and the best treatment in the arthritis of knee. It can correct the varus and valgus knee deformity, flexion deformity, and the limitation of the motion etc.. This treatment can be accepted by the doctors and the patients. There are various kinds of knee prosthesis, such as the unicompartmental knee arthroplasty used for lesion in anteromedial compartment of knee, the hinged prosthesis of knee used for serious arthritis of knee with instability of knee, the high flexion prosthesis of knee used for the man or woman who need much more campaign, and the last one is widely accepted, that is traditional condylar prosthesis, which is used for serious patients which is accompanied with sharp pain, instability, and deformity, that will limit daily motions. We have to neglect the pain, which will persist the postoperative time, and analgesia must be a significant question during perioperative time of total knee arthroplasty.OBJECTIVE:We analyze the VAS and rehabilitation in postoperative time by these records we have recorded, such as VAS, ROM (range of motion) of knee, the perimeter of the operative thigh and leg, the dosage of analgesic drugs and the follow-up records, to discover the potential of traditional Chinese therapy participating in the perioperative time of total knee arthroplasty.METHOD:We choose60female patients who get arthroplasty surgery from Mar.2012to Oct.2013in the department of bone and joint surgery of China-Japan Friendship Hospital.60participants were randomly assigned into two groups, the experimental group and the control group, both of them contain30patients. We respectively analyze these main records, such as sex, age, course of disease, HSS score, ROM of knee, VAS at rest and motion before operation, the perimeter of thigh and leg before operation and free walking distance.All the patients were operated by the same team in the median incision of the knee, then separating the quadriceps in medial edge of the patella, at the same time overturning the patella to the lateral side. All the operations were installed in the same knee prosthesis made by Zimmer in USA.The similarities between two groups were:They all oral Oxycodone Acetaminophen, drip Flurbiprofen Axetil and subcutaneously inject Low Molecular Heparin. In the rehabilitation, guiding the patient do ankle pump practice, train quadriceps, actively and passively flex and extend the knee and walk with the Cam Walker etc... Finally, patient controlled femoral nerve block analgesia pump (PCFA) from returning to ward to the second postoperative day, and the ice press ion adopt the same usage. Notably, the antithrombotic stretch hose were also dressed in the first postoperative day in case of the deep vein thrombosis.The differences were:The ice compression therapy in the experimental group will continue to the time of discharge, and adding traditional Chinese massage therapy when cancel the PCFA in the second postoperative day. In this experiment, we adopted the manipulation to treat the arthritis of knee summarized by the the3rd hospital of traditional medicine of Beijing university, and we revise some of these according to the particularity of total knee arthroplasty.Observing and recording VAS, ROM of knee, perimeter of thigh and leg in the preoperative time, the2nd postoperative time, the3rd postoperative time, the5th postoperative time and the7postoperative time etc. In the VAS records including motion and relaxation. Finally, the total dosage of analgesic drugs, the follow-up records and the length of stay were also recorded.We give the patients the guidance both in two groups, to guide them how to do exercise when they go home. In the experimental group, we excessively teach them how to do Chinese massage that continue a month. Finally we should regularly follow-up these two group, and collect relative data.THE TREATMENT CYCLE:From the2nd day to7th day in the postoperative stage.STATISTICAL SOFTWARE:SPSS17.0STATISTICAL METHODS:Firstly, we adopt two groups of independent sample T test to analyze the preoperative VAS and VAS of the second postoperative day in two group to prove that there is no differences between two group in the preoperative VAS and VAS of the second postoperative day.Next, we adopt repeated measured design to analyze the VAS in the2nd,4th,7th day in postoperative stage to certify the VAS in the experimental group in lower than the control group.RESULT60patients were finally analyzed in two groups and4patient were excluded, the reason that the LOS (length of stay) of1patient in experimental group was less than7days and the others were more than1month. The VAS in two groups were:3rd postoperative day(M:6.55±0.910vs7.80±1.240, R:3.50±1.318vs4.40±0.883, M refers to motion, R refers to at rest);5th postoperative day (M:4.35±1.268vs7.10±1.553; R:2.15± 1.089vs4.00±0.858);7th postoperative day (M:2.65±0.813vs4.20±1.056; R:1.75±0.716vs2.30±0.801). Summarily, the values of P these data were less than0.05, so these differences in two groups were in statistical significance.At the same time, the perimeter in these two groups were different.3rd postoperative day(U:46.54±3.09vs47.01±4.15;D:43.65±2.18vs43.97±2.70. U refers to15cm upward of the patella, D refers to15cm down-ward of the patella);5th postoperative day (U:45.94±2.70vs46.55±2.38; D:42.92±2.51vs43.52±3.04);7th postoperative day (U:44.08±2.13vs-45.62±3.04;D:42.05±1.39vs43.52±43.10±2.21). Summarily, the values of P these data were less than0.05, so these differences in two groups were in statistical significance.At the same time, the ROM of knee were also different. The ROM in two groups were:7th postoperative day:80.83±11.148vs72.67±11.798;1st month:91.83±7.598vs86.50±7.895. The consumption of analgesia drug in two groups were:the first7days:9.90±1.971vs12.30±2.437; the first month (except the first7days):28.27±5.065vs40.20±8.010; The frequency of adverse events of analgesia drug:the alimentary system:6.7%vs40.0%, the circulation system:3.3%vs30.0%, the others:0vs6.7%. The HSS after1month were:67.60±6.516vs67.40±5.491. Summarily, the values of P these data were less than0.05, so these differences in two groups were in statistical significance.CONCLUSIONThe analgesic effect of this method could be superior to the control group, not only the VAS, but also the perimeter of operative leg and the ROM of knee were both less than the control group. At the same time, the consumption of analgesia drug in experimental group were superior to another group, and the frequency of adverse events were the same. Finally, taking the plan with manipulation with ice compression could get the higher analgesic effect, which include safety and convenience. |
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