Intervention Effect Of Blood Flow Restriction Training On Sarcopenia In Patients Undergoing Total Knee Arthroplasty

ObjectiveThe aim of this study was to explore the intervention effect of blood flow restriction(BFR)training on sarcopenia in patients undergoing total knee arthroplasty(TKA),so as to provide necessary rehabilitation training options for the intervention of sarcopenia in patients undergoing TKA.Method1.A total of 264 patients with total knee replacement(TKA)combined with sarcopenia who met the inclusion criteria and were hospitalized in the Department of Orthopaedics of a Grade A hospital in Zhengzhou city from October 2020 to July 2021 were selected as the study subjects by convenience sampling method.They were divided into intervention group and control group by random number table method.Through literature review,semi-structured interview,expert demonstration and pre-experiment,blood flow restriction training program for patients with sarcopenia of knee replacement was developed.The control group was given routine nursing after surgery,and the intervention group was combined with blood flow restriction training(BFR)intervention for 8 weeks from 2 weeks after surgery.2.Before surgery,6 weeks after surgery(4 weeks after intervention)and 10 weeks after surgery(8 weeks after intervention),Inbody720 body composition analyzer was used to measure skeletal muscle mass(ASM)and SMI in all patients.The American Knee Association Score(AKS)was used to assess the recovery of knee function,the levels of interleukin-6(IL-6)and C-reactive protein(CRP)were measured to assess the levels of inflammatory factors,and the quality of life of the patients was assessed by the health Survey Brief Form(SF-36),and the incidence of complications was compared between the two groups.3.SPSS 22.0 statistical software was used to analyze the survey results.Description of general patient data by frequency and composition ratio;When the measurement data meet the normal distribution,t test is used.When the measurement data do not meet the normal distribution,non-parametric test is used.Chi-square test was used to compare counting data.Repeated measures analysis of variance to evaluate the change trend of the indicators,with P<0.05 for the difference was statistically significant.Results1.Among the 264 patients with sarcopenia of knee replacement included in this study,there were 132 cases in the intervention group and 132 cases in the control group.During the study,2 patients in the intervention group were removed due to serious complications and 1 patient in the control group was removed due to voluntary withdrawal.Finally,261 patients with sarcopenia after knee replacement were actually included,including 130 in the intervention group and 131 in the control group.Among the patients,57.47%were female,42.53%were male,and their age was mainly ≥ 60 years old.42.91%of the patients had high school or technical secondary school education.There was no statistical significance in skeletal muscle mass index of limbs,knee function score,health survey questionnaire score,inflammatory factor level and other baseline comparisons(P>0.05).2.Comparison of sarcopenia related indicators between the two groups:SMI,HGS and 4M step speed of the two groups at 4 and 8 weeks of intervention were significantly higher than those before surgery,and the intervention group was significantly higher than the control group,with statistical significance(P<0.05).Repeated measures analysis of variance showed that the rising trend of the intervention group was better than that of the control group(P<0.05),which was affected by the time factor,that is,the time effect was statistically significant(F=9.063,F=18.327,F=13.295,P<0.001);The grouping effect was statistically significant(F=11.294,F=22.893,F=18.637,P<0.001);there was an interaction between the time effect and the grouping effect(F=16.321,F=38.196,F=29.635,P<0.001).3.Comparison of knee function scores between the two groups:after 4 and 8 weeks of intervention,the knee function(AKS)scores in the intervention group were higher than those in the control group,with statistical significance(P<0.05).Repeated measurement variance analysis showed that intervention group(AKS)of the knee joint function score rise superior to control group(P<0.05),two groups of patients affected by time factor,total score time effect was statistically significant(F=19.347,P<0.001);The grouping effect was statistically significant(F=69.246,P<0.001).There was an interaction between time effect and grouping effect(F=27.610,P<0.001).4.Comparison of the incidence of complications between the two groups:the total incidence of complications in the intervention group(8.46%)was significantly lower than that in the control group(18.32%),with statistical significance(P<0.05)5.Comparison of inflammatory factor levels between the two groups:IL-6 and CRP levels in the control group were higher than those before surgery after 4 weeks and 8 weeks of intervention,while IL-6 and CRP levels in the intervention group were lower than those in the control group,with statistical significance(P<0.05).Repeated measures analysis of variance showed that the levels of inflammatory factors in the two groups of patients were affected by time factors,that is,the time effect was statistically significant(F=9.021,F=5.329,P<0.001);the grouping effect was statistically significant(F=19.674,F=11.146,P<0.001);there is an interaction between time effect and grouping effect(F=12.309,F=8.738,P<0.001).6.Comparison of scores of quality of life between the two groups:PCS and MCS scores of the two groups were significantly higher after 4 weeks and 8 weeks of intervention,and the intervention group was significantly higher than the control group,with statistically significant differences(P<0.05).The multiple-measure analysis of variance showed that the increasing trend of scores in each dimension of the intervention group was better than that of the control group(P<0.05).The scores of each dimension of the two groups of patients were affected by time factors,that is,the time effect was statistically significant(F=19.324,F=14.619,P<0.001);the grouping effect is statistically significant(F=14.659,F=17.067,P<0.001);there is an interaction between the time effect and the grouping effect(F=34.629,F=21.537,P<0.001).ConclusionBFR training can achieve clear intervention effect on sarcopenia in patients undergoing TKA.It can not only significantly improve knee function and significantly increase skeletal muscle mass and muscle strength of the patients,but also significantly inhibit inflammatory response and improve quality of life of the patients.In addition,it can effectively reduce the risk of postoperative complications.The research results provide a theoretical basis for the application of BFR training in intervention of sarcopenia in patients undergoing TKA.