Observation Of Curative Effect Of Manual Lymphatic Drainage On Lower Extremity Swelling After Total Knee Arthroplasty

Background: Total knee arthroplasty is an effective method to treat advanced knee osteoarthritis with the development of scientific progress and the maturity of replacement surgery technology,the use period of artificial prosthesis is prolonged,which solves the problems of patients' joint pain,deformity and dysfunction,and is recognized by most patients and families.However,due to the open surgery,complications can not be avoided,and lower limb swelling is a common postoperative complication.At present,more and more people pay attention to postoperative rehabilitation and gradually improve the awareness of rehabilitation,but for postoperative swelling,patients think it is the "normal" phenomenon caused by the operation,ignoring the harm brought and the importance of treatment.Unarmed lymphatic drainage is a special intervention for swelling,which is widely used after breast cancer surgery.It has the advantages of safety,non-invasive and targeted,and can effectively reduce the phenomenon of limb swelling.However,the application of detumescence after orthopedic injury has different effects.Objectives: In this study,Manual lymphatic drainage(MLD)was used to observe the efficacy of rehabilitation of lower limb swelling after Total Knee Arthroplasty(TKA).Whether MLD after TKA could effectively reduce the swelling of lower limb.Observe the efficacy evaluation of blood inflammation and function of postoperative patients,and observe the effectiveness of the method from various perspectives.To provide practical basis and new clinical ideas for the curative effect of postoperative swelling rehabilitation.Methods: From May 2021 to January 2022,33 patients with unilateral knee arthroplasty were enrolled in the Rehabilitation Department of Tianjin Hospital and randomly assigned to the experimental group and control group.Preoperative limb circumference measurement and Hospital for Special Surgery(HSS)score were performed in both groups,and the harm of postoperative lower limb swelling was informed and rehabilitation education was given.Both groups underwent preoperative limb circumference measurements and HSS scores,and were informed of the risks of postoperative limb swelling and rehabilitation education.The intervention in the experimental group consisted of unarmed lymphatic drainage(MLD)and routine rehabilitation.The intervention of control group was routine rehabilitation training.The intervention lasted two weeks.Surgical circumference of 10 cm above the patella,10 cm below the patella and 5 cm above the external ankle were measured,and the thickness index of the subcutaneous tissue in the swollen lower extremities was measured by ultrasound to evaluate the extent of swelling and MLD effect in both groups.White blood cell(WBC)value and C-reactive protein(CRP)concentration were observed to evaluate the results of inflammatory response after MLD.The Range of Motion(ROM)of knee flexion and extension joints,the mean root mean square(RMS)of surface electromyography of lateral femoris,rectus femoris,medial femoris and biceps femoris muscles,and the area ratio,length ratio and stability limit of the wave test of balance function were evaluated to evaluate the functional indexes after detumescence.Pain,strength,flexibility,stability,motor function and malformation were evaluated by HSS scale with semi-quantitative index.Results:1.There was no statistical difference(P > 0.05)between the two groups of subjects and the experiments were comparable.2.There was no statistical difference in circumference of affected limb(upper patella 10 cm,lower patella 10 cm,upper lateral malleolus 5cm)between the two groups(P>0.05);On the 1st,7th and 14 th day of intervention,limb circumference in both groups decreased gradually with the change of postoperative time.The upper 10 cm and lower 10 cm of patella in The MLD group were significantly different from those in the conventional rehabilitation group on the 7th and 14 th day(P<0.05),but there was no significant difference in the upper 5cm of lateral malleolus(P>0.05).3.There was no statistical difference in the subcutaneous tissue thickness of healthy and affected sides of ultrasound examination indexes between the two groups(P>0.05).There was significant difference in the decrease of subcutaneous tissue thickness before and after intervention in both groups(P<0.05),and the difference between groups was statistically significant(P<0.05),and the subcutaneous tissue thickness in the MLD group was less than that in the conventional rehabilitation group.4.There were no significant differences in the number of white blood cell and the concentration of C-reactive protein in inflammatory blood between the two groups(P>0.05);WBC and CRP concentrations in both groups decreased significantly before and after the intervention(P<0.05);no statistically significant difference in WBC values(P>0.05)was observed between the two groups after the intervention(P<0.05).5.There was no statistically significant difference in knee rang of motion(flexion and elongation)between the two groups(P>0.05);knee flexion and elongation angle were statistically significant before and after intervention(P<0.05);knee flexion angle was statistically significant in the MLD group compared to the conventional rehabilitation group(P<0.05),and knee flexion angle was not statistically significant(P>0.05).6.There was no significant difference between the two groups in the root mean square of muscle surface EMG on the affected muscle surface(P>0.05).The root mean square of the Vastus lateralis,Rectus femur,Vastus medialis and Biceps femoris before and after the intervention increased.7.There was no statistically significant difference in the blalance function index between the two groups(P>0.05);there was a statistically significant difference in Romberg test area ratio,Romberg test length ratio and stable limit before and after the intervention(P<0.05);there was no statistically significant difference in Romberg test area ratio and Romberg test length ratio between the two groups(P>0.05),and the MLD group was significantly better than the conventional rehabilitation group with statistically significant difference between the two groups(P<0.05).8.There was no significant difference in preoperative HSS scores between the two groups(P>0.05).After two weeks of intervention,HSS scores in both groups were significantly lower than those before surgery(P<0.05),and scores in MLD group were significantly better than those in conventional rehabilitation group(P<0.05).Conclusion: In this study,the rehabilitation effect of lower extremity swelling after TKA was observed by the intervention method of MLD for two weeks.MLD combined with routine rehabilitation was used in the experimental group and routine rehabilitation was used in the control group.The analysis results showed that MLD combined with routine rehabilitation training can effectively reduce limb swelling,shorten the inflammatory response cycle and improve the functional level of patients.