2024 年第 10 期 第 19 卷

化瘀消肿汤对全膝关节置换术后早期功能康复及血液相关指标的影响

Effect of Huayu Xiaozhong decoction on early functional rehabilitation and blood related indexes after total knee arthroplasty

作者：蔡军1路聊东1于希名2王东伟1，2

英文作者：Cai Jun1 Lu Liaodong1 Yu Ximing2 Wang Dongwei12

单位：1山东省聊城市中医医院骨关节科，聊城252000；2山东中医药大学，济南250000

英文单位：1Department of Orthopaedics Liaocheng Hospital of Traditional Chinese Medicine Shandong Province Liaocheng 252000 China; 2Shandong University of Traditional Chinese Medicine Jinan 250000 China

关键词：全膝关节置换术；化瘀消肿汤；功能康复；关节肿痛；炎症因子

英文关键词：Totalkneearthroplasty;HuayuXiaozhongdecoction;Functionalrehabilitation;Jointswellingandpain;Inflammatoryfactors

• 摘要：

• 目的 探讨化瘀消肿汤对全膝关节置换术（TKA）后患者早期功能康复及血液相关指标的影响。方法 收集2023年6月至2024年4月山东省聊城市中医医院骨关节科收治的行TKA的220例患者的病历资料，根据术后是否服用化瘀消肿汤分为对照组（103例）和观察组（117例）。比较2组患者的一般资料、关节功能改善情况、关节肿胀及疼痛改善情况、血清指标、下肢深静脉血栓发生情况。结果对照组和观察组性别、年龄、体重指数和手术侧别比较，差异均无统计学意义(均P＞0.05)。2组术后1周的膝关节功能（HSS）评分、膝关节活动度均低于术前，术后2周、1个月的HSS评分、膝关节活动度均高于术前，差异均有统计学意义（均P＜0.05）。观察组术后1周、2周、1个月的HSS评分、膝关节活动度均高于对照组，差异均有统计学意义（均P＜0.05）。2组各时点的膝关节围度比较，差异均无统计学意义(均P＞0.05)。2组术后1周、2周、1个月的视觉模拟量表（VAS）评分均低于术前，观察组术后1周、2周VAS评分均低于对照组，术后1个月的VAS评分高于对照组，差异均有统计学意义(均P＜0.05)。对照组术后1周、2周的D-二聚体、术后1周、2周、1个月的高敏C反应蛋白（hs-CRP）、术后1周的白细胞介素6（IL-6）水平均高于术前，术后2周、1个月的IL-6水平均低于术前，差异均有统计学意义(均P＜0.05)。观察组术后1周、2周、1个月的D-二聚体、hs-CRP、术后1周的IL-6水平均高于术前，术后2周、1个月的IL-6水平均低于术前，差异均有统计学意义(均P＜0.05)。观察组术后1周、2周的hs-CRP、IL-6、术后1个月的IL-6水平均低于对照组，差异均有统计学意义(均P＜0.05)。观察组下肢深静脉血栓发生率低于对照组［4.3%(5/117)比6.8%(7/103)］，但差异无统计学意义（χ2=0.676，P=0.411）。结论 TKA术后应用化瘀消肿汤能够在术后早期降低血清炎症因子水平，减轻炎症反应并缓解膝关节疼痛，从而提高关节活动度、改善关节功能评分，起到促进术后早期康复的目的。

• Objective To explore the effects of Huayu Xiaozhong decoction on early functional rehabilitation and blood related indexes in patients after total knee arthroplasty (TKA). Methods The medical records of 220 patients who underwent TKA in the Department of Orthopedics, Liaocheng Hospital of Traditional Chinese Medicine, Shandong Province from June 2023 to April 2024 were collected. The patients were divided into control group (103 cases) and observation group (117 cases) according to whether they took Huayu Xiaozhong decoction after operation. The general data, improvement of joint function, improvement of joint swelling and pain, serum indexes, and incidence of deep vein thrombosis of lower extremities were compared between the two groups. Results There were no significant differences in gender, age, body mass index and surgical side between the control group and the observation group (all P＞0.05). The knee joint function (HSS) score and knee range of motion of the two groups at 1 week after operation were lower than those before operation, and the HSS score and knee range of motion at 2 weeks and 1 month after operation were higher than those before operation (all P＜0.05). The HSS score and knee range of motion of the observation group were higher than those of the control group at 1 week, 2 weeks and 1 month after operation (all P＜0.05). There were no significant differences in knee circumference between the two groups at each time point (all P＞0.05). The visual analogue scale (VAS) scores of the two groups at 1 week, 2 weeks and 1 month after operation were lower than those before operation, the VAS scores of the observation group at 1 week and 2 weeks after operation were lower than those of the control group, and the VAS score of the observation group at 1 month after operation was higher than that of the control group (all P＜0.05). In the control group, the levels of D-dimer at 1 week and 2 weeks after operation, high-sensitivity C-reactive protein (hs-CRP) at 1 week, 2 weeks and 1 month after operation, and interleukin-6 (IL-6) at 1 week after operation were higher than those before operation, and the levels of IL-6 at 2 weeks and 1 month after operation were lower than those before operation (all P＜0.05). The levels of D-dimer, hs-CRP and IL-6 in the observation group at 1 week, 2 weeks and 1 month after operation were higher than those before operation, and the levels of IL-6 in the observation group at 2 weeks and 1 month after operation were lower than those before operation (all P＜0.05). The levels of hs-CRP and IL-6 in the observation group were lower than those in the control group at 1 week and 2 weeks after operation, and the levels of IL-6 in the observation group at 1 month after operation were lower than those in the control group (all P＜0.05). The incidence of deep vein thrombosis of lower extremities in the observation group was lower than that in the control group ［4.3%(5/117) vs 6.8%(7/103)］, but the difference was not statistically significant (χ2=0.676, P=0.411). Conclusions The application of Huayu Xiaozhong decoction after TKA can reduce the level of serum inflammatory factors in the early postoperative period, reduce the inflammatory response and relieve knee pain, so as to improve the range of motion of the joint, improve the joint function score, and promote the purpose of early postoperative rehabilitation.