世界中医药

目的:探讨中医药综合疗法方对全膝关节置换术(TKA)围手术期镇痛的疗效。方法:选取2015年1月至2015年12月在我院行单侧人工膝关节置换的膝关节骨性关节炎患者60，随机分为2组，每组30例。A组(对照组):使用西医多模式镇痛方案;B组(实验组):在西医多模式镇痛方案的基础上，配合中医药综合疗法。记录各组术前、术后各时间节点患者的静止、运动视觉模拟评分(VAS评分)、膝关节主被、动活动度(ROM值)、膝关节功能评定(HSS评分)，西药镇痛药物的使用量及不良反应。结果:2组患者在术前3 d、术后6 h、12 h、1 d、2 d、4 d、7 d、14 d、30 d静态、动态VAS评分进行比较，患者术前3 d、术后12 h、1 d、2 d、4 d、7 d、14 d、30 d静态VAS评分B组均小于A组，具有统计意义（P均<0.05），术后6 h静态VAS评分结果比较差异均无统计学意义(P>0.05);患者术前3 d、术后6 h、12 h、1 d、2 d、4 d、7 d、14 d、30 d动态VAS评分B组均小于A组，具有统计意义（P均<0.05）。2组术前3 d，术后1 d、7 d、14 d关节主、被动关节活动度(ROM值)B组明显优于A组，比较差异有统计学意义(P<0.05)，术后30 d随访2组ROM值比较，差异无统计学意义(P>0.05)。2组术后3 d、7 d、14 d、30 d患者进行HSS评分，B组均优于A组，具有统计学意义（P<0.05）。B组的不良反应发生率及选择性镇痛药物的使用量明显低于A组。结论:中医药综合疗法结合西医多模式镇痛方案比较单纯西医多模式镇痛方案能更有效地减轻TKA术后早中期的疼痛，有利于尽早功能锻炼，恢复关节功能，且不增加相关并发症的发生率，并减少术后选择性镇痛药物的使用量。

English Summary:

To study the comprehensive treatment of traditional Chinese medicine on total knee arthroplasty(TKA)perioperative analgesic efficacy.Methods:Selected in January 2015-December 2015 in our hospital artificial knee joint replacement of 60 patients with unilateral，randomly divided into 2 groups，30 cases in each group.Group A(control group)：use western medicine multimodal analgesia; Group B(experimental group)：on the basis of western medicine multimodal analgesia scheme，with comprehensive therapy of traditional Chinese medicine.Record each node in patients with preoperative and postoperative time stationary，visual analogue scale(VAS score)，knee joint is Lord，dynamic of motion(ROM)，knee joint function assessment(HSS score)，western medicine analgesia drug usage and adverse reactions.Results:Two groups of patients in the preoperative 3 d，postoperative 6 and 12 h，1，2，4，7，14，30 static，dynamic VAS score comparison，preoperative patients with 3 d，12 h after operation，1，2，4，7，14，30 static VAS score were less than group A，group B(P<0.05，with statistical significance，6 h after static VAS score results compare differences had no statistical significance(P>0.05); Patients with preoperative 3 d，postoperative 6 and 12 h，1，2，4，7，14，30 dynamic VAS score were less than group A，group B(P<0.05，with statistical significance.Two groups of preoperative 3 d，postoperative 1，7，14 d main joints and passive joints of motion(ROM)group B was better than group A，compare the difference was statistically significant(P<0.05)，the two groups after 30 d follow-up ROM value was no significant difference(P>0.05).Two groups of patients with postoperative 3，7，14，30 d，HSS score are better than that of group A，group B(P<0.05，with statistical significance.Group B of the incidence of adverse reactions and selective analgesic drugs usage was lower than that in group A.Conclusion:The combination therapy of traditional Chinese medicine combined with western medicine multimodal analgesia than pure western medicine multimodal analgesia scheme can more effectively reduce middle TKA postoperative pain，early functional exercise and restore joint function，and does not increase the incidence of related complications，selectivity and reduce postoperative analgesia drug usage.

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