[1]袁帅,丁喆如,吴宇黎,等. 膝关节镜下前交叉韧带重建术后冰敷对患者早期康复效果的影响[J].中华老年骨科与康复电子杂志,2019,(04):190-195.[doi:DOI：10.3877/cma.j.issn.2096-0263.2019.04.002]
　Yuan Shuai,Ding Zheru,Wu Yuli,et al. Effection of ice pack for the early rehabilitation of the patient underwent anterior cruciate ligament reconstruction with arthroscopy[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2019,(04):190-195.[doi:DOI：10.3877/cma.j.issn.2096-0263.2019.04.002]
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 膝关节镜下前交叉韧带重建术后冰敷对患者早期康复效果的影响
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2019年04期
页码:
190-195
栏目:
膝关节
出版日期:
2019-08-05

文章信息/Info

Title:
 Effection of ice pack for the early rehabilitation of the patient underwent anterior cruciate ligament reconstruction with arthroscopy
作者:
 袁帅; 丁喆如 ; 吴宇黎;  吴海山 ; 祝云利

作者单位：200003 上海，第二军医大学长征医院关节外科
Author(s):
Yuan Shuai;  Ding Zheru;  Wu Yuli;  Wu Haishan;  Zhu Yunli.
 Department of Joint Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, 200433, China
关键词:
 ; 【关键词】 冰袋;  关节镜;  膝关节
Keywords:
 ; 【Key words】 Ice;  Arthroscopy;  Knee Joint
DOI:
DOI：10.3877/cma.j.issn.2096-0263.2019.04.002
文献标志码:
A
摘要:
 【摘要】 目的 探讨膝关节镜下前交叉韧带重建术后局部冰敷疗法的早期临床效果。方法 前瞻性收集2016年1月至2016年6月第二军医大学长征医院关节外科行膝关节镜下前交叉韧带重建术的患者共40例，其中男性33例，女性7例，采用随机数字表法随机分为两组，每组20例。冰敷组平均年龄（27±8）岁，对照组（27±7）岁。对照组术后给予常规护理，冰敷组在常规护理的基础上术后立即给予10%NaCl冰袋冰敷，观察两组患者疼痛度，肿胀度，膝关节活动度，足趾氧饱和度的区别。结果 所有患者均获得满意随访，随访率100%。随访时间6个月，冰敷组患者术后6 h、12 h、24 h、48 h、72 h疼痛视觉模拟评分（VAS）均小于对照组，差异有统计学意义（t=4.160，P<0.05；t=5.286，P<0.05；t=6.799，P<0.05；t=14.150，P<0.05； t=5.670，P<0.05）。冰敷组患膝取三定点测量术后24、48、72 h肿胀值均小于对照组，且差异具有统计学意义（髌骨中点t=4.101，P<0.05；t=9.430，P<0.05；t=5.800，P<0.05；髌骨上极2 cm处t=3.187，P=0.003；t=6.539，P<0.05；t=3.002，P<0.05；腓肠肌最粗处t=4.105，P<0.05; t=8.437，P<0.05；t=5.670，P<0.05）。冰敷组术后6 w膝关节活动度优于对照组，差异具有统计学意义（t=7.503，P＜0.05）。冰敷组术后6个月膝关节活动度优于对照组，差异无统计学意义（t=1.872，P=0.067）。冰敷组与对照组患肢足趾末梢氧饱和度差异无统计学意义。结论 膝关节镜下前交叉韧带重建术后立即给予冰袋冰敷并持续72 h，并结合适当的功能锻炼，可减轻术后早期疼痛、减轻患肢肿胀发生、改善患肢膝关节活动度，同时冰敷并不会影响患肢末梢血运。
Abstract:

【Abstract】 Objective To investigate the early clinical effect of local ice therapy after anterior cruciate ligament reconstruction with knee arthroscopy. Methods A total of 40 patients underwent reconstruction of anterior cruciate ligament with knee arthroscopy in our department between January 2016 and June 2016.They were divided into two groups by random number table, and there were 20 cases in each group. The control group received routine nursing after the operation, and the observation group was give nice compress with cold packs besides routine nursing at the same time. The difference of pain degree, swelling degree, knee mobility and toe oxygen saturation between the two groups were observed. Results The VAS of the patients in the observation group after 6, 12, 24, 48 and 72 hours were all smaller than that of the control group, the difference was statistically significant. The swelling value of observation group after 24, 48 and 72 hours was smaller than that of control group, and the difference was statistically significant. The knee mobility of the observation group was better than that of the control group at 6 weeks after operation, and the difference was statistically significant. The knee mobility of the observation group was better than that of the control group at 6 months after operation, and the difference was not statistically significant. There was no significant difference in toe oxygen saturation between the two groups. Conclusion Patients after anterior cruciate ligament reconstruction with knee arthroscopy, given ice compress and lasted for 72 hours, and combined with the appropriate function exercise, can help to reduce postoperative pain and limb swelling, improve knee joint motion effectively, and the ice compress will not affect the patient’s peripheral blood supply.

参考文献/References:

 1 Ahn JH, Lee YS, Ha HC. Anterior cruciate ligament Reconstruction with preservation of remnant bundle using hamstring autograft: technical note [J]. Arch Orthop Trauma Surg, 2009, 129(8): 1011-1015.
2 章亚东, 侯树勋, 张轶超, 等. 关节镜下前交叉韧带重建后内侧和外侧半月板同期移植术 [J]. 中华外科杂志, 2011, 49(7): 581-585.
3 王洪, 孟春庆, 段德宇, 等. 关节镜下自体腘绳肌和异体胫前肌单束重建前交叉韧带的1年随访比较 [J]. 中国组织工程研究与临床康复, 2011, 15(53): 10064-10067.
4 WolfSK, BarfieldWR, MerrillKD, et al. Comparison of a continuous temperature-controlled cryotherapy device to a simple icing regimen following outpatient kneearthroscopy [J]. J Knee Surg, 2008, 21(1): 15-19.
5 范海燕, 马海燕. 冰袋冷敷在四肢骨折术后早期的应用 [J]. 河南外科学杂志, 2004, 10(1): 79.
6 孟虹, 王悦. 膝关节镜术后护理与康复指导 [J]. 中国实用医药, 2012, 7(13): 212-213.
7 MuirL. Complicationsof arthroscopyoftheknee [J]. JBoneJoint Surg Br, 2003, 85(6): 932.
8 许世超, 傅孙丹. 低频脉冲电磁场结合乙醇冰袋冰敷治疗膝关节镜术后关节肿胀疼痛的疗效观察 [J]. 现代医药卫生, 2016, 32(21): 3331-3332.
9 古永恒, 汤璇, 李翠玲, 等. 外治法防治膝关节镜术后关节肿胀的临床护理研究进展 [J]. 现代中西医结合杂志, 2012, 21(32): 3642-3644.
10 谢燕崧, 陈艺, 宁军. 10%盐水冰袋持续冷敷减少膝关节置换术后出血的应用 [J/CD]. 中华关节外科杂志:电子版, 2011, 5(6): 791-793.
11 黄芳艳. 冰敷在人工全髋关节置换术后减少出血的体会 [J]. 医学文选, 2003, 22(5): 755-756.
12 张博, 罗从风. 骨科相关软组织损伤局部冷疗 [J]. 国际骨科学杂志, 2009, 30(5): 293-295, 298.
13 Kullenberg B, Ylipää S, Söderlund K, et al. Postoperative cryotherapy after total knee arthroplasty - A prospective study of 86 patients [J]. J Arthroplasty, 2006, 21(8): 1175-1179.
14 武迪, 段敏, 王卫青. 全膝关节置换术后膝关节肿胀、疼痛程度对膝关节功能的影响及护理 [J]. 中国医药导报, 2012, 9(9): 128-129, 134.
15 Hubbard TJ, Denegar CR. Does cryotherapy improve outcomes with Soft tissue injury? [J]. J Athl Train, 2004, 39(3): 278-279.
16 Boyraz I, Oktay F, Celik C, et al. Effect of cold application and tizanidine on clonus: clinical and electrophysiological assessment [J]. J Spinal Cord Med, 2009, 32(2): 132-139.
17 临床医学编辑委员会. 中国医学百科全书 [M] . 上海: 上海科学技术出版社, 1997: 2494.
18 White GE, WellsGD. Cold-waterimmersion and other forms of cryotherapy:physiological changes potentially affecting recovery from high-intensity exercise [J]. Extrem Physiol Med, 2013, 2(1): 26-28.
19 Deal DN, TiptonJ, RoseneranceE, et al. Ice reduces edema.Astudyof microvascularpermeabilityinrats [J]. J Bone Joint Surg Am, 2002, 84-A(9): 1573-1578.
20 Abramson DI, Chu LS, Tuck S, et al. Effect of tissue temperatures and blood flow on motor nerve conduction velocity [J]. JAMA, 1966, 198(10): 1082-1088.

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备注/Memo

备注/Memo:
 基金项目：上海市卫生和计划生育委员会科研课题计划任务书（20144Y0129）
更新日期/Last Update: 2019-09-19