Effect of fire dragon cupping on patients with Qi stagnation and blood stasis swelling after total knee arthroplasty
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摘要:
目的 探讨火龙罐综合灸在全膝关节置换术(TKA)后气滞血瘀型肿胀患者中的应用效果，以期为TKA术后肿胀管理提供参考依据。 方法 选取2022年6月—2023年12月在浙江中医药大学附属第一医院骨伤科住院的88例行TKA的患者作为研究对象，采用随机数字表法分为火龙罐组和对照组，每组各44例。对照组予常规消除肿胀的措施，火龙罐组予常规措施和火龙罐综合灸。比较患者干预后第3、7天下肢周径及变化值、关节活动度(ROM)、疼痛评分、不良反应和干预方案完成情况。 结果 干预后第3天火龙罐组髌骨中点上15 cm周径优于对照组[(42.7±3.5)cm vs. (44.7±3.5)cm, F=7.073, P=0.009]；髌骨中点下10 cm周径较对照组显著改善[(33.0±2.7)cm vs. (35.3±3.4)cm, F=11.554, P=0.001]；第7天髌骨中点上15 cm周径[(41.6±4.0)cm vs.(43.7±3.3)cm, F=6.775, P=0.011]和髌骨中点下10 cm周径[(32.4±2.8)cm vs.(34.3±3.2)cm, F=7.765, P=0.007]及周径变化值均优于对照组(P＜0.05)；火龙罐组ROM和疼痛评分均优于对照组(P＜0.05)。火龙罐组完成43例，完成率为97.7%，未发生不良反应。 结论 火龙罐综合灸能改善TKA术后患肢肿胀，改善ROM，减轻疼痛，且方案安全可行。 Abstract:Objective To explore the effect of fire dragon cupping in patients with Qi stagnation and blood stasis swelling after total knee arthroplasty (TKA), in order to provide reference for swelling management after TKA. Methods A total of 88 patients receiving TKA were hospitalized in the Department of Orthopedics of the First Affiliated Hospital of Zhejiang Chinese Medical University from June 2022 to December 2023. They were divided into fire dragon cupping group and control group using the random number table methods, with 44 cases in each group. The control group was subjected to routine measures for alleviating swelling, and the fire dragon cupping group was subjected to comprehensive moxibustion and routine measures. The lower extremity circumference and change values, range of motion (ROM), pain scores, adverse events, and completion of the intervention program on days 3 and 7 post-intervention were compared. Results Three days after the intervention, the upper 15 cm circumference of the middle point of the patella in the fire dragon cupping group was significantly better than that in the control group [(42.7±3.5) cm vs. (44.7±3.5) cm, F=7.073, P=0.009]. The circumference of 10 cm below the midpoint of the patella was significantly improved compared with the control group [(33.0±2.7) cm vs. (35.3±3.4) cm, F=11.554, P=0.001]. Seven days post-intervention, the circumference 15 cm above the midpoint of the patella [(41.6±4.0) cm vs. (43.7±3.3) cm, F=6.775, P=0.011] and the circumference of 10 cm below the midpoint of patella [(32.4±2.8) cm vs. (34.3±3.2) cm, F=7.765, P=0.007] and the change of circumference diameter were significantly better than those in the control group (P < 0.05). The ROM and pain scores of the fire dragon cupping group were better than the control group (P < 0.05). The fire dragon cupping group has completed 43 cases with a completion rate of 97.7%, and no adverse reactions have occurred. Conclusion The fire dragon cupping therapy can improve the swelling of the affected limb, improve the range of motion of the knee joint, and alleviate pain after TKA, and it is safe and feasible. -
Key words:
- Total knee arthroplasty /
- Swelling /
- Qi stagnation and blood stasis /
- Fire dragon cupping
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表 1 火龙罐综合灸干预方案
Table 1. Comprehensive moxibustion intervention plan of fire dragon cupping
干预方案 干预内容 经络范围和穴位 足太阳膀胱经：委中穴至京骨穴选穴：委中、京骨
足少阴肾经：太溪穴至阴谷穴选穴：太溪、阴谷
足阳明胃经：梁丘穴至冲阳穴选穴：梁丘、冲阳
足太阴脾经：太白穴至血海穴选穴：太白、血海时长 每次30 min 频次 每天1次 时机 术后第1天 周期 术后1~7 d 人员资质 (1)具有护士执业证书；(2)护师及以上；(3)工作年限≥2年；(4)通过浙江中医药大学附属第一医院护理部火龙罐综合灸技术培训、考核及发证 
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表 2 2组TKA术后肿胀患者一般资料比较
Table 2. Comparison of general information between the two groups of patients with postoperative swelling after TKA
项目 火龙罐组(n=43) 对照组(n=43) 统计量 P值 性别[例(%)] 0.420a 0.517 男性 19(44.2) 22(51.2) 女性 24(55.8) 21(48.8) 年龄(x±s, 岁) 70.3±6.5 70.8±5.8 0.333b 0.740 BMI[M(P25, P75)] 24.7(22.3，27.8) 24.6(23.6，26.0) -0.160c 0.873 高血压[例(%)] 0.052a 0.820 有 28(65.1) 29(67.4) 无 15(34.9) 14(32.5) 糖尿病[例(%)] 1.124a 0.289 有 7(16.3) 11(25.6) 无 36(83.7) 32(74.4) 手术部位[例(%)] 0.745a 0.388 左侧 19(44.2) 23(53.5) 右侧 24(55.8) 20(46.5) 注：a为χ2值，b为t值，c为Z值。
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表 3 2组TKA术后肿胀患者下肢周径比较(x±s, cm)
Table 3. Comparison of lower limb circumference between the two groups of patients with postoperative swelling after TKA (x±s, cm)
组别 例数 髌骨中点上15 cm 髌骨中点下10 cm 手术前1 d 干预后3 d 干预后7 d 手术前1 d 干预后3 d 干预后7 d 火龙罐组 43 41.1±4.2 42.7±3.5 41.6±4.0 32.2±2.7 33.0±2.7 32.4±2.8 对照组 43 42.3±3.6 44.7±3.5 43.7±3.3 32.2±3.3 35.3±3.4 34.3±3.2 F值 1.872 7.073 6.775 0.001 11.554 7.765 P值 0.175 0.009 0.011 0.983 0.001 0.007 注：2组髌骨中点上15 cm下肢周径比较，F时间=55.810，P＜0.001；F组间=5.173，P=0.025；F交互=3.624，P=0.049；2组下肢周径髌骨中点下10 cm比较，F时间=284.404，P＜0.001；F组间=4.359，P=0.040；F交互=105.117，P＜0.001。
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表 4 2组TKA术后肿胀患者下肢周径变化值比较(x±s, cm)
Table 4. Comparison of the change in lower limb circumference between the two groups of patients with postoperative swelling after TKA (x±s, cm)
组别 例数 髌骨中点上15 cm 髌骨中点下10 cm 干预后3 d 干预后7 d 干预后3 d 干预后7 d 火龙罐组 43 2.5(2.0，3.2) 1.0(1.0，1.5) 3.0(2.0，4.0) 2.0(1.5，2.7) 对照组 43 1.5(1.0，2.0) 0.5(0.0, 0.5) 1.0(0.5，1.0) 0.0(0.0，0.5) Z值 -4.219 -3.930 -5.589 -5.594 P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001
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表 5 2组TKA术后肿胀患者ROM比较(x±s, °)
Table 5. Comparison of ROM between the two groups of patients with postoperative swelling after TKA (x±s, °)
组别 例数 手术前1 d 干预后3 d 干预后7 d 火龙罐组 43 64.4±5.5 52.1±5.3 93.2±4.5 对照组 43 62.3±6.2 48.0±5.1 85.8±8.2 F值 2.912 13.577 26.979 P值 0.092 ＜0.001 ＜0.001 注：2组患肢ROM比较，F时间=1 461.415，P＜0.001；F组间=6.398，P=0.004；F交互=23.198，P＜0.001。
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表 6 2组TKA术后肿胀患者NRS评分比较(x±s, 分)
Table 6. Comparison of NRS scores between the two groups of patients with postoperative swelling after TKA (x±s, points)
组别 例数 活动痛 静息痛 干预后3 d 干预后7 d 干预后3 d 干预后7 d 火龙罐组 43 4.3±0.6 3.1±0.4 3.3±0.6 1.7±0.5 对照组 43 4.7±0.7 3.4±0.5 3.5±0.6 2.3±0.6 统计量 2.551a 2.001b 2.216a 22.539b P值 0.014 0.161 0.032 ＜0.001 注：a为t值，b为F值。
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