四神煎加减联合平衡针对全膝关节置换术后患者的影响

Effects of Modified Sishen Decoction Combined with Balance Acupuncture on Patients After Total Knee Arthroplasty

摘要:

目的：观察四神煎加减联合平衡针对全膝关节置换术后患者疼痛、应激反应及血清β-防御素-3 （HBd-3）、可溶性血管细胞间黏附分子-1（sVCAM-1） 的影响。方法：选择2023年2月—2025年1月于濮阳市中医医院骨科治疗的108例膝骨关节炎患者，按随机数字表法分为对照组和研究组各54例。对照组失访脱落3例，纳入51例；研究组失访脱落3例，申请主动退出2例，共脱落5例，纳入49例。2组均进行全膝关节置换术治疗，术后给予常规治疗，对照组在此基础上给予平衡针治疗，研究组在对照组基础上联合四神煎加减治疗。评价2 组临床疗效。术后1 天、术后4 周检测患者血清肾上腺髓质素（AM）、降钙素基因相关肽（CGRP）、大麻素（AEA）、sVCAM-1、缓激肽（BK）、超敏C-反应蛋白（hs-CRP）、血浆促肾上腺皮质激素（ACTH）、皮质醇（COR）、HBd-3蛋白、血浆D-二聚体、纤维蛋白原水平。术后4周进行6点行为评分法（BRS-6） 评价，测量患者患侧与健侧大腿（髌骨上缘15 cm）、小腿（髌骨下缘10 cm） 周径差。随访6个月，统计2组假体松动发生率、滑膜炎发生率、慢性疼痛发生率。结果：研究组总有效率为95.92%（47/49），高于对照组80.39% （41/51）（P＜0.05）。术后4周，2组hs-CRP、HBd-3、ACTH、COR、sVCAM-1、D-二聚体、纤维蛋白原、CGRP、AM、BK水平较术后1天降低（P＜0.05）；且研究组hs-CRP、HBd-3、ACTH、COR、sVCAM-1、D-二聚体、纤维蛋白原、CGRP、AM、BK水平低于对照组（P＜0.05）。术后4周，2组AEA水平较术后1天升高（P＜0.05）；且研究组AEA水平高于对照组（P＜0.05）。治疗后，研究组BRS-6评分、大小腿周径差小于对照组（P＜0.05）。2组不良反应发生率比较，差异无统计学意义（P＞0.05）。术后6个月随访显示，研究组假体松动发生率、滑膜炎发生率、慢性疼痛发生率均低于对照组，差异有统计学意义（P＜0.05）。结论：四神煎加减联合平衡针治疗全膝关节置换术后患者，可调节促疼痛相关介质及疼痛抑制相关介质水平，减少应激反应及炎症反应，改善凝血功能，缓解疼痛及患肢水肿情况，预防远期并发症，提升临床疗效。

Abstract:

Abstract：Objective：To observe the effects of modified Sishen Decoction combined with balance acupuncture on pain， stress response， serum levels of β -defensin-3 （HBd-3）， and soluble vascular cell adhesion molecule- 1 （sVCAM-1） in patients after total knee arthroplasty （TKA）. Methods： A total of 108 patients with knee osteoarthritis treated in the Department of Orthopedics，Chinese Medicine Hospital of Puyang，from February 2023 to January 2025 were selected and randomly divided into the control group and the study group using the random number table method， with 54 cases in each group. In the control group， 3 cases were lost to follow-up， leaving 51 cases included； in the study group， 3 cases were lost to follow-up and 2 cases voluntarily withdrew， totaling 5 cases excluded， leaving 49 cases included. Both groups underwent TKA and received conventional postoperative treatment. The control group additionally received balance acupuncture，while the study group received modified Sishen Decoction combined with balance acupuncture. Clinical effects were evaluated. Serum levels of adrenomedullin （AM），calcitonin gene-related peptide （CGRP）， anandamide （AEA）， sVCAM-1， bradykinin （BK）， high-sensitivity C-reactive protein （hs-CRP）， plasma adrenocorticotropic hormone （ACTH）， cortisol （COR）， HBd-3 protein， plasma Ddimer， and fibrinogen were measured on postoperative day 1 and at 4 weeks after surgery. At 4 weeks after surgery，the 6-Point Behavioral Rating Scale （BRS-6） was used for pain assessment， and the circumference differences of the affected versus the healthy side at the thigh （15 cm above the upper edge of the patella） and calf（ 10 cm below the lower edge of the patella） were measured. A 6-month follow-up was conducted to record the incidence of prosthesis loosening， synovitis，and chronic pain in both groups. Results：The total effective rate in the study group was 95.92% （47/49）， higher than that of 80.39%（ 41/51） in the control group（ P＜0.05）. At 4 weeks after surgery，levels of hs-CRP，HBd-3， ACTH，COR，sVCAM-1，D-dimer，fibrinogen，CGRP，AM，and BK were decreased when compared with those on postoperative day 1 in both groups （P＜0.05），and the levels in the study group were lower than those in the control group （P＜0.05）. At 4 weeks after surgery，AEA levels were increased when compared with those on postoperative day 1 in both groups（ P＜0.05），and the AEA level in the study group was higher than that in the control group（ P＜0.05）. After treatment，the BRS-6 score and circumference differences of the thigh and calf in the study group were lower than those in the control group （P＜0.05）. There was no significant difference in the incidence of adverse reactions between the two groups （P＞0.05）. The 6-month follow-up after surgery showed that the incidence of prosthesis loosening， synovitis， and chronic pain in the study group was lower than that in the control group， the difference being significant （P＜0.05）. Conclusion：Modified Sishen Decoction combined with balance acupuncture in the treatment of patients after TKA can regulate the levels of pain-promoting and pain-inhibiting mediators， reduce stress and inflammatory responses，improve coagulation function，alleviate pain and edema of the affected limb，prevent longterm complications，and enhance clinical effect.