四神煎加减联合平衡针对全膝关节置换术后患者的影响OA

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 D-dimer,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 long-term complications,and enhance clinical effect.