背景:全膝关节置换术(TKR)是治疗严重膝关节骨性关节炎的有效方法。随着手术数量的增加,并发症,如下肢水肿,疼痛,有限的流动性造成了沉重的负担。手动淋巴引流(MLD)可能是解决问题的解决方案。该研究旨在评估MLD减轻膝关节水肿的疗效,疼痛,改善TKR后患者的活动范围(ROM)。
方法:在PubMed中进行了搜索,Embase,科克伦图书馆,WebofScience,CNKI,贵宾,万方数据库,和谷歌学者从成立到2023年6月。只有随机对照试验(RCT)比较了MLD和非MLD(或其他物理治疗)对改善膝关节水肿的影响,疼痛,包括TKR后的ROM。Stata16.0用于荟萃分析。GRADE用于评估证据质量。
结果:总计,确定了7个RCT,其中285名患者。膝关节屈曲的ROM(标准化平均差(SMD)=0.03,95%置信区间(CI):-0.22,0.28,P=0.812)和膝关节伸展的ROM(SMD=-0.30,95CI:-0.64,0.04,P=0.084)没有显着差异。TKR后下肢围无差异(SMD=-0.09,95CI:-0.27,0.09,P=0.324)。对于术后疼痛,MLD组和非MLD组之间无显著优势(SMD=-0.33,95CI:-0.71,0.04,P=0.083)。
结论:根据RCT的当前证据,人工淋巴引流不建议用于全膝关节置换术后患者的康复。
BACKGROUND: Total knee joint replacement (TKR) is an effective method for the treatment of severe knee osteoarthritis. With an increasing number of surgeries, complications such as lower limb edema, pain, and limited mobility have caused a heavy burden. Manual lymphatic drainage (MLD) may be a solution to solve the problem. The study aims to evaluate the efficacy of MLD in reducing knee edema, pain, and improving range of motion (ROM) in patients after TKR.
METHODS: A search was conducted in PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIPs, WanFang database, and Google Scholar from inception to June 2023. Only randomized controlled trials (RCTs) that compared the effects of MLD and non-MLD (or another physiotherapy) on improving knee edema, pain, and ROM after TKR were included. Stata 16.0 was used for meta-analysis. GRADE was used to assess the quality of evidence.
RESULTS: In total, 7 RCTs with 285 patients were identified. There were no significant differences found in the ROM of knee flexion (standardized mean difference (SMD) = 0.03, 95% confidence interval (CI): -0.22, 0.28, P = 0.812) and the ROM of knee extension (SMD= -0.30, 95%CI: -0.64, 0.04, P = 0.084). No differences were observed in the lower extremity circumference after TKR (SMD= -0.09, 95%CI: -0.27, 0.09, P = 0.324). For postoperative pain, there was no significant advantage between the MLD and non-MLD groups (SMD= -0.33, 95%CI: -0.71, 0.04, P = 0.083).
CONCLUSIONS: Based on the current evidence from RCTs, manual lymphatic drainage is not recommended for the rehabilitation of patients following total knee replacement.