目的 探索整体针联合运动处方应用于伴骨质疏松症（OP）的膝骨关节炎（KOA）患者全膝关节置换术（TKA）术前预康复的可行性、有效性及其对Wnt/β-catenin通路的影响。方法 2021年5月—2022年4月在广州市第一人民医院南沙医院骨科住院治疗的伴OP的KOA患者随机入组,分3组：A组予常规术前宣教和准备;B组在A组基础上,术前应用标准化运动处方3周;C组在A组基础上,术前联合应用整体针和运动处方3周。比较术前3周、术前1天、术后8周视觉模拟疼痛评分（VAS）、关节活动度（ROM）、膝关节功能评分（HSS）的组间差异,并比较术中关节液β连环蛋白（β-catenin）、基质金属蛋白酶-13（MMP-13）、重组人Dickkopf相关蛋白-1（DKK-1）含量的组间差异。结果 共纳入50例受试者,A组15例,B组18例,C组17例。术前1天组间方差分析显示：B、C组VAS均低于A组（P<0.05）,C组VAS低于B组（P<0.05）;B、C组ROM均高于A组（P<0.05）,B、C组ROM比较差异无统计学意义（P>0.05）;B、C组HSS均高于A组（P<0.05）,C组HSS高于B组（P<0.05）。术后8周组间方差分析显示：B、C组VAS均低于A组（P<0.05）,C组VAS低于B组（P<0.05）;B、C组ROM均高于A组（P<0.05）,B、C组ROM比较差异无统计学意义（P>0.05）;B、C组HSS均高于A组（P<0.05）,C组HSS高于B组（P<0.05）。术中关节液标志物含量组间方差分析显示：B、C组β-catenin、MMP-13含量均低于A组（P<0.05）,C组β-catenin、MMP-13含量均低于B组（均P<0.05）;B、C组DKK-1含量均高于A组（均P<0.05）,C组DKK-1含量高于B组（P<0.05）。结论 整体针联合运动处方在OP患者TKA术前应用切实可行,可有效缓解疼痛、改善功能。整体针可增强运动处方的正向预康复作用,其作用机制可能与Wnt/β-catenin通路调节有关。

Objective To explore the feasibility,effectiveness and impact on the Wnt/β-catenin pathway of combined holistic acupuncture and exercise prescription for preoperative rehabilitation in knee osteoarthritis（KOA）patients with osteoporosis（OP）undergoing total knee arthroplasty（TKA）．Methods KOA patients with OP were divided into three groups randomly：Group A received conventional preoperative education and preparation,Group B received standardized exercise prescription for three weeks additionally,Group C received combined holistic acupuncture and exercise prescription for three weeks additionally．Between-group differences in visual analogue scale（VAS）pain scores,range of motion（ROM）and knee joint function scores（HSS）were compared at 3 weeks preoperatively,1 day preoperatively and 8 weeks postoperatively．Differences in intraoperative joint fluid levels of β-catenin,MMP-13 and DKK-1 were also compared．Results A total of 50 participants were included,with 15 in Group A,18 in Group B and 17 in Group C．Baseline conditions were comparable among the three groups．One-day preoperative analysis showed that VAS scores were lower in both Groups B and C compared to Group A（P<0.05）,and VAS score was lower in Group C compared to Group B（P<0.05）．ROM was higher in Groups B and C compared to Group A（P<0.05）,with no statistically significant between-group difference between Groups B and C．HSS scores were higher in Groups B and C compared to Group A（P<0.05）,and HSS score was higher in Group C compared to Group B（P<0.05）．Eight-week postoperative analysis revealed that VAS scores were lower in both Groups B and C compared to Group A（P<0.05）,and VAS score was lower in Group C compared to Group B（P<0.05）．ROM were higher in Groups B and C compared to Group A（P<0.05）,with no statistically significant between-group difference between Group B and C．HSS scores were higher in Groups B and C compared to Group A（P<0.05）,and HSS score was higher in Group C compared to Group B（P<0.05）．Intraoperative joint fluid biomarker analysis showed that β-catenin and MMP-13 levels were lower in Groups B and C compared to Group A（P<0.05）,and β-catenin and MMP-13 levels were lower in Group C compared to Group B（P<0.05）．DKK-1 levels were higher in Groups B and C compared to Group A（P<0.05）,and DKK-1 level was higher in Group C compared to Group B（P<0.05）．Conclusions Combined holistic acupuncture and exercise prescription is feasible and effective for preoperative rehabilitation in TKA for KOA patients with OP．Holistic acupuncture enhances the positive pre-rehabilitation effect of exercise prescription,and its mechanism may be related to the regulation of the Wnt/β-catenin pathway．

目的 探索在全膝关节置换(TKA)围手术期中实施以中医透药+整体针疗法为特色的中西医结合加速康复方案的可行性,考察中医、西医加速康复措施在单独应用和联合应用时的促康复效能。方法 以在我院行首次单侧全膝关节置换术的患者为研究对象。根据围手术期干预差异分为四组:A组12例,根据指南采取传统常规的围手术期处理;B组12例,在A组基础上,采取了西医加速康复措施;C组14例,在A组基础上,采取了中医透药+整体针疗法;D组15例,兼采用西医加速康复措施和中医透药+整体针疗法。统计所有患者术后24小时、术后3天视觉模拟疼痛评分(VAS)和术前、术后2周膝关节功能评分(HSS)。并作以上数据的组间比较。结果 四组患者术后24 h VAS组间差异无统计学意义,术后3 d VAS组间总体差异有统计学意义:组间两两比较,B、C、D组均低于A组(P<0.05),B、C、D组间差异则无统计学意义。四组患者术前HSS组间差异无统计学意义,术后2周HSS组间总体差异有统计学意义:组间两两比较,B、C、D组均高于A组(P<0.05),A、B、C组均低于D组(P<0.05),B、C组间差异无统计学意义。结论 中医透药+整体针疗法在TKA围术期应用切实可行,与加速康复理念有机结合可有效缓解患者围术期疼痛,改善术后膝关节功能。

Objective To explore the feasibility of implementing the accelerated rehabilitation program of integrated traditional Chinese and western medicine featuring TCM and holistic acupuncture in the perioperative period of total knee arthroplasty (TKA),and investigate the effectiveness of accelerated rehabilitation under concept of recovery after surgery ERAS of traditional Chinese medicine and western medicine in single application and joint application. Methods The patients who underwent the first unilateral total knee arthroplasty in our hospital were studied. According to the interventions during the perioperative period, they were divided into 4 groups: 12 cases in group A, which were treated according to the guidelines and traditional perioperative treatment; 12 cases in group B, on the basis of group A, western medicine accelerated rehabilitation measures were taken; for the 14 case in group C, on the basis of group A, TCM penetration combinate with holistic acupuncture therapy was adopted; in group D, the combination of western medicine accelerated rehabilitation measures and the TCM therapy above were implemented in 15 cases. The visual analogue score (VAS)of all patients at 24 hours and 3 days after surgery were counted, and their knee function scores in hospital for special surgery (HSS scores) were recorded before and 2 weeks after the surgery. Comparisons of the data above between different groups were carried out. Results There was no statistically significant difference between the 4 groups in the VAS at 24 h after the operation, but statistically significant difference was found in the comparison of VAS at the 3rd day after the operation;In pairwise comparison, the 3rd day's VAS of group B, C and D were all lower than that of group A (P<0.05). There was no statistically significant difference between the 4 groups in the HSS score before the operation, but statistically significant difference was found in the comparison of HSS score at the 2nd week after the operation;In pairwise comparison, the 2nd week's HSSscore of group B, C and D were all higher than group A (P<0.05),and that of group A,B and C were all lower than that of group D (P<0.05). Conclusion The application of TCM penetration medicine combinated with holistic acupuncture in perioperative period of TKA is practical and feasible. The combination of western medicine accelerated rehabilitation measures and the TCM therapy can effectively relieve patients' perioperative pain and improve postoperative knee function.