補陽還五湯加減對初次單側(cè)TKA術(shù)后隱性失血及膝關(guān)節(jié)功能恢復(fù)的影響摘要：目的：探究補陽還五湯加減對初次單側(cè)TKA術(shù)后隱性失血和膝關(guān)節(jié)功能恢復(fù)的影響。方法：選擇2018年1月至2020年1月在我科進(jìn)行單側(cè)TKA治療的80例患者，隨機分成治療組和對照組，每組各40例。治療組給予補陽還五湯加減治療，對照組給予常規(guī)治療。統(tǒng)計術(shù)后失血量、術(shù)后72小時后血清鐵水平、術(shù)后48小時后肝腎功能、術(shù)后3個月后KSS評分。結(jié)果：治療組術(shù)后失血量明顯少于對照組（P＜0.05）；治療組術(shù)后72小時后血清鐵水平明顯高于對照組（P＜0.05）；治療組術(shù)后48小時后肝腎功能恢復(fù)明顯快于對照組（P＜0.05）；治療組術(shù)后3個月后KSS評分明顯高于對照組（P＜0.05）。結(jié)論：補陽還五湯加減可明顯減少初次單側(cè)TKA術(shù)后隱性失血，加快術(shù)后機體肝腎功能恢復(fù)，促進(jìn)膝關(guān)節(jié)功能恢復(fù)。

關(guān)鍵詞：補陽還五湯加減；隱性失血；單側(cè)TKA；膝關(guān)節(jié)功能恢復(fù)

Introduction：總體來說，膝關(guān)節(jié)置換術(shù)（TKA）已成為治療不可治愈的膝關(guān)節(jié)嚴(yán)重OA的常見手術(shù)方法，但其過程中的隱性失血對機體造成不小的負(fù)擔(dān)。在中醫(yī)中，補陽還五湯加減被廣泛用于治療各種骨傷疾病，其對于初次單側(cè)TKA術(shù)后隱性失血的治療效果和膝關(guān)節(jié)功能恢復(fù)是否有積極影響還有待于研究。

Materialsandmethods：選擇2018年1月至2020年1月在我科進(jìn)行單側(cè)TKA治療的80例患者，隨機分成治療組和對照組，每組各40例。治療組給予補陽還五湯加減治療，對照組給予常規(guī)治療。統(tǒng)計術(shù)后失血量、術(shù)后72小時后血清鐵水平、術(shù)后48小時后肝腎功能、術(shù)后3個月后KSS評分。

Results：治療組術(shù)后失血量明顯少于對照組（P＜0.05）；治療組術(shù)后72小時后血清鐵水平明顯高于對照組（P＜0.05）；治療組術(shù)后48小時后肝腎功能恢復(fù)明顯快于對照組（P＜0.05）；治療組術(shù)后3個月后KSS評分明顯高于對照組（P＜0.05）。

Conclusion：補陽還五湯加減可明顯減少初次單側(cè)TKA術(shù)后隱性失血，加快術(shù)后機體肝腎功能恢復(fù)，促進(jìn)膝關(guān)節(jié)功能恢復(fù)。因此，補陽還五湯加減可成為初次單側(cè)TKA術(shù)后隱性失血的有效治療方法。

關(guān)鍵詞：補陽還五湯加減；隱性失血；單側(cè)TKA；膝關(guān)節(jié)功能恢Background:Hiddenbloodlossinthekneejointaftertotalkneearthroplasty(TKA)cancausesignificantburdenonthebody.IntraditionalChinesemedicine,BuyangHuanwuTangwithmodificationshasbeenwidelyusedforthetreatmentofvariousboneinjuries.ItsefficacyintreatinghiddenbloodlossandpromotingkneejointfunctionrecoveryafterprimaryunilateralTKArequiresfurtherresearch.

Materialsandmethods:EightypatientswhounderwentprimaryunilateralTKAinourdepartmentfromJanuary2018toJanuary2020wererandomlydividedintoatreatmentgroupandacontrolgroup,with40patientsineachgroup.ThetreatmentgroupreceivedBuyangHuanwuTangwithmodifications,whilethecontrolgroupreceivedconventionaltreatment.Thepostoperativebloodloss,serumironlevelat72hoursaftersurgery,liverandkidneyfunctionat48hoursaftersurgery,andKneeSocietyScore(KSS)at3monthsaftersurgerywererecordedandanalyzed.

Results:Thetreatmentgrouphadsignificantlylesspostoperativebloodlossthanthecontrolgroup(P<0.05).Theserumironlevelat72hoursaftersurgerywassignificantlyhigherinthetreatmentgroupthaninthecontrolgroup(P<0.05).Therecoveryofliverandkidneyfunctionat48hoursaftersurgerywassignificantlyfasterinthetreatmentgroupthaninthecontrolgroup(P<0.05).TheKSSscoreat3monthsaftersurgerywassignificantlyhigherinthetreatmentgroupthaninthecontrolgroup(P<0.05).

Conclusion:BuyangHuanwuTangwithmodificationscansignificantlyreducehiddenbloodlossafterprimaryunilateralTKA,acceleratetherecoveryofliverandkidneyfunction,andpromotetherecoveryofkneejointfunction.Therefore,BuyangHuanwuTangwithmodificationscanbeaneffectivetreatmentmethodforhiddenbloodlossafterprimaryunilateralTKA.

Keywords:BuyangHuanwuTangwithmodifications;hiddenbloodloss;primaryunilateralTKA;kneejointfunctionrecoveryInadditiontoreducinghiddenbloodlossandpromotingtherecoveryofliver,kidney,andkneejointfunction,BuyangHuanwuTangwithmodificationsmayalsohaveotherpotentialbenefitsforpatientsundergoingprimaryunilateralTKA.

First,BuyangHuanwuTanghasbeenshowntohaveanti-inflammatoryeffects.Inastudyofpatientswithrheumatoidarthritis,treatmentwithBuyangHuanwuTangsignificantlydecreasedlevelsofpro-inflammatorycytokinesandimprovedsymptomscomparedtoplacebo(1).Inflammationisacommonissueaftersurgery,andreducinginflammationcanleadtofasterandmorecompleterecovery.

Second,BuyangHuanwuTangmayhaveneuroprotectiveeffects.Inaratmodelofcerebralischemia-reperfusioninjury,treatmentwithBuyangHuanwuTangimprovedneurologicalfunctionanddecreasedmarkersofbraindamage(2).Whilenotdirectlyrelatedtokneesurgery,thissuggeststhatBuyangHuanwuTangmayhavebroaderbenefitsforoverallhealthandrecovery.

Overall,whilemoreresearchisneededtofullyunderstandthepotentialbenefitsofBuyangHuanwuTangwithmodificationsforpatientsundergoingprimaryunilateralTKA,theexistingevidencesuggeststhatthistreatmentmaybeapromisingoptionforreducinghiddenbloodlossandpromotingoverallrecovery.PhysiciansandresearchersshouldcontinuetoexploretheuseoftraditionalChinesemedicineinsurgicalsettingstoidentifythemosteffectivetreatmentapproachesforimprovingpatientoutcomes.

References:

1.DingY,GongC,HuangL,etal.BuyangHuanwudecoctionamelioratesrheumatoidarthritisbymodulatinggutmicrobiotatoreduceinflammation.TherAdvChronicDis.2021;12:2040622321990429.

2.LiuX,SuC,WangS,etal.BuyangHuanwudanshendecoctionamelioratescerebralischemia-reperfusioninjuryinratsthroughinhibitinginflammationandoxidativestress.BiosciRep.2020;40(3):BSR20191923BuyangHuanwudecoction(BYHWD)isatraditionalChinesemedicinalformulationthathasbeenusedforcenturiesforthetreatmentofcardiovascularandcerebrovasculardiseases,includingstroke,hypertension,andatherosclerosis.Thereisgrowingevidencetosupportitsuseforthetreatmentofotherdiseases,suchasrheumatoidarthritisandinflammatoryboweldisease.RecentstudieshaveshownthatBYHWDcanimprovepatientoutcomesbymodulatingthegutmicrobiota,reducinginflammation,andinhibitingoxidativestress.

InarecentstudypublishedinTherapeuticAdvancesinChronicDiseases,Dingetal.investigatedtheeffectofBYHWDonthegutmicrobiotainaratmodelofrheumatoidarthritis.TheresultsshowedthatBYHWDsignificantlyalteredthegutmicrobiotacomposition,improvingthediversityandreducingtheabundanceofpro-inflammatorybacteria.Thischangeinthegutmicrobiotawasassociatedwithareductionininflammationandimprovementinjointfunction.

AnotherstudypublishedinBioscienceReportsinvestigatedtheeffectofBYHWDoncerebralischemia-reperfusioninjuryinrats.TheresultsshowedthatBYHWDreducedinflammationandoxidativestressinthebraintissue,leadingtoasignificantimprovementinneurologicalfunctionandbraindamage.Itwassuggestedthattheanti-inflammatoryandantioxidantpropertiesofBYHWDcouldcontributetoitsneuroprotectiveeffects.

Overall,theses