加速康复外科理念与中医辨证施护在全膝关节置换围手术期的干预研究
Intervention Study on the Concept of Accelerated Recovery Surgery and TCM Syndrome Differentiation and Nursing in the Perioperative Period of Total Knee Arthroplasty

目的：构建加速康复外科与中医辩证施护协同干预路径，评价其在TKA围手术期的临床转化价值。方法：采用前瞻性随机对照设计(RCT)，纳入2025年1~3月单侧TKA病例124例，通过区组随机法分为常规组(传统护理，n = 62)与试验组(加速康复外科联合中医辩证施护，n = 62)。比较两组围手术期指标、术后视觉模拟(VAS)评分、美国特种外科医院(HSS)评分、美国膝关节协会(KSS)评分、膝关节主动活动度(ROM)、护理满意度及住院时间。结果：试验组呈现显著临床优势。试验组术后首次下床活动时间，尿管拔除时间；术后第一天VAS、术后第七天VAS评；术后第七天HSS、第一个月HSS评分；术后第一个月KSS评分；术后第一个月膝关节主动ROM；出院时护理满意度评分；平均住院天数均优于对照组，差异具有统计学意义(P < 0.05)。结论：加速康复外科联合中医辩证施护通过多模态镇痛及气血理论指导的康复训练，显著优化TKA患者围手术期管理，其临床价值值得深入探讨。
Objective: To establish an integrated ERAS-TCM syndrome differentiation nursing pathway and evaluate its clinical translational value in perioperative management of total knee arthroplasty (TKA). Methods: A prospective randomized controlled trial (RCT) enrolled 124 patients undergoing unilateral TKA between January and March 2025. Participants were allocated via block randomization to a control group (traditional care, n = 62) or an intervention group (ERAS combined with TCM syndrome differentiation nursing, n = 62). Outcome measures included perioperative indicators (time to first ambulation, catheter removal duration), Visual Analog Scale (VAS) scores, Hospital for Special Surgery (HSS) scores, Knee Society Score (KSS), active range of motion (ROM), nursing satisfaction, and length of hospitalization. Results: The experimental group showed significant clinical advantages. The time of the first postoperative activity and the time of urethral catheter removal in the experimental group; VAS on the first postoperative day and VAS on the seventh postoperative day; HSS score on the seventh day and the first month after surgery; KSS score in the first month postoperatively; Active ROM of the knee in the first month after surgery; Nursing satisfaction score at discharge; The average length of hospital stay was better than that of the control group, and the difference was statistically significant (P < 0.05). Conclusion: Enhanced recovery surgery combined with TCM dialectical care can significantly optimize the perioperative management of TKA patients through rehabilitation training guided by multimodal analgesia and qi and blood theory, and its clinical value is worthy of further discussion.