冰敷處置於人工全膝關節置換術後成效探討：系統性文獻回顧與統合分析

背景：冰敷處置為人工全膝關節置換手術後常見的非藥物臨床措施，用以減少出血和降低疼痛，目前較缺乏實務應用的研究分析。目的：系統性文獻回顧方式探究冰敷處置在使用時間與溫度選擇因素，對於人工全膝關節置換術後患者運用的實務成效。方法：「人工全膝關節置換手術」、「冰敷」、「Total knee arthroplasty」、「Ice pack」等關鍵詞，搜尋Cochrane Library、PubMed、CINAHL、EMBASE、PEDro與華藝、萬方等資料庫與手動查詢，搜尋收納至2022年11月30日之前相關的隨機臨床試驗或類實驗研究等級的中英文文獻。由兩位研究者分別獨立以考科藍誤差風險工具完成文獻品質評讀及資料萃取。以RevMan 5.3進行統合分析。結果：經排除重複、納入條件篩選後，最終共納入14篇隨機分派研究文章。研究對象總受試者人數為1073人，平均年齡介於50歲至85歲之間。整體上有10篇（71.4%）呈現在運用較低溫（12℃）、或每次使用持續時間超過2小時的方式，在部分成效指標上有顯著改善。以統合分析結果發現，冰敷的時間持續與間歇效益，於人工全膝關節術後第二天成效之疼痛視覺分數分析綜合效應量為1.02（95%CI=[-2.77,0.73]）。15度以下的低溫組比較高溫組於患肢腫脹程度具顯著緩解效果-0.79（95%CI=[-1.30,-0.29]）。結論：本實證研究發現術後使用冰敷，可緩解手術造成的不適。10－15℃較低溫冰敷運用對於人工全膝關節術後患肢腫脹情形，具中等程度改善效果。

關鍵字

冰敷；溫度；人工全膝關節置換術後；系統性文獻回顧；統合分析

並列摘要

Background: Cryotherapy is a common non-pharmacological intervention used after total knee replacement (TKR) to reduce bleeding and pain. Currently, there is a lack of practical evidence supporting its effectiveness. Objective: The purpose of this study is to review related research and provide more high-quality empirical evidence for this common management practice. Method: We searched the Cochrane Library, PubMed, CINAHL, EMBASE, PEDro, CEPS, and Wanfang databases, as well as conducted manual inquiries, on November 30, 2022. The keywords used were "total knee arthroplasty" and "ice pack, cryotherapy." We included randomized controlled trials or clinical trials where the experimental group received any form of cryotherapy and was compared to any control following TKR indicated for osteoarthritis. Two reviewers independently selected trials based on inclusion criteria. Data were extracted and the Cochrane risk of bias tool was used to evaluate the research bias of selected articles. The main outcomes measured were pain, swelling, and range of motion. Quantitative data were integrated using Rev Man 5.3 to provide a comprehensive effect analysis. Results: Fourteen randomized trials published from 2012 to 2022 involving 1,073 participants met the inclusion criteria. Evidence from 3 trials indicated that the use of cryotherapy machines and traditional ice packs, whether used persistently or intermittently, had no significant benefit on VAS scores (-1.02 [ -2.77, 0.73]). However, the group treated with cryotherapy at 15 degrees Celsius or lower showed significant relief in swelling (-0.79, 95% CI=[-1.30, -0.29]). Conclusion: This systematic review found that cryotherapy can alleviate discomfort following total knee replacement. According to the meta-analysis, cryotherapy at low temperatures (10-15°C) has a moderate improvement effect on swelling of the affected limb after TKR. However, its effect on other indicators remains unclear. Future clinical research should emphasize high-quality research designs.