初次与二次分期双侧全膝关节置换后的早期疼痛:回顾性对照分析  

Early postoperative pain between the first and second staged bilateral total knee arthroplasty: a retrospective comparative analysis

作　　者：孙久一[1] 周义钦 

机构地区：[1]解放军455医院骨科,上海市200052 [2]解放军第二军医大学第二附属医院,上海市200052

出　　处：《中国组织工程研究》2014年第31期4944-4949,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:全膝关节置换为严重膝关节疾病患者解决了极大的痛苦,临床疗效已得到公认。临床上双膝关节置换的患者,两次手术临床镇痛方案的制定尚缺乏临床循证医学证据的支持。目的:比较分期双侧全膝关节置换中初次与二次手术后早期疼痛的差异,为临床镇痛方案提供证据。方法:选择2009年1月至2013年1月进行分期双侧全膝关节置换的87例患者进行回顾性分析。比较分期双侧膝关节置换患者初次与二次手术后24,48,72 h的目测类比评分,包括休息位和最大屈曲位;另外还比较了两次手术间隔时间为6个月以内、6-12个月、12个月以上3个时间段二次手术与初次手术后早期疼痛评分差值的差异。结果与结论:二次全膝关节置换在术后24,48 h的休息位和最大屈曲位目测类比评分均显著高于初次置换。而术后72 h休息位与最大屈曲位目测类比评分则没有明显差异。两次手术时间间隔在6个月以内的患者第二次全膝关节置换后24 h休息位和最大屈曲位目测类比评分均显著高于6-12个月组和12个月以上组;而6-12个月组与12个月以上组的休息位和屈曲位目测类比评分的差值均未见明显差异。提示分期双侧全膝关节置换后48 h内二次手术的疼痛程度明显高于初次手术,这为适当加强双膝关节置换二次手术后的镇痛方案提供了有效的临床证据;而两次手术的时间间隔长短也可影响二次手术后早期疼痛的改变程度,从术后患者疼痛角度出发,可建议双侧分期置换的间隔时间可以大于6个月,以减少二次手术后疼痛,提高患者满意度,加快恢复速度。BACKGROUND：Total knee arthroplasty solves a great pain for patients with severe knee joint disease, and its clinical curative effects have been general y accepted. In the clinic, the formulation of clinical analgesic program of the two surgeries in patients undergoing double knee prosthesis lacks of the support of evidence-based medicine. OBJECTIVE：To compare the differences in pain during early stage of primary and secondary surgeries in bilateral total knee arthroplasty, and to provide evidence for clinical analgesic programs. METHODS：A total of 87 patients receiving staged bilateral total knee arthroplasty from January 2009 to January 2013 were retrospectively analyzed. Visual analogue scale was compared at 24, 48 and 72 hours after first and second staged total knee arthroplasty, including seating and maximum flexion position. In addition, the difference in early pain score was compared between second and first total knee arthroplasty in different intervals （less than 6 months, 6-12 months, more than 12 months）. RESULTS AND CONCLUSION：The visual analogue scale scores at seating and maximum flexion position at 24 and 48 hours after second total knee arthroplasty were significantly higher than the first surgery. No significant＆amp;nbsp;difference in visual analogue scale scores was detected between 72-hour seating and maximum flexion position. Visual analogue scale scores were significantly higher in the interval of less than 6 months than in the 6-12 month group and more than 12 month group in the 24-hour seating and maximum flexion position after second total knee arthroplasty. No significant difference in visual analogue scale scores was detected between the 6-12 month group and more than 12 month group at seating and maximum flexion position. Results suggested that the pain of second surgery was obviously higher than the first surgery within 48 hours after staged bilateral total knee arthroplasty, and this can provide a clinical evidence to enhance the analgesic strategy in the second stage

关 键 词：植入物 人工假体 分期 双侧全膝关节置换 术后疼痛 手术间隔时间 

分 类 号：R318[医药卫生—生物医学工程]