全膝关节置换术后三种镇痛方案的对比  

Comparison of three analgesic regimens after total knee arthroplasty

作　　者：张印[1] 史永安[2] 余攀 乔宗瑞[1] 

机构地区：[1]河南南阳市第一人民医院,473010 [2]山东文登整骨医院,266440

出　　处：《中国矫形外科杂志》2017年第19期1763-1766,共4页Orthopedic Journal of China

摘　　要：[目的]评价不同镇痛方案在全膝关节置换术后的临床效果。[方法]全膝关节置换术90例,随机采用三组,分别采用"鸡尾酒"关节腔灌注(关节灌注组)、关节周围多点注射(多点注射组)及股神经阻滞(神经阻滞组),每组30例。比较三组间术后VAS评分、哌替啶使用例数、不良反应的发生和功能恢复情况。[结果]术后6 h及72 h,三组间VAS评分差异无统计学意义(P>0.05);术后24 h时,神经阻滞组后关节囊疼痛明显,VAS评分高于其他两组,差异有统计学意义(P<0.05)。术后加用哌替啶患者数三组间差异无统计学意义(P>0.05)。不良反应三组间差异有统计意义(P<0.05)。神经阻滞组诉股四头肌无力比例较高,自主直腿抬高及下地活动时间方面均不如其他两组,差异有统计学意义(P<0.05)。术后3个月三组间HSS评分的差异无统计学意义(P>0.05)。[结论]关节腔灌注"鸡尾酒"配方药物在全膝关节置换术后镇痛方面效果良好。可有效降低术后疼痛,且操作简单,在术后早期活动及不良反应发生率方面均有一定优势。[Objective] To evaluate the clinical outcome of 3 analgesic regimens after total knee arthroplasty （TKA） . [Methods] Consecutive 90 patients who underwent unilateral TKA were randomly divided into 3 groups with 30 patients in each group. Correspondingly, 3 perioperative analgesic regimens were given respectively, including ＂cocktail＂ joint cavity perfusion （the joint perfusion group） , multipoint periarticular injection point （the multipoint injection group） and femoral nerve block （the nerve block group） . Postoperatively the VAS, supplementary use of pethidine, adverse reactions and functional recovery were compared among 3 groups. [Results] Although there were on significant differences in VAS among the 3 groups at 6 h and 72 h postoperatively （P〉0.05） , the patients in the nerve block group suffered from notable posterior pain, associated with the highest VAS, which was statistically different with the other two groups at 24 h after operation （P〈0.05） . The supplementary use of pethidine was not statistically different anomy the 3 groups, nevertheless adverse reactions occurred most frequently in the nerve block group, where likewise was statistically different compared to the other two groups （P〈 0.05） . In addition, the nerve block group tended to make complaint of weakness of knee extension, associated with significant differences in time to return active straight leg raising and ambulation with the other two groups （P〈0.05） . At 3 months there were no statistical difference in HSS anomy the 3 groups （P〉0.05） . [Conclusion] The ＂cocktail＂ joint cavity perfusion for analgesia after total knee arthroplasty with advantages of easy handling, less adverse reaction, and facilitation to early rehabilitation, does achieves satisfactory clinical outcome.

关 键 词：全膝关节置换 镇痛 关节腔灌注 

分 类 号：R687.4[医药卫生—骨科学]