不同镇痛方法对膝关节置换术后疼痛和早期康复的影响  

Effects of different analgesic methods on pain and early rehabilitation after total knee arthroplasty

作　　者：蒋秋香 张正迪[1] 邓斌 曹慧娟 蔡铁良[1] 

机构地区：[1]安徽医科大学解放军174临床学院麻醉科,福建厦门361000 [2]厦门大学附属翔安医院麻醉科,福建厦门361000

出　　处：《中国矫形外科杂志》2018年第3期198-202,共5页Orthopedic Journal of China

基　　金：国家自然科学基金青年项目(项目编号：81501207)

摘　　要：[目的]对比不同镇痛方法对膝关节置换术后疼痛和早期康复的影响。[方法]2016年9月~2017年9月,择期行单侧全膝关节置换术(TKA)的患者75例列入本研究,依据术后镇痛方式,随机均分为3组:连续收肌管阻滞联合关节周围浸润组(CA+P组)、连续股神经阻滞联合关节周围浸润组(CF+P组)、连续硬膜外镇痛组(E组),所有患者均采用腰硬联合麻醉。记录术前、术后静息及活动状态下的疼痛视觉模拟评分(VAS)和股四头肌肌力,记录术后膝关节最大主动屈曲角度(°)和不良反应。[结果]术后24、48、72 h活动状态下,E组患者VAS评分明显高于CA+P组和CF+P组,差异有统计学意义(P<0.05)。CF+P组和E组患者术后6、12、24 h股四头肌肌力下降,差异有统计学意义(P<0.05)。CF+P组和E组术后1、2、3 d膝关节主动屈曲角度明显降低,差异有统计学意义(P<0.05)。E组加用镇痛药物用量及术后并发症的发生率明显高于其他两组,差异有统计学意义(P<0.05)。[结论]连续收肌管阻滞联合关节周围浸润可有效缓解全膝关节置换术患者疼痛,且对股四头肌肌力影响更小,不良反应发生率更低。[Objective] To compare the effects of different analgesic methods on pain and early rehabihtation after total knee arthroplasty （TKA） . [Methods] From September 2016 to September 2017, 75 patients who would undergo unilateral total knee arthroplasty were enrolled in this study. In term of postoperative analgesia, the patients were randomly divided into three- groups, including the continuous adductor canal block combined with periarticular local infiltration analgesia （the CA ＋ P group）, continuous femoral nerve block combined with periarticular local infiltration analgesia （the CF＋P group ） and continu- ous epidura[ analgesia group （the E group） . All patients received TKA under combined spinal and epidnral anesthesia. The VAS, quadriceps muscle strength, maximum active flexion angle and adverse reactions were compared among the three groups. [Results] At 24, 48 and 72 hours postoperatively, the moving VAS of the E group was statistically higher than the CA＋P group and the CF＋P group （P〈0.05） . The strength of quadriceps femoris of the CF＋P group and E group statistically decreased at 6, 12 and 24 hours （P〈0.05）. The flexion angle of knee joint was significantly decreased in CF＋P group and E group at 1, 2 and 3 days （P〈0.05）. The additional intravenous analgesic drug dosage and postoperative complication in the E group were significant- ly higher than the other two groups （P〈0.05）. [Conclusion] Continuous adductor canal block combined with periarticular local infiltration analgesia does effectively relieve pain in patients with total knee arthroplasty, with minimized impact on quadriceps muscle strength and less adverse reactions.

关 键 词：全膝关节置换术 连续收肌管阻滞 关节周围浸润镇痛 早期康复 

分 类 号：R687.4[医药卫生—骨科学]