倍他米松在初次单髁置换术中关节周围浸润注射的有效性及安全性评价  

Efficacy and safety of compound betamethasone cocktail therapy in primary unilateral unicompartmental knee arthroplasty

作　　者：刘沛 郭万首[2] 张启栋[2] 王卫国[2] 张毅 王洋洋 Liu Pei;Guo Wanshou;Zhang Qidong;Wang Weiguo;Zhang Yi;Wang Yangyang(Beijing University of Chinese Medicine,Beijing 100029,China;Department of Orthopedic Surgery,China-Japan Friendship Hospital,Beijing 100029,China;Peking University,China-Japan Friendship Clinical Medical College,Beijing 100029,China)

机构地区：[1]北京中医药大学,北京100029 [2]中日友好医院骨科,北京100029 [3]北京大学中日友好临床医学院,北京100029

出　　处：《中华医学杂志》2019年第39期3100-3104,共5页National Medical Journal of China

基　　金：国家重点研发计划课题(2017YFC0108102);国家自然科学基金(81703896、81673776);首都卫生发展科研专项(2016-2-4062)。

摘　　要：目的研究初次单髁置换术(UKA)中关节周围浸润注射含小剂量复方倍他米松注射液"鸡尾酒"的有效性及安全性。方法纳入中日友好医院2017年7月至2018年10月行初次单侧UKA的患者70例,电脑随机数字表法分为两组。A组"鸡尾酒"配方中含复方倍他米松注射液;B组不含倍他米松。比较两组患者术后6、12、18、24、30、36、42和48 h膝关节疼痛视觉模拟评分(VAS)及其他镇痛药物使用率,术后1、2、3 d膝关节最大屈曲度数,直腿抬高时间及并发症。组间计量资料的比较采用独立样本t检验。结果术后前12 h,两组的VAS评分无明显差异(t=-1.154、-1.108,均P>0.05);术后18~48 h,A组VAS评分明显低于B组(t=-2.959、-2.808、-2.080、-2.519、-3.378、-3.237,均P<0.05),且其他镇痛药物的使用率更低。术后1~3 d,A组膝关节最大屈曲度数均大于B组(t=2.985、4.575、4.013,均P<0.05),两组直腿抬高时间、并发症发生率均无统计学差异(χ^2=0.141、0.000,均P>0.05)。结论初次UKA术中,关节周围浸润注射含小剂量倍他米松的"鸡尾酒"可更有效缓解术后急性疼痛,改善膝关节功能,且不增加并发症的发生率。Objective To evaluate the efficacy and safety of an intraoperative betamethasone periarticular injection in patients undergoing primary unicompartmental knee arthroplasty(UKA).Methods Seventy patients with knee anteromedial osteoarthritis who underwent the primary unilateral UKA in China-Japan Friendship Hospital from July 2017 to October 2018 were randomized into two groups with random number table.In the group A,an analgesic mixture of morphine,ropivacaine,epinephrine,ketorolac and betamethasone was infiltrated intraoperatively into the soft tissue.While in the group B,a same volume of mixture without betamethasone was injected alternatively.The visual analogue scale(VAS)of pain and analgesic consumption were evaluated to compare the effectiveness of pain control between the two groups.In addition,maximal flexion of the knee andinitial time of the straight leg raising were monitored.Complications were assessed too.The data were compared with independent-sample t test.Results No significant differences in VAS score was found between the groups at 6 h and 12 h after the operation(t=-1.154,-1.108,both P>0.05),but the pain level and analgesic consumption were significantly lower in the group A from 18 h to 72 h post operation(t=-2.959,-2.808,-2.080,-2.519,-3.378,-3.237,all P<0.05).The maximal flexion in group A was significantly higher than that in the group B from 1 d to 3 d(t=2.985,4.575,4.013,all P<0.05).The straight leg raising ability and incidence of complications were similar between the groups(χ^2=0.141,0.000,both P>0.05).Conclusions The cocktail analgesics injection containing small dose of betamethasone during UKA can provide effective acute pain control early after the surgery,which is conducive to knee joint function,and it does not increase the incidence of postoperative complications.

关 键 词：单髁置换术 膝 鸡尾酒疗法 镇痛 

分 类 号：R68[医药卫生—骨科学]