对比不同镇痛方案对初次全膝关节置换术后康复效果的影响  

Comparison of the effect of different analgesic regimens on the rehabilitation results after the first total knee arthroplasty

作　　者：许珂 井文森 鲁超 蔡元真 杨治[1] 许鹏[1] Xu Ke;Jing Wensen;Lu Chao(Osteonecrosis and Joint Reconstruction Ward,Arthropathy Hospital,the Affiliated Honghui Hospital of Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]西安交通大学附属红会医院关节病医院骨坏死与关节重建病区,710054

出　　处：《美中国际创伤杂志》2021年第4期29-32,共4页U.S.Chinese International Journal of Traumatology

基　　金：国家自然科学基金青年项目(81601877)。

摘　　要：目的:对比不同镇痛方案对初次全膝关节置换术后康复效果的影响。方法:选择我院单侧全膝关节置换患者150例,随机分为2组,每组各75例。术中分别采用股神经联合坐骨神经阻滞镇痛(神经阻滞组)和关节周围多点注狀“鸡尾酒”(鸡尾酒组)。比较两组术前、术后HSS评分、术后静息状态及被动活动状态下VAS评分以及术后引流量、隐性失血量、输血率、并发症发生率。结果:两组术前、术后HSS评分、术后隐性失血量、输血率、并发症发生率对比无统计学差异。术后12h、24h静息及被动活动状态下VAS评分鸡尾酒组明显高于神经阻滞组(P<0.05);术后48h静息状态及被动活动状态下VAS评分鸡尾酒组明显低于神经阻滞组(P<0.05)。鸡尾酒组术后引流量明显低于神经阻滞组,且差异具有统计学意义(P<0.05)。结论:股神经联合坐骨神经阻滞早期镇痛效果较关节周围多点注射“鸡尾酒”配方好,但后者较前者作用时间长,且能减少出血量。Objective:To compare the effect of different analgesic regimens on the rehabilitation results after the first total knee arthroplasty.Methods:A total of 150 patients underwent unilateral total knee replacement in our hospital,and were randomly divided into 2 groups according to the different analgesic regimens.75 patients received femoral nerve combined with sciatic nerve block analgesia(nerve block group)during operation,and the other 75 patients received multi-point injection of"cocktail"(cocktail group)around the joints.Preoperative and postoperative HSS score,VAS score in resting state and passive activity state,postoperative drainage volume,the amount of hidden blood loss,blood transfusion rate,and complication rate after operation between the two groups were compared and analyzed.Results:There was no significant difference in preoperative and postoperative HSS score,postoperative hidden blood loss,blood transfusion rate,and complication rate between the two groups.At 12h and 24h after operation,the VAS score of cocktail group in the resting state and passive activity state was significantly higher than that in the nerve block group(P<0.05).However,48h after the operation,the VAS score of cocktail group in the resting state and passive activity state was significantly lower than that in the nerve block group(P<0.05).The postoperative drainage volume of the cocktail group was significantly lower than that of the nerve block group,and the difference was statistically significant(P<0.05).Conclusion:The early analgesic effect of femoral nerve combined with sciatic nerve block is better than that of multi-point injection of"cocktail"around the joint,but the latter has a longer action time than the former and it can also reduce the amount of bleeding.

关 键 词：镇痛 全膝关节置换 神经阻滞 鸡尾酒 

分 类 号：R68[医药卫生—骨科学]