| 王丽静,王培浩.不同部位局部浸润麻醉对全膝关节置换术后疼痛及关节功能恢复的影响[J].中国烧伤创疡杂志,2024,(6):472~476. |
| DOI： |
| 中文关键词: 全膝关节置换术 局部浸润麻醉 早期镇痛 术后疼痛 膝关节功能 |
| 英文关键词:Total knee arthroplasty Local infiltration anesthesia Early analgesia Postoperative pain Knee joint function |
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| 中文摘要: |
| 【摘要】 目的 分析探讨不同部位局部浸润麻醉对全膝关节置换术后疼痛及关节功能恢复的影响。方法 选取 2018 年 6月至 2022 年 6 月濮阳市中医医院收治的93例拟行全膝关节置换术治疗的患者作为研究对象, 按照不同麻醉方法将其分为研究组 (31 例)、对照组 (31 例) 与空白组(31 例), 研究组患者术后行膝关节后侧浸润麻醉, 对照组患者术后行膝关节前侧浸润麻醉, 空白组患者术后行生理盐水注射, 对比观察 3组患者疼痛程度、膝关节功能、曲马多用量及不良反应发生情况。结果 术后 12 h, 研究组患者静止状态及被动屈伸运动状态视觉模拟评分法 (VAS) 评分均明显低于对照组与空白组 (静止状态: q = 4.648、7.562, P = 0.004、P<0.001；被动屈伸运动状态: q = 3.615、6.338, P = 0.033、P<0.001)；术后 24、48 h, 研究组患者静止状态及被动屈伸运动状态 VAS 评分均明显低于空白组 (静止状态: q = 5.120、6.750, P = 0.001、P<0.001； 被动屈伸运动状态:q = 5.839、5.329, P<0.001、P= 0.001)。术后第 5 天, 研究组患者美国膝关节协会评分 (KSS) 中的临床评分及功能评分均明显高于空白组、膝关节活动度明显大于空白组 ( q = 6.610、7.001、6.330, P 均<0.001), 且 KSS的临床评分明显高于对照组 ( q = 3.573, P = 0.041), 对照组患者 KSS 中的功能评分明显高于空白组 ( q =3.872, P= 0.048)。术后 48 h, 研究组患者曲马多用量明显少于对照组与空白组 ( q = 3.420、6.370, P = 0.046、P<0.001)。研究组患者不良反应发生率为 19.35%, 与对照组患者的不良反应发生率 9.68%及空白组患者的不良反应发生率 16.13%无明显差异 (χ2 = 1.177, P= 0.555)。结论 与膝关节前侧浸润麻醉及不使用浸润麻醉相比,膝关节后侧浸润麻醉能够有效提高全膝关节置换术后患者早期镇痛及膝关节功能恢复效果, 减少术后镇痛药物用量, 且安全性良好。 |
| 英文摘要: |
| 【Abstract】 Objective To analyze the effects of local infiltration anesthesia at different sites on postoperative pain and knee function recovery after total knee arthroplasty. Methods Ninety-three patients admitted to Chinese Medicine Hospital of Puyang from June 2018 to June 2022 for total knee arthroplasty were enrolled as research subjects and divided into study group (n = 31), control group (n = 31) and blank group (n = 31) according to the different anesthesia methodsthey received. After the surgery of total knee arthroplasty, patients in the study group received posterior knee joint infiltration anesthesia, patients in the control group received anterior knee joint infiltration anesthesia and patients in the blank group received saline injection. Postoperative pain levels, knee function, tramadol dosage, and occurrence of adverse reactions of patients were compared among the three groups. Results At 12 h after surgery, the visual analogue scale (VAS) scores in resting state and passive flexion-extension movement were both significantly lower in the study group respectively compared with the control group and the blank group ( resting state: q = 4.648 and 7.562, P = 0.004, P<0.001; passive flexion-extension movement: q = 3.615 and 6.338, P= 0.033, P<0.001). Respectively at 24 h and 48 h after surgery, the VAS scores in the above two items were all significantly lower in the study group compared with the blank group ( resting state:q = 5.120 and 6.750, P = 0.001, P<0.001; passive flexion-extension movement: q = 5.839 and 5.329, P<0.001, P =0.001). On day 5 after surgery, the clinical and functional scores of patients using the American Knee Society score (KSS) scale in the study group were significantly higher than those in the blank group, and knee joint range of motion was significantly greater than that in the blank group (q = 6.610, 7.001 and 6.330, all P<0.001), and the KSS clinical score was significantly higher than that in the control group ( q = 3.573, P = 0.041) . The KSS functional score of patients in the control group was significantly higher than that in the blank group ( q = 3.872, P = 0.048) . At 48 h after surgery, the tramadol dosage in the study group was significantly lower than that respectively in the control and blank groups ( q =3.420 and 6.370, P= 0.046, P<0.001) . The incidence of adverse reactions was 19.35% in the study group, which showed no significant difference as compared with the corresponding 9.68% in the control group and 16.13% in the blank group ( χ2 = 1.177, P= 0.555) . Conclusion Compared with anterior knee joint infiltration anesthesia and the non-use of infiltration anesthesia, posterior knee joint infiltration anesthesia can effectively improve the early analgesia effect and knee function recovery of patients after total knee arthroplasty, and reduce the dosage of postoperative analgesic drugs, with high treatment safety. |
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