中国组织工程研究

中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (30): 5540-5543.doi: 10.3969/j.issn.2095-4344.2012.30.007

• 人工假体 artificial prosthesis • 上一篇    下一篇

多模式镇痛在初次全膝关节置换中的应用

蒋 涛，瞿玉兴，许建安   

  • 收稿日期:2011-09-06 修回日期:2012-04-13 出版日期:2012-07-22 发布日期:2012-07-22
  • 通讯作者: Graduate School of Nanjing University of Chinese Medicine， Nanjing 210046, Jiangsu Province, China
  • 作者简介:蒋涛☆，男，1974年生，江苏省常州市人，汉族，2012年南京中医药大学毕业，博士，副主任医师，主要从事骨与关节疾病的研究。 jiangtao20111111@126.com

Appliation of multimodal pain control protocol in primary total knee arthroplasty

Jiang Tao, Qu Yu-xing, Xu Jian-an   

  1. 南京中医药大学研究生院，江苏省南京市 210046
  • Received:2011-09-06 Revised:2012-04-13 Online:2012-07-22 Published:2012-07-22
  • About author:Jiang Tao☆, Doctor, Associate chief physician, Department of Orthopedics, Changzhou Traditional Chinese Medicine Hospital, Changzhou 213000, Jiangsu Province, China jiangtao20111111@126.com

PDF

482

被引次数

20

摘要：

背景：全膝关节置换后围置换期急性疼痛广泛存在，阻碍了早期康复锻炼，增加并发症发生。虽然有研究者提出一系列的新方式并证实了其有效性，但滥用药物及神经阻滞的并发症无法避免，寻找一种安全而有效的镇痛方案成为当前关节置换的重要课题。
目的：观察包括关节周围注射复合麻醉药物的多模式镇痛方案在全膝关节置换患者中的疗效及安全性。
方法：回顾性分析2009-05/2011-05常州市中医医院骨科收治的行单侧全膝关节置换患者80例，分为2组，对照组(n=38)，接受股神经阻滞或硬膜外自控镇痛治疗；实验组(n=42)，采用包括关节周围注射复合麻醉药物的多模式镇痛方案。
结果与结论：在置换后6 h，12 h，24 h，2 d，3 d内，实验组较对照组疼痛评分降低(P < 0.05)。但在置换后第4，5天两组间疼痛评分差异无显著性意义(P > 0.05)。实验组置换后短期内疼痛减轻明显，置换后主动、被动屈膝90°时间明显缩短，且助行器辅助下地行走时间明显提前(P < 0.05)。两组不良反应发生率相似，由于引流合理使用，未见伤口感染或延迟愈合出现。提示多模式镇痛方案可作为一种安全镇痛方案，能显著减少置换后疼痛。

关键词: 多模式镇痛, 全膝关节置换, 目测类比疼痛评分, 关节活动度, 人工假体

Abstract:

BACKGROUND: Acute pain during the peri-replacement period after total knee arthroplasty can impede the early rehabilitation exercises and increase the complications. Although the researchers have proposed a series of new ways and confirmed its effectiveness, the complications of drug abuse and nerve block cannot be avoided. Looking for a safe and effective analgesic program has become an important issue in joint replacement.
OBJECTIVE: To evaluate the therapeutic effect and safety of multimodal pain control protocol by periarticular injection of composite narcotic drugs on postoperative pain and functional rehabilitation after total knee arthroplasty．
METHODS: Between May 2009 and May 2010, 80 patients undergoing unilateral total knee arthroplasty were divided into two groups. The patients (n=38) in control group received the treatment of femoral nerve block or patient-controlled epidural analgesia; the patients (n=42) in the experimental group were treated with multimodal pain control protocol by periarticular injection of composite narcotic drugs.
RESULTS AND CONCLUSION: At 6, 12 and 24 hours and 2 and 3 days after replacement, the visual analogue scale score of the experimental group was lower than that of the control group (P < 0.05). There was no significant difference of visual analogue scale score between two groups at 4 and 5 days after replacement (P > 0.05). Compared with control group, the short-term pain was reduced, time for active and passive flexion 90° was significantly shorter after replacement, and the walker assisted walking fields time was significantly decreased in the experimental group (P < 0.05). The patients in the two groups had the similar incidence of adverse reactions, and no wound infection or delayed healing appeared due to the rational use of drainage. Multimodal pain control protocol after total knee arthroplasty as a secure and effective analgesic program can significantly reduce the pain after replacement.

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