中国组织工程研究

中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (27): 5839-5844.doi: 10.12307/2025.850

• 人工假体Artificial prosthesis • 上一篇    下一篇

新型局部浸润麻醉应用于人工全膝关节置换的早期效果评估

王  俊，张  辉，李正远，郝  琳，陈圣洪，尹宗生   

  • 收稿日期:2024-07-25 接受日期:2024-09-26 出版日期:2025-09-28 发布日期:2025-03-05
  • 通讯作者: 尹宗生，博士，主任医师，教授，安徽医科大学第一附属医院骨科，安徽省合肥市 230022
  • 作者简介:王俊，男，1987年生，安徽省芜湖市人，汉族，博士，主治医师，主要从事骨关节炎的临床诊疗与基础研究。
  • 基金资助:
    安徽省自然科学基金(2308085MH250)，项目负责人：王俊；安徽省高校自然科学基金(2023AH053327)，项目负责人：王俊

Assessment on initial effectiveness of a novel local infiltration anesthesia in total knee arthroplasty

Wang Jun, Zhang Hui, Li Zhengyuan, Hao Lin, Chen Shenghong, Yin Zongsheng   

  1. Department of Joint Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China

  • Received:2024-07-25 Accepted:2024-09-26 Online:2025-09-28 Published:2025-03-05
  • Contact: Yin Zongsheng, MD, Chief physician, Professor, Department of Joint Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
  • About author:Wang Jun, MD, Attending physician, Department of Joint Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
  • Supported by:
    Anhui Natural Science Foundation, No. 2308085MH250 (to WJ); Anhui Provincial College Natural Science Foundation, No. 2023AH053327 (to WJ)

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摘要：


文题释义：

全膝关节置换：是一种外科手术，用人工关节组件替换受损的膝关节软骨和骨骼组织，以缓解膝关节疼痛并恢复关节功能。这项手术主要适用于晚期骨关节炎患者，可缓解疼痛、稳定关节、矫正畸形，并提升关节的活动范围。
局部浸润麻醉：又被称作“鸡尾酒疗法”，是指在手术过程中将局部麻醉药物注射到手术部位的组织内，通过作用于神经末梢，能够使其失去传递疼痛感的能力，从而实现麻醉效果。

摘要

背景：全膝关节置换后患者会经历明显的疼痛，这对功能恢复存在负面影响，探索并寻求有效的镇痛手段具有重要的临床价值。
目的：为探求全膝关节置换患者有效的围术期镇痛策略，首次提出了一种由吗啡、氟比洛芬酯和复方倍他米松配置而成的新型局部浸润麻醉制剂，同时探讨该方案的有效性及安全性。
方法：对2023年11月至2024年4月在安徽医科大学第一附属医院关节外科接受初次单侧全膝关节置换60例患者的临床资料进行回顾性分析，根据置换过程中是否使用局部浸润麻醉将患者分为对照组与研究组，每组30例。研究组在全膝关节置换过程中关节腔周围注射吗啡、氟比洛芬酯及复方倍他米松配置而成的局部浸润麻醉制剂，而对照组术中未使用任何镇痛药物作为空白对照。记录并比较两组患者在术后不同时间节点的疼痛目测类比评分、膝关节活动度、膝关节学会评分、术后膝关节肿胀程度及术后并发症的发生情况。 
结果与结论：①与对照组相比，研究组患者置换后6，12及24 h的疼痛目测类比评分更低，差异有显著性意义(Z=-2.367，-2.906，-4.199，P < 0.05)；但在术后48，72 h，两组患者的疼痛目测类比评分并无显著性差异(Z=-1.287，-1.478，P > 0.05)；②置换后第3天，研究组患者的膝关节活动度和膝关节学会评分均优于对照组，差异有显著性意义(t=-2.519，-8.027，P < 0.05)；③研究组患者术后的膝关节肿胀程度轻于对照组，差异有显著性意义(Z=-2.818，P < 0.05)；④在术后早期，两组患者的发热发生率相比无显著性差异(P > 0.05)，两组均未发生切口愈合不良及假体周围感染；⑤结果表明：在全膝关节置换过程中应用由吗啡、氟比洛芬酯及复方倍他米松组成的局部浸润麻醉制剂，可以明显减轻患者术后早期疼痛，并显示出较高的安全性，但仍需大样本的前瞻性研究提供数据支持。


中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 全膝关节置换, 局部浸润麻醉, 镇痛, 复方倍他米松, 疼痛目测类比评分, 关节活动度

Abstract: BACKGROUND: After total knee arthroplasty, patients may experience significant pain, which has negative effects on functional recovery. Exploring and seeking effective means of analgesia has important clinical value.
OBJECTIVE: To explore an effective perioperative analgesic strategy for total knee arthroplasty patients, we first proposed a novel local infiltration anesthetic formulation consisting of morphine, flurbiprofen, and compound betamethasone, and we explored its efficacy and safety.
METHODS: This study retrospectively analyzed the clinical data of 60 patients who underwent unilateral total knee arthroplasty at First Affiliated Hospital of Anhui Medical University from November 2023 to April 2024. Based on whether local anesthesia was used during surgery, the patients were divided into the control and study groups, each consisting of 30 cases. In the study group, the local infiltration anesthesia mixture consisting of morphine, flurbiprofen, and compound betamethasone was injected into the joint cavity around the knee during surgery. No analgesic drugs were used in the control group as a blank control. We recorded and compared the postoperative visual analog scale pain scores, knee range of motion, knee function score, degree of postoperative knee edema, and incidence of postoperative complications between the two groups at different time points.
RESULTS AND CONCLUSION: (1) Compared with the control group, the visual analog scale pain score in the study group was lower at 6, 12, and 24 hours after operation, and the difference was statistically significant (Z=-2.367, -2.906, -4.199, P < 0.05). However, there was no significant difference in the pain visual analog scale score between the two groups at 48 and 72 hours after operation (Z=-1.287, -1.478, P > 0.05). (2) The postoperative knee range of motion and knee function score of the study group were better than those of the control group, and the difference was statistically significant (t=-2.519, -8.027, P < 0.05). (3) The degree of knee joint swelling in the study group was also lighter than that in the control group, and the difference was statistically significant (Z=-2.818, P < 0.05). (4) In the early postoperative period, there was no significant difference in fever between the two groups (P > 0.05). There was no poor wound healing or periprosthetic infection in the two groups. (5) The results show that applying local infiltration anesthesia composed of morphine, flurbiprofen axetil, and compound betamethasone in total knee arthroplasty can relieve early postoperative pain and show high safety. However, prospective studies with large samples are still needed to provide data support.

Key words: total knee arthroplasty, local infiltration analgesia, analgesia, compound betamethasone, visual analog scale pain score, range of motion

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