人工全膝关节置换过程中及围术期镇痛对关节功能恢复的影响

Effect of intra-and peri-operative analgesia on the recovery of joint function following total knee arthroplasty

背景:人工全膝关节置换后的疼痛控制是每个骨科医生都需要面对的难题,近年来镇痛技术有了长足发展,但是各有缺点。目的:观察多模式镇痛对人工全膝关节置换后关节功能的影响。方法:行单侧人工全膝关节置换的患者30例,男5例,女25例,随机分为两组。实验组:在围手术期采用选择性环氧合酶2抑制剂、股神经阻滞、关节周围注射罗哌卡因等多途径镇痛;对照组:术后使用自控镇痛泵和选择性环氧合酶2抑制剂镇痛。观察人工全膝关节置换后患者疼痛程度和膝关节的活动度。结果与结论:采用多途径镇痛特别是膝关节周围浸润注射可以使患者疼痛程度明显减轻,膝关节活动度增加,与对照组比较差异有显著性意义。说明人工全膝关节置换后应采取有效的镇痛措施来提高患者的治疗效果,围手术期采用多途径镇痛可以有效减轻人工全膝关节患者术后疼痛,加大患膝近期的活动度。

BACKGROUND：Pain control following artificial total knee arthroplasty（TKA）is a key concern for orthopedic surgeons.Although analgesis techniques have been improved in recent years,they have specific disadvantages.OBJECTIVE：To asses the effect of a multimodal pain management protocol in primary TKA.METHODS：A total of 30 patients,including 5 males and 25 females,undergoing primary unilateral TKA were selected and randomly assigned to 2 groups.Trial group was treated with cyclooxygenase-2 inhibitor,periarticular ropivacaine infiltration analgesia and femoral nerve block to pain control.Control group received cyclooxygenase-2 inhibitor and patient-controlled analgesia（PCA）.The pain severity and range of motion（ROM）in patients was observed postoperatively.RESULTS AND CONCLUSION：A multimodal protocol that emphasizes local periarticular injections after TKA provides better pain control and improved postoperative ROM of troubled knee in early time compared with control group.Multimodal pain management that emphasizes local periarticular infiltration analgesia in peri-operative period of TKA could provide better pain control and improved function of the knee.