经皮神经电刺激在全膝关节置换术后多模式镇痛中的应用研究

Application of transcutaneous electrical nerve stimulation to multimodal analgesia after total knee arthroplasty

目的:观察经皮神经电刺激治疗在全膝关节置换术后多模式镇痛方案中的应用疗效。方法:2009年3月至2012年5月在浙江省中医院骨伤科就诊,诊断为膝骨性关节炎需行单侧全膝关节置换术的患者60例,分为试验组和对照组,每组30例。所有患者术前口服塞来昔布,术中行膝关节腔周围注射,术后口服塞来昔布、硫酸吗啡控释片。试验组术后增加使用经皮神经电刺激治疗,每日1次。患者于术后24 h开始做膝关节功能锻炼。记录患者术后各时间点疼痛视觉模拟评分、膝关节活动角度、不良反应等。结果:术后24、48、72 h及术后1周,试验组患者的疼痛评分分别为3.39±0.69,2.79±0.51,2.16±0.52,1.07±0.57,均低于对照组患者的3.80±0.86,3.22±0.58,2.53±0.54,1.38±0.52。术后24、48、72 h及术后1周、2周,试验组患者的膝关节被动活动角度分别为(30.67±3.65)°,(39.17±3.96)°,(47.83±4.86)°,(93.67±7.30)°,(107.67±7.51)°;术后72 h及1、2周主动活动角度分别为(29.83±5.33)°,(78.33±8.24)°,(95.17±5.94)°;均高于对照组的(28.67±3.92)°,(36.83±4.25)°,(45.17±5.17)°,(89.83±7.25)°,(103.17±7.37)°和(24.17±10.26)°,(73.83±9.07)°,(91.33±7.42)°。试验组19例膝部皮肤出现不同程度环形瘀血性压迹,5例出现局部水泡。结论:将经皮神经电刺激治疗应用于全膝关节置换术后多模式镇痛可以降低患者术后疼痛评分,促进术后膝关节功能尽早恢复。

To study the effects of transcutaneous electrical nerve stimulation on multimodal analgesia after total knee arthroplasty. Methods ： Sixty patients diagnosed as knee osteoarthritis and suffered unilateral total knee arthroplasty in the department of orthopedics,Zhejiang Traditional Chinese Medicine Hospital from March 2009 to May 2012 were randomly divided into control group and test group, 30 cases in each group. All the patients received celecoxib preoperatively, knee peri- articular injection with the drug mixture intraoperatively, and celecoxib and morphine sulfate controlled-release tablets postop- eratively. The patients in the test group were also treated with transcutaneous electrical nerve stimulation each day after opera- tion. All the patients started doing functional exercises at 24 h after operation. Postoperative visual analogue scales （VAS）, pas- sive and active range of motion of knee joint, and complications were recorded. Results：The VAS scores of test group during postoperative 24 h to 1 week were 3.39±0.69,2.79±0.51,2.16±0.52,and 1.07±0.57 separately,which were lower than 3.80±0.86,3.22±0.58,2.53±0.54 and 1.38±0.52 in the control group. The passive and active range of knee joint motion in the test group during postoperative 24 h to 2 weeks were （30.67±3.65）°, （39.17±3.96）°, （47.83±4.86）°, （93.67±7.30）°, （107.67± 7.51）° and （29.83±5.33）°, （78.33±8.24）°, （95.17±5.94）° respectively,which were higher than （28.67±3.92）°, （36.83± 4.25）°, （45.17±5.17）°, （89.83±7.25）°, （103.17±7.37）° and （24.17±10.26）°, （73.83±9.07）°, （91.33±7.42）° in the control group. In the test group, 19 patients had ring-shaped haemostasis impression to some extent in the skin of knee joint to different degree, and 5 patients had blister formation. Conclusion： It is meaningful to apply transcutaneous electrical nerve stimulation for treating multimodal analgesia after total knee arthroplasty, which can not only relieve patients＇ postoperative pain, and also promote the rehabilitation of knee function as far as possible.