混合镇痛剂联合不同糖皮质激素在全膝关节置换术中的应用

Application of multimodal analgesic periarticular injection with different type steroid in total knee arthroplasty

目的比较混合镇痛剂分别联合醋酸泼尼松和复方倍他米松在全膝关节置换术(TKA)后镇痛效果及安全性。方法将79例单侧TKA患者随机分为醋酸泼尼松组(40例)与复方倍他米松组(39例),记录两组手术前后膝关节静息和活动时疼痛VAS评分;记录患者术后72 h内吗啡的使用量;监测手术前后ESR、CRP变化;记录手术前后膝关节活动度、KSS评分以及术后塞来昔布服用持续时间。结果患者均获得随访,时间6～18个月。术后12 h静息时VAS评分醋酸泼尼松组较复方倍他米松组低(P <0. 05);两组其余时间点静息和活动时VAS评分比较差异均无统计学意义(P> 0. 05)。膝关节活动度、术后72 h吗啡使用量两组比较差异均无统计学意义(P> 0. 05)。醋酸泼尼松组术后1、3、5 d的CRP以及术后3、5 d的ESR下降迅速,与复方倍他米松组比较差异有统计学意义(P <0. 05)。术后各时间点KSS评分、塞来昔布服用持续时间两组比较差异无统计学意义(P> 0. 05)。结论混合镇痛剂联合醋酸泼尼松注射于关节周围,在TKA术后早期镇痛效果良好,炎性指标低,且安全性高。

Objective To compare the efficacy of pain control and safety after total knee arthroplasty(TKA) by using multimodal analgesic periarticular injection with prednisone acetate or compound betamethasone. Methods Seventy-nine patients who underwent unilateral TKA were randomly divided into two groups: prednisone acetate group( n =40) and compound betamethasone group( n =39).Preoperative and postoperative visual analogue scale (VAS) at rest and during activity,the volume of daily and cumulative morphine consumption in the postoperative first 72 h,serum C-reactive protein(CRP) and erythrocyte sedimentation rate(ESR),the range of motion,knee society score(KSS),the duration of celecoxib usage were recorded and compared between the two groups. Results All patients were followed up for 6~18 months.The VAS at rest of the prednisone acetate group at postoperative 12 h was lower than that of compound betamethasone group( P <0.05).However, there were no differences for VAS at rest and activity in the other time points between the two groups ( P >0.05).There were no significant differences in motion range of knee and consumption of the morphine within 72 h between the two groups( P >0.05).The CRP values at postoperative 1, 3,5 d,and ESR values at postoperative 3,5 d of the patients in the prednisone acetate group had significantly decreased,compared with the compound betamethasone group( P <0.05).The KSS, the duration of celecoxib usage showed no significant difference between the groups( P >0.05). Conclusions Adding prednisone acetate to local infiltration analgesia show significant pain relief,reduction in biochemical marker of inflammation,more security.