膝关节镜术中不同生理盐水继续灌洗量对早期膝关节疼痛和肿胀程度的影响

The effect of different continuous saline irrigation volume under arthroscopy on early postoperative pain and swelling of the knee

目的探讨膝关节镜术中不同生理盐水继续灌洗量对术后早期膝关节疼痛和肿胀程度的影响。方法回顾2016年7月—2020年2月符合选择标准的539例行关节镜下半月板成形术治疗的半月板损伤患者临床资料,根据术中手术操作完成后生理盐水继续灌洗量不同将患者分为3组,不灌洗组176例(A组)、灌洗1 L组183例(B组)、灌洗3 L组180例(C组)。3组患者性别、年龄、致伤原因、损伤侧别、体质量指数、病程、合并吸烟史情况、半月板损伤分类等一般资料比较差异均无统计学意义(P>0.05)。术后6、12、24、48、72 h采用疼痛视觉模拟评分(VAS)评估患者疼痛程度,测定肿胀值(健、患侧膝关节髌骨上极上2 cm处周径差值)评估膝关节肿胀情况;术后1、3 d测定膝关节皮温值(健、患侧皮温差值),测定血清中C反应蛋白(C-reactive protein,CRP)含量;术后1、3、5 d测定膝关节活动度。结果各组术后切口均Ⅰ期愈合,无手术相关并发症发生。术后随时间延长,各组VAS评分呈缓慢升高后降低趋势,于48 h后低于术后6 h;术后各时间点3组间VAS评分比较差异均无统计学意义(P>0.05)。术后各组膝关节肿胀值则呈逐渐递减趋势,术后各时间点3组间肿胀值比较差异均无统计学意义(P>0.05)。术后3 d各组皮温值较1 d时降低,各时间点各组间皮温值比较差异均无统计学意义(P>0.05)。术后1、3 d间各组CRP含量无明显差异,各时间点各组间CRP含量比较差异均无统计学意义(P>0.05)。术后1、3、5 d各组膝关节活动度逐渐增加,各时间点3组间膝关节活动度比较差异均无统计学意义(P>0.05)。结论膝关节镜下半月板成形术中,手术操作完成后生理盐水继续灌洗量不同对术后早期膝关节疼痛、肿胀程度及炎症表现等方面的影响无明显差异。

Objective To investigate the effect of different saline irrigation volume under arthroscopy on early postoperative pain and swelling of the knee. Methods The clinical data of 539 patients with meniscus injury treated by arthroscopic menisci reformation who met the selection criteria between July 2016 and February 2020 were retrospectively analyzed. They were divided into three groups according to the continuous saline irrigation volume during the operation:176 patients in the non-irrigation group(group A), 183 patients in the 1 liter-irrigation group(group B), and 180 patients in the 3 liters-irrigation group(group C). There was no significant difference in gender, age, cause of injury, sides of injury, body mass index, disease duration, smoking history, and classification of meniscus injury among 3 groups(P>0.05). At 6, 12, 24, 48, and 72 hours after operation, the patient’s pain level was evaluated by the visual analogue scale(VAS) score, and the knee swelling situation was evaluated by the swelling ratings(the difference between both sides in circumference of the 2 cm upper patella of the knee). Knee skin temperature(the difference of the skin temperature between both sides) and the C-reactive protein(CRP) level in serum were measured at the 1 st and 3 rd days after operation. Range of motion of the knee was measured at the 1 st, 3 rd, and 5 th days after operation. Results All incisions healed by first intention without any complication after operation. The VAS scores of each group showed a slow increase trend after operation, and gradually decreased to less than the VAS score of 6 hours at 48 hours after operation. There was no significant difference in VAS scores among the 3 groups at each time point after operation(P>0.05). The swelling ratings of the knee in each group showed a gradually decrease trend after operation. There was no significant difference in the swelling ratings of the knee among the 3 groups at each time point after operation(P>0.05).The skin temperature of the knee in each group decreased at the 3 rd day after operation than the 1 st day, and there was no significant difference in the skin temperature of the knee among the 3 groups at each time point after operation(P>0.05).There was no significant difference in CRP level within the group and among the 3 groups at each time point after operation(P>0.05). Range of motion of the knee in each group increased gradually at the 1 st, 3 rd, and 5 th days after operation, and there was no significant difference among the 3 groups at each time point after operation(P>0.05).Conclusion The different continuous saline irrigation volume would not affect the early postoperative pain, swelling,and inflammation of the knee during the arthroscopic menisci plasty.