复方倍他米松应用于人工全膝关节置换术中局部浸润麻醉的早期疗效评估

Evaluation of early effectiveness of local infiltration anesthesia with compound betamethasone in total knee arthroplasty

目的评估人工全膝关节置换术(total knee arthroplasty,TKA)中局部浸润麻醉(local infiltration analgesia,LIA)制剂添加复方倍他米松的早期疗效。方法回顾分析2022年5月—2023年3月采用TKA治疗的符合选择标准的102例膝关节骨关节炎患者临床资料。根据LIA制剂是否添加复方倍他米松,患者分为对照组和研究组,每组51例。两组患者年龄、性别、身体质量指数、手术侧别、术侧术前关节活动度(range of motion,ROM)、膝关节学会评分系统(KSS)评分、白细胞计数(white blood cell,WBC)、红细胞压积等基线资料比较,差异均无统计学意义(P>0.05)。记录术中总失血量和隐性失血量,术后1、2、3 d WBC;以及术后1、2、3 d疼痛视觉模拟评分(VAS)及术后48 h内摄入吗啡毫克当量评估疼痛程度;术后第3天测量患者膝关节被动ROM及最大伸直和屈曲角度;记录术后早期并发症发生情况。结果两组患者总失血量和隐性失血量比较差异无统计学意义(P>0.05)。两组术后疼痛程度均较轻,术后前3 d两组VAS评分及术后48 h内摄入吗啡毫克当量比较差异均无统计学意义(P>0.05)。术后前3 d两组WBC均较术前显著改善(P<0.05);研究组术后1、2 d WBC高于对照组(P<0.05),但术后3 d两组差异无统计学意义(P>0.05)。术后3 d研究组膝关节最大伸直角度小于对照组,膝关节最大屈曲角度及被动ROM均大于对照组,差异均有统计学意义(P<0.05)。术后早期对照组患者发生发热6例、下肢深静脉血栓形成17例,研究组分别为1例和14例,两组均无切口愈合不良及人工关节假体周围感染发生,两组并发症发生率比较差异均无统计学意义(P>0.05)。结论复方倍他米松应用于TKA术中LIA是促进患者术后早期康复的安全优化策略。

Objective To evaluate the early effectiveness of local infiltration anesthesia(LIA)with compound betamethasone in total knee arthroplasty(TKA).Methods The clinical data of 102 patients with knee osteoarthritis who were treated by TKA and met the selection criteria between May 2022 and March 2023 were retrospectively analyzed.They were divided into control group and study group according to whether LIA preparation was added with compound betamethasone,with 51 cases in each group.There was no significant difference of baseline data,such as age,gender,body mass index,operative side,preoperative range of motion(ROM),Knee Society Score(KSS),white blood cell(WBC),and hematocrit between the two groups(P>0.05).The intraoperative total blood loss and hidden blood loss were recorded,and WBC was recorded on the 1st,2nd,and 3rd days after operation.Pain was assessed by visual analogue scale(VAS)score on the 1st,2nd,and 3rd days after operation and morphine intake milligrames equivalent within 48 hours after operation.Passive ROM,maximum extension and flexion angles of knee joint were measured on the 3rd day after operation;the early postoperative complications were recorded.Results There was no significant difference in total blood loss and hidden blood loss between the two groups(P>0.05).The postoperative pain levels in both groups were relatively mild,and there was no significant difference in VAS scores in the first 3 days after operation and in morphine intake milligrams equivalent within 48 hours after operation between the two groups(P>0.05).The WBC in the first 3 days after operation was significantly improved in both groups(P<0.05).The WBC in the study group was significantly higher than that in the control group on the 1st and 2nd days after operation(P<0.05),but there was no significant difference between the two groups on the 3rd day after operation(P>0.05).On the 3rd day after operation,the maximum extension angle of knee joint in the study group was smaller than that in the control group,while the maximum flexion angle and passive ROM of knee joint in the study group were larger than those in the control group,and the differences were significant(P<0.05).There were 6 cases of fever and 17 cases of deep venous thrombosis in the control group,and 1 case and 14 cases in the study group,respectively.There was no poor wound healing and periprosthetic joint infection in the two groups,and there was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion The application of compound betamethasone in LIA during TKA is a safe and optimal strategy to promote the early postoperative rehabilitation of patients.