【摘要】 背景:屈曲畸形骨关节炎患者行全膝关节置换术中进行大范围软组织松解,术后存在较严重的急性疼痛,导致早期功能恢复不佳而影响手术效果。目前有多种围手术期镇痛模式,其中关节周围注射复合镇痛药物简单易行,可较好控制置换术后的早期疼痛,减少不良反应。目的:观察罗哌卡因复合液关节周围注射在屈曲畸形骨关节炎患者行全膝关节置换术后的镇痛效果及其对早期功能恢复的作用。方法:60例屈曲畸形骨关节炎患者均接受初次单侧全膝关节置换术,随机分为2组:对照组(n=30)接受术后静脉自控镇痛治疗,实验组(n=30)接受术后静脉自控镇痛治疗,同时术中在关节周围注射复合麻醉药物(盐酸罗哌卡因+肾上腺素)。评估手术前后患膝静止和活动时的视觉模拟疼痛评分(VAS)及活动范围,比较两组术后早期镇痛效果及早期功能恢复情况。结果:实验组术后4、8、12、24、36h患膝静息时和活动时VAS评分均小于对照组(P<0.05),活动范围大于对照组(P<0.05);实验组术后48h、3d运动时VAS评分小于对照组(P<0.05),静息时VAS评分与对照组比较无显著性差异(P>0.05),活动范围大于对照组(P<0.05);术后7d两组间VAS评分及活动范围无统计学差异(P>0.05)。结论:关节周围注射罗哌卡因复合液可减轻屈曲畸形骨关节炎患者行全膝关节置换术后的早期疼痛,提高关节活动度,有助于早期功能恢复。更多还原

【Abstract】 Background:Because of a wide range of soft tissue release during the TKA(total knee arthroplasty),acute pain after the surgery for osteoarthritis with flexion deformity is serious.This will lead to a poor early functional recovery and thus affect the surgical effect.Currently there are a variety of peri-operative analgesic methods,of which the injection of mixed analgesic drugs around the joint is quite easy and practicable.It can ease the early pain after the surgery and also reduce the adverse reactions.Objective:To observe the analgesic effects of the ropivacaine local injection in TKA for flexion deformity,as well as its effects on the early functional recovery.Methods:60 cases of osteoarthritis with flexion deformity were randomly divided into 2 groups.All of them accepted the unilateral TKA for the first time.The control group(n=30) were treated with intravenous postoperative self-control analgesia(PCA).The experimental group(n=30) accepted the same PCA,but were injected with mixed analgesic drugs(ropivacaine hydrochloride + adrenaline) during the operation.Evaluate the visual analog scores(VAS) of the rest and motion knee,and also the rang of motion(ROM) of the knee,and compare the early analgesic effects and early functional recovery of the two groups.Results:At 8,12,24,36 hours after the TKA,the rest and motion VAS in the experimental group was lower than that in the control group(P<0.05),while the ROM of the former was larger than that of the later(P<0.05).At 48 hours and 3 days after the TKA,the motion VAS in the experimental group was lower than that in the control group(P<0.05),and the ROM of the former was also larger than that of the later(P<0.05);while there was no significant difference in rest VAS between the two groups(P>0.05).At 7 days after the TKA,there was no significant difference in the rest and motion TKA and ROM scores between the two groups(P>0.05) Conclusions:Ropivacaine injection around the joint in TKA for flexion deformity can ease the early postoperative pain and improve the joint mobility.It is helpful to early functional recovery.更多还原