【摘要】 目的 探讨利多卡因联合塞来昔布对前交叉韧带（ACL）断裂合并半月板损伤拟行膝关节镜下重建术患者术后疼痛及关节功能的影响。方法 选取2022年3月至2025年2月复旦大学附属金山医院收治的132例单侧ACL断裂合并半月板损伤拟行膝关节镜下重建术患者，采用随机数字表法将其分为联合组（给予利多卡因联合塞来昔布）和塞来昔布组（给予塞来昔布），每组66例。记录两组术后不同时间点（T₀～T₅，即用药前、用药后1、7、14 d、1、3个月）的疼痛数字分级评分法（NRS）评分、睡眠干扰量表（SIS）评分、膝关节功能评分、术后并发症及镇痛补救情况。结果 用药后1、7、14 d、1、3个月，两组患者的NRS评分均低于用药前（均P<0.05），且联合组[（3.67±0.75）、（2.04±0.63）、（1.57±0.50）、（1.49±0.48）、（0.69±0.22）分]低于塞来昔布组[（4.21±0.83）、（2.65±0.77）、（2.18±0.67）、（1.91±0.45）、（1.34±0.30）分]（t=3.922、4.981、5.928、5.186、14.194，均P<0.05）。用药后14 d、1、3个月，联合组SIS评分[（4.84±1.10）、（3.71±0.87）、（2.89±0.91）分]低于塞来昔布组[（6.37±1.32）、（5.28±0.99）、（4.13±1.07）分]（t=7.234、9.678、7.172，均P<0.05）。用药2周后，两组膝关节评分和活动功能评分均高于用药前（均P<0.05），且联合组[（75.30±3.51）、（47.32±5.49）分]高于塞来昔布组[（72.20±3.44）、（45.28±5.21）分]（t=5.124、2.190，均P<0.05）。两组术后并发症发生率比较[9.09%（6/66） vs15.15%（10/66）]，差异无统计学意义（χ²=1.138,P>0.05）。与塞来昔布组相比，联合组患者术后2周内镇痛补救总次数减少[7.58%（5/66） vs 19.70%（13/66）]（χ²=4.117,P<0.05），且首次追加时间延长[（33.56±2.72）h vs（31.29±2.33）h]（t=5.149,P<0.05）。结论 利多卡因联合塞来昔布用于ACL重建合并半月板修复术后患者，能显著降低术后早期及中长期疼痛强度，改善疼痛相关睡眠干扰，促进膝关节功能恢复，减少术后镇痛补救率，且未增加术后并发症的发生率，安全性良好。更多还原

【Abstract】 Objective To investigate the effects of lidocaine combined with celecoxib on postoperative pain and joint function in patients with anterior cruciate ligament（ACL） rupture and meniscus injury scheduled for arthroscopic reconstruction surgery. Methods A total of 132 patients with unilateral ACL rupture and meniscus injury scheduled for arthroscopic reconstruction at Jinshan Hospital of Fudan University from March 2022 to February 2025 were enrolled and randomly assigned to the combination group（n=66, receiving lidocaine plus celecoxib） and the celecoxib monotherapy group（n=66, receiving celecoxib alone）. The Numerical Rating Scale（NRS）, Sleep Interference Scale（SIS）, knee function scores, postoperative complications, and analgesic rescue situation were recorded at baseline（T₀） and at 1 day, 7 days, 14 days, 1 month, and 3 months postoperatively（T₁-T₅）. Results At 1, 7, and 14 days, 1 month and 3 months post-medication, NRS scores in both groups were lower than those before medication（all P<0.05）, and the scores in the combination group（（3.67±0.75）,（2.04±0.63）,（1.57±0.50）,（1.49±0.48）, and（0.69±0.22） points, respectively） were lower than those in the celecoxib monotherapy group（（4.21±0.83）,（2.65±0.77）,（2.18±0.67）,（1.91±0.45）, and（1.34±0.30） points, respectively）（t=3.922, 4.981, 5.928, 5.186, 14.194, all P<0.05）. At 14 days, 1 and 3 months post-medication, SIS scores in the combination group（（4.84±1.10）,（3.71±0.87）,（2.89±0.91） points） were significantly lower than those in the celecoxib monotherapy group（（6.37±1.32）,（5.28±0.99）,（4.13±1.07） points）（t=7.234, 9.678, 7.172, all P<0.05）.After 2 weeks of medication, knee joint scores and functional activity scores in both groups were significantly higher than those before medication（all P<0.05）, and the scores in the combination group（（75.30±3.51）,（47.32±5.49） points, respectively） were higher than those in the celecoxib monotherapy group（（72.20±3.44）,（45.28±5.21） points, respectively）（t=5.124, 2.190, both P<0.05）. The incidence of postoperative complications did not differ significantly between the two groups（9.09%（6/66） vs 15.15%（10/66）; χ²=1.138, P>0.05）. The combination group required less rescue analgesia within 2 weeks（7.58%（5/66） vs 19.70%（13/66）; χ²=4.117, P<0.05） and had a longer time to first rescue analgesia（（33.56±2.72） h vs（31.29±2.33） h, t=5.149, P<0.05）. Conclusion The combination of lidocaine and celecoxib for patients undergoing ACL reconstruction combined with meniscus repair significantly reduces postoperative pain intensity in both early and medium-to long-term, alleviates pain-related sleep disturbances, promotes knee joint functional recovery, decreases the postoperative rescue analgesia rate, and does not increase the incidence of postoperative complications, demonstrating a favorable safety profile.更多还原