硬膜外镇痛泵膝关节腔连续镇痛在全膝关节表面置换术中的应用

目的 探讨使用自控硬膜外镇痛(PCEA)泵留置膝关节腔连续镇痛对全膝关节表面置换术(TKA)疼痛疗效及对膝关节活动度的影响.方法 将2010年1月-2011年9月在新疆维吾尔自治区人民医院行全膝关节置换术的130例患者随机分成两组,每组65例.试验组采用自控硬膜外镇痛(PCEA)导管留置于膝关节腔连续镇痛,对照组采用常规硬膜外镇痛泵硬膜外腔连续镇痛.观察两组患者术后72 h内的术后平均静息痛VAS评分记录以及TKA术后1、2、3 、7、14、40 d的术后平均运动痛程度VAS评分、术后的膝关节活动度(ROM)以及膝关节术后膝关节协会评分(KSS)和患者的总体满意度来比较2种镇痛方式的效果.结果 试验组TKA术后72 h内的术后平均静息痛VAS评分和术后的平均运动痛程度VAS评分优于对照组,试验组的膝关节活动度ROM与膝关节术后KSS平均评分亦优于对照组,差异有统计学意义(P＜0.05),两组患者的总体满意度差异无统计学意义(P>0.05).结论 采用硬膜外镇痛泵膝关节腔连续镇痛的方法 对人工全膝关节置换术围手术期镇痛疗效显著,可有效控制手术后疼痛,减少局部组织挛缩粘连,预防关节活动度受限,最大限度提高膝关节屈曲活动度,值得推广.

Clincal study on the efficacy of continues intra-articular after total knee arthroplasty

Objective To assess the effect of painless and the activity of knee joint postoperative through the use of patient-controlled epidural analgesia(PCEA) continues intra-articular and conventional of continuous epidural analgesia with epidural analgesia pump on postoperative pain after total knee arthroplasty(TKA).Methods From January 2010 to September,150 cases of patients with total knee replacement in People′s Hospital of Xinjiang Uygur Autonomous Region were randomly divided into 2 groups,each group had 65 cases.Patients in test group were taken patient-controlled epidural analgesia(PCEA) pumps at the knee joint cavity of continuous analgesia,control group were with routine epidural analgesia pump continuous epidural analgesia.Compared the two groups of patients with postoperative TKA 72 hours average resting after surgery pain in visual analogue scales(VAS) score record and postoperative(TKA) 1,2,3,7,40 day degree of motion in postoperative pain of VAS scores,activities of range of movement(ROM) and average score of KSS and overall satisfaction,in order to evluate the effects of two analgesia methods.Results In the postoperative TKA 72 h mean VAS score of resting pain after the surgery and postoperative pain VAS score of test group were significantly better than average movement control group,contrasted the activity of knee joint after knee surgery,the ROM and KSS average scores were significantly better than the control group(P<0.05),but similar to the overall satisfaction of the two groups(P>0.05).Conclusion With epidural analgesia pump knee joint cavity of continuous analgesia methods on total knee replacement in perioperative analgesic has significant,it can effectively control the pain after surgery to reduce adhesion of local soft tissue contracture,joint prevention activities limited,maximize activity of knee flexion,which was worth promoting.