不同镇痛方式对全膝关节置换后关节功能及不良反应的影响

背景：全膝关节置换后剧烈疼痛是导致患者置换后膝关节功能恢复不佳的重要因素，如何给予患者置换后效果满意的镇痛方案是目前研究的热点。目的：观察不同镇痛方案对全膝关节置换患者置换后疼痛和功能恢复的影响。方法：将徐州市中心医院自2010年3月到2014年2月期间收治的60例单侧的膝关节置换患者随机分为3组：硬膜外镇痛组，静脉镇痛组，连续股神经阻滞镇痛组，每组各20例，均采用相应方法进行术后镇痛。记录并比较3组患者置换前、置换后不同状态下1，6，24，48，96 h的目测类比评分，置换后24，48，72 h关节活动度恢复情况；膝关节置换患者膝关节KSS评分；置换后出现的不良反应。结果与结论：与置换前比较，置换后1，24，48，96 h连续股神经阻滞镇痛组患者目测类比评分降低(P < 0.05)。连续股神经阻滞镇痛组患者关节活动度恢复最好，其次为硬膜外镇痛组患者，静脉镇痛组恢复最差(P < 0.05)；同置换前比较，3组患者置换后1，3个月膝关节功能KSS评分均升高(P < 0.05)。同连续股神经阻滞镇痛组患者比较，置换后1，3个月硬膜外镇痛组，静脉镇痛组患者膝关节功能评分降低(P < 0.05)。结果证实，连续股神经阻滞镇痛方案置换后总体效果较好，能够帮助患者更好的进行置换后关节功能恢复，安全可靠。中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Effects of different analgesia schemes on joint function and adverse reactions following total knee arthroplasty

BACKGROUND:Severe knee pain after total knee arthroplasty is an important factor for the poor recovery of knee function after replacement. How to give a satisfactory postoperative analgesia scheme is currently a hot research. OBJECTIVE:To explore the clinical effects of different analgesic program methods on postoperative pain and functional recovery in patients undergoing total knee arthroplasty. METHODS:From March 2010 to February 2014, 60 patients with unilateral knee arthroplasty were randomly divided into three groups: epidural analgesia group, intravenous analgesia group, and continuous femoral nerve block analgesia group. 20 patients in each group received corresponding postoperative analgesia. Visual Analogue Scale score before replacement, 1, 6, 24, 48 and 96 hours after replacement, the recovery of range of motion at 24, 48 and 72 hours after replacement, KSS score of the knee and adverse reactions after replacement were recorded and compared in each group.  RESULTS AND CONCLUSION:Compared with the preoperative data, Visual Analogue Scale score was reduced in continuous femoral nerve block analgesia group at 1, 24, 48 and 96 hours after replacement (P < 0.05). The recovery of range of motion was best in the continuous femoral nerve block analgesia group, followed by epidural analgesia group, and it was poorest in the intravenous analgesia group (P < 0.05). Compared with the preoperative data, postoperative KSS scores increased at 1 and 3 months after replacement in the three groups (P < 0.05). Compared with the continuous femoral nerve block analgesia group, knee joint function score was  decreased in the intravenous analgesia group (P < 0.05). Results verified that continuous femoral nerve block analgesia had good overall effects, helped the recovery of postoperative joint function, and was safe and reliable.