四种多模式镇痛方案对全膝关节置换术后康复影响的回顾性分析

目的 回顾性分析四种多模式镇痛方案对全膝关节置换术后患者康复的影响。方法通过提取电子病历系统中的数据,回顾性分析2015年4月至2020年4月行初次单侧全膝关节置换术的537例骨关节炎患者,采用四种多模式镇痛方案：A组耳穴贴压联合股神经阻滞,B组耳穴贴压联合隐神经阻滞,C组塞来昔布联合股神经阻滞,D组塞来昔布联合隐神经阻滞。统计术前一般资料及术后第1、3、7天VAS评分、股四头肌肌力、匹兹堡睡眠质量指数（PSQI）量表评分、膝关节主动活动度。结果 四组术前一般资料比较差异无统计学意义。术后第3和7天,A组和B组的VAS评分均比C组和D组低。A组和C组股四头肌肌力在术后第1和3天明显比B组和D组差。A组和B组术后第1、3、7天PSQI量表评分均低于同时间段的C组和D组。A组和B组术后第1和3天膝关节主动活动度比C组和D组大。结论 全膝关节置换术患者采用耳穴贴压联合单次收肌管隐神经阻滞更能有效缓解术后疼痛,改善睡眠,促进早期功能锻炼,达到快速康复的效果。

Retrospective analysis of the influence of four multi-mode analgesia schemes on the rehabilitation after total knee arthroplasty

Objective To analyze the effects of four kinds of multi-mode analgesia on the rehabilitation of patients after total knee replacement. Methods Based on the data extracted from the electronic medical record system of our hospital, 537 patients with osteoarthritis who underwent the first unilateral total knee arthroplasty from April 2015 to April 2020 were analyzed retrospectively. Four kinds of multi-mode analgesia schemes were adopted, including auricular point sticking combined with femoral nerve block in group A, auricular point sticking combined with saphenous nerve block in group B, celecoxib combined with femoral nerve block in group C, celecoxib combined with saphenous nerve block in Group D Stagnation. The general data before operation, VAS score, quadriceps muscle strength, Pittsburgh sleep quality index （PSQI） score and knee joint active activity were analyzed. Results No statistically differences were determined in baseline among four groups. The VAS scores of group A and group B were lower than those of group C and group D on the 3rd and 7th day after operation. The muscle strength of quadriceps femoris in group A and group C was significantly worse than that in group B and group D on the first and third days after operation. The PSQI scores of group A and group B were lower than those of group C and group D at the same time. In group A and B, the active range of motion of knee joint was higher on the 1st and 3rd day after operation than in group C and D. Conclusion Auricular point sticking combined with single time adductor canal block is more effective in relieving postoperative pain, improving sleep, promoting early functional exercise and achieving rapid recovery.