抗骨质疏松对髋关节术后早期疼痛的疗效分析

发布时间：2018-01-21 17:35

本文关键词： 骨质疏松髋关节置换疼痛　出处：《安徽医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨抗骨质疏松治疗对骨质疏松患者髋关节置换术后早期疼痛的治疗效果。方法：选取2011年9月至2012年12月期间在我科行髋关节置换术伴有骨质疏松的80例患者为研究对象，将8O例患者分为治疗组、对照组各4O例，同一组人员对患者在全麻下后外侧入路行髋关节置换术，对于体弱的老年患者原则上是以最小的创伤、尽快恢复功能为目的，所以多选用半髋关节置换术，假体均为骨水泥型，术中监测血压，预防“骨水泥危象”。术后行常规预防感染、抗凝、功能锻炼治疗，两组患者术后48小时内使用镇痛泵缓解疼痛。为避免麻醉及术后全身应激反应的影响，研究从术后第3天开始。治疗组用鲑鱼降钙素50IU肌注，第l周每天1次，联合维D钙咀嚼片两片睡前嚼服。第2周隔日1次，同时配合饮食调整、术后康复训练，对照组未予抗骨质疏松治疗。疼痛明显时，予盐酸曲马多缓释片0.05mg（半片）临时口服止痛,用视觉模拟评分(VAS)和Harris髋关节功能评分比较观察两组术后情况。记录时间为每天早上及傍晚各做一次评分，将结果用平均分进行统计分析，资料运用SPSS进行处理所有数据均为x±s表示，各数据求样本均数，组间比较行差异性检验(运用t检验)，P 0.05为差异有显著性意义。结果：所有患者均获随访，治疗前均有明显疼痛，治疗组用药后其疼痛评分下降，对照组疼痛虽然也有所下降，但明显不及治疗组，其中治疗组三位患者出现面色潮红及胃部不适，未予特殊处理，自行消退。治疗组和对照组术后第3天视觉模拟评分（VAS）未见明显差异，治疗组术后第7天VAS评分为6.05±1.40，对照组为7.13±0.99，行差异性检验(t检验)，P为0.026。治疗组术后第10天VAS评分为3.53±1.01，对照组为4.28±1.36，行差异性检验(t检验)，P为0.006，治疗组术后第14天VAS评分为2.93±1.10，，对照组为3.60±3.37，行差异性检验(t检验)，P为0.017，差异均具有统计学意义。治疗组术后第1周髋关节Harris评为74.75±6.66，对照组为69.93±8.57，行差异性检验(t检验)，P为0.006，治疗组术后第2周髋关节Harris评为80.63±5.47，对照组为77.03±6.11，行差异性检验(t检验)，P为0.007，差异也均具有统计学意义。结论：抗骨质疏松治疗对髋关节置换术后早期疼痛的治疗效果满意，能有效缓解术后早期疼痛，从长远看可达到有效预防假体周围松动,假体周围或其他部位再骨折等后遗症的发生。
[Abstract]:Objective: to investigate the effect of anti-osteoporosis therapy on early pain after hip arthroplasty in patients with osteoporosis. Methods: 80 cases of hip arthroplasty with osteoporosis were selected from September 2011 to December 2012, and 80 cases were divided into treatment group. In the control group of 40 cases, the same group of patients under general anesthesia under the posterolateral approach hip replacement, for frail elderly patients in principle with the minimum trauma, as soon as possible to restore the function of the purpose. Therefore, most of the hemihip arthroplasty, prosthesis are bone cement type, monitoring blood pressure during the operation, to prevent "bone cement crisis." postoperative routine prevention of infection, anticoagulant, functional exercise treatment. In both groups, analgesic pump was used to relieve pain within 48 hours after operation. In order to avoid the effect of anesthesia and postoperative general stress reaction, the study began on the 3rd day after operation. The treatment group was injected with 50 IU salmon calcitonin intramuscularly. Once a day in the first week, two tablets of vitamin D calcium chewable tablets were chewed before bedtime, and once every other day in the second week with diet adjustment and rehabilitation training after operation. The control group was not treated with anti-osteoporosis treatment. Tramadol hydrochloride sustained release tablet (half tablet) was administered orally temporarily to relieve pain. Visual analogue score (vas) and Harris hip function score were used to observe the postoperative status of the two groups. The recording time was one time in the morning and one in the evening. The results were statistically analyzed with the average score. Data were processed by SPSS, all the data were expressed as x 卤s, the mean of each sample was calculated, and the difference test was performed between groups (using t test / P 0.05 as the difference). There was significant difference between the two groups (P < 0. 05, P < 0. 05, P < 0. 05). Results: all the patients were followed up, there was obvious pain before treatment, the pain score of the treatment group decreased after medication, the pain of the control group was also decreased, but obviously less than that of the treatment group. Three patients in the treatment group appeared flashes and stomach discomfort, no special treatment, self-subsiding. There was no significant difference between the treatment group and the control group in visual analogue score on the 3rd day after operation. The VAS score was 6.05 卤1.40 on the 7th day after operation in the treatment group and 7.13 卤0.99 in the control group. The VAS score was 3.53 卤1.01 on the 10th day after operation in the treatment group and 4.28 卤1.36 in the control group. The VAS score was 2.93 卤1.10 on the 14th day after operation in the treatment group and 3.60 卤3.37 in the control group. The difference was statistically significant. The Harris of hip joint was 74.75 卤6.66 in the treatment group and 69.93 卤8.57 in the control group at the first week after operation. P = 0.006. The Harris of hip joint was 80.63 卤5.47 in the treatment group and 77.03 卤6.11 in the control group at the 2nd week after operation. P = 0.007, the difference was statistically significant. Conclusion: Anti-osteoporosis treatment is effective in the treatment of early postoperative pain after hip arthroplasty. It can effectively relieve postoperative early pain and can effectively prevent periprosthetic loosening in the long run. The occurrence of sequelae such as refracture around the prosthesis or elsewhere.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R687.4

【参考文献】