膝关节镜术后切口痛的发生及早期预防性封闭治疗的疗效分析

发布时间：2018-01-19 19:27

  本文关键词： 膝关节镜手术 并发症 切口痛 封闭 防治　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:(1)观察膝关节镜手术后切口痛的发生情况及其自然转归;(2)分析膝关节镜手术后切口痛的发生原因及相关因素;(3)观察早期切口局部封闭治疗对预防发生膝关节镜手术后切口痛的疗效。方法:选择自2015年9月至2016年8月间就诊于山西大医院并行膝关节镜手术的患者作为研究对象。根据以下纳入标准进行病例筛选。纳入标准:(1)入院后术前症状、体征及MRI检查符合半月板损伤、滑膜皱襞综合征、关节内游离体形成等膝关节镜检手术适应证,且无关节镜手术常规切口位置疼痛;(2)术中诊断与术前诊断相符;(3)术后无明显肿胀及切口感染、滑膜疝等其他切口相关并发症;(4)认知功能正常,能够按照要求完成随访。最终选出68例患者作为研究对象,将所选病例随机分为两组,即观察组和治疗组,每组34例。(1)研究膝关节镜手术后切口痛的发生情况及自然转归:采用视觉模拟评分法(visual analogue scale,VAS)随访观察观察组患者术后2周、4周、8周膝关节镜手术后膝前内及前外侧切口痛的发生情况,切口痛阳性病例继续随访至切口痛转阴性,并记录随访时间;(2)观察手术时间对膝关节镜手术切口痛发生率的影响:根据观察组患者的手术时间不同分为3组(45分钟组、45~60分钟组、60分钟组)。采用视觉模拟评分法(VAS)随访观察各组患者术后4周时膝关节镜手术切口痛的发生情况;(3)观察年龄对膝关节镜手术切口痛发生率的影响:根据观察组患者的年龄分为3组(15岁组、15~50岁组、50岁组)。采用视觉模拟评分法(vas)随访观察各组患者术后4周时膝关节镜手术切口痛的发生情况;(4)观察早期封闭治疗对预防膝关节镜手术切口痛的疗效:对治疗组患者在术后即予膝前内及前外侧入口皮下封闭注射(醋酸曲安奈德0.5ml+2%利多卡因2ml),观察组患者不予封闭注射。采用视觉模拟评分法(vas)随访观察记录各组患者术后4周时膝关节镜手术切口痛的发生情况。本研究所得计量资料的比较用方差分析,计数资料的比较采用c2检验,多因素分析使用logistic回归分析进行统计学分析,检验结果以p0.05为差异具有统计学意义。结果:(1)膝关节镜手术切口痛的发生率观察组患者术后2周、4周、8周膝前内侧切口痛阳性发生率分别为47.05%、23.53%、3.03%,术后10周膝前内侧切口痛阳性发生率为0%;说明膝关节镜术后膝前内侧切口痛的发生率自术后2周、4周、8周渐低,至术后10周已自行缓解。(2)切口侧别因素术后4周观察组患者膝前内侧切口痛阳性发生率为23.53%(8/34),膝前外侧切口痛阳性发生率为8.82%(3/34),二者差异有统计学意义(p0.05),说明膝关节镜术后切口痛主要发生在前内侧切口。(3)手术时间因素各组(45分钟组、45~60分钟组、60分钟组)术后4周膝前内侧切口痛阳性发生率分别为0%、11.76%、50%,手术时间与膝关节镜手术后4周膝前内侧切口痛阳性发生率之间具有显著相关关系,差异具有统计学意义(p0.05);说明手术时间越长,越易发生切口痛。(4)年龄因素各组(15岁组、15~50岁组、50岁组)术后4周膝前内侧切口痛阳性发生率分别为0%、25%、26.67%,年龄与膝关节镜手术后4周膝前内侧切口痛阳性发生率之间不存在显著相关关系,差异无统计学意义(p0.05);说明患者年龄与切口痛的发生无明显相关性。(5)封闭治疗效果观察组与治疗组患者术后4周膝前内侧切口痛阳性发生率分别为23.53%、2.94%,两组患者术后4周膝前内侧切口痛阳性发生率差异有统计学意义(均p0.05);说明切口局部封闭注射能减少膝前内侧切口痛的发生。结论:(1)膝关节镜手术后膝前内侧切口痛较前外侧切口痛的发生率高;切口痛阳性患者,大部分于术后10周内自然缓解;(2)患者年龄与切口痛的发生无明显相关性;手术时间与切口痛的发生成正相关,即手术时间越长,越易发生切口痛;(3)早期封闭注射能有效预防膝关节镜手术后切口痛的发生。
[Abstract]:Objective: (1) observed after knee arthroscopy incision pain incidence and natural history; (2) analysis of causes and related factors of incision pain after knee arthroscopy; (3) to observe the early local incision closed treatment efficacy on prevention of incision pain occurred after knee arthroscopy. Methods: from September 2015 to August 2016 between visits to the Shanxi Hospital of parallel knee arthroscopy patients as the research object. According to the following criteria were screened. Inclusion criteria: (1) after admission, preoperative symptoms, signs and MRI examination with meniscus injury, synovial plica syndrome, loose bodies in the joint formation of knee arthroscopy surgery indications, and no routine arthroscopic surgery incision pain; (2) consistent with the preoperative diagnosis during operation; (3) no obvious swelling and incision infection, synovial hernia and other incision related complications; (4) the normal cognitive function That can be completed in accordance with the requirements of the final follow-up. 68 patients were selected as the research object, the selected cases were randomly divided into two groups, observation group and treatment group, 34 cases in each group. (1) study after knee arthroscopy incisional pain and the incidence of natural history: the visual analogue score (visual analogue scale. VAS) were followed up for 2 weeks, the patients in the observation group after 4 weeks, the incidence of 8 weeks after knee arthroscopy of knee anterior and anterolateral incision pain, incision pain continued follow-up to positive cases of incisional pain turned negative, and record the follow-up time; (2) to observe the operation time on the incidence of knee arthroscopy surgical incision pain: according to the observation group of patients with operation time were divided into 3 groups (45 minutes group, 45~60 minutes group, 60 minutes group). Using the visual analogue scale (VAS) were observed in patients with the incidence of 4 weeks after surgery, arthroscopic surgery incision pain; (3) to observe the years Age on the incidence of knee arthroscopic surgery incision pain: according to the patients in the observation group were divided into 3 age groups (15 years old group, 15~50 years old group, 50 years old). Using the visual analogue scale (VAS) were observed in patients with postoperative 4 weeks after arthroscopic knee surgery incision pain occurrence (4; to observe the curative effect in the treatment of closed early) on the prevention of knee arthroscopic surgery incision pain: patients in the treatment group after surgery for anterior knee and anterior lateral subcutaneous injection entrance closed (triamcinolone 0.5ml+2% lidocaine 2ml), patients in the observation group were not closed by injection. The visual analogue score (VAS) were observed in patients 4 weeks after arthroscopic knee surgery incision pain occurrence. Compared with the results of this study of measurement data analysis of variance, count data were compared by C2 test, multivariate analysis using logistic regression analysis were used for statistical analysis, test results to p0.05涓哄樊寮傚叿鏈夌粺璁″�︽剰涔�.缁撴灉:(1)鑶濆叧鑺傞暅鎵嬫湳鍒囧彛鐥涚殑鍙戠敓鐜囪�傚療缁勬偅瑁�

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