不同的疼痛管理模式对关节镜下创伤后伸膝装置粘连松解的疗效分析

发布时间：2018-11-05 12:43

【摘要】：目的探讨不同疼痛管理模式对膝关节镜下行伸膝装置黏连松解的伸直型膝关节僵硬患者术后镇痛效果及疗效分析。方法将于2012年1月至2016年9月在广西医科大学一附院创伤骨科手外科同一治疗小组膝关节镜下行伸膝装置黏连松解术的41例伸直型膝关节僵硬患者按其不同镇痛模式分为2组,其中将术后口服塞来昔布为术后镇痛方案的21膝患者为A组,将术前口服塞来昔布及联合术中关节腔注射“鸡尾酒”多模式疼痛管理为术后镇痛方案的20膝患者为B组,回顾性分析其治疗效果,随访时间6个月,以视觉疼痛模拟评分量表(VSA)评价患者术后镇痛效果,以膝关节屈曲改变角度及外科特种医院膝关节评分(HHS)评估患者术后1个月、3个月、6个月患膝功能改善情况。结果1、术后12小时、1天、2天,静息状态下,患膝关节VAS评分B组比A组小,P小于0.05,差异有统计学意义。术后3天、4天,静息状态下,患膝关节VAS评分B组与A组大至相当,P大于0.05,差异无统计学意义。2、术后2天、3天,被动活动时患膝关节VAS评分B组比A组小,P小于0.05,差异有统计学意义。术后1周,被动活动时,患膝关节VAS评分B组与A组大至相当,P大于0.05,差异无统计学意义。3、术后2天、14天,主动活动时患膝关节屈曲角度B组比A组大,P小于0.05,差异有统计学意义,术后1个月、3个月、6个月,主动活动时,B组与A组屈曲角度大至相当,P大于0.05,差异无统计学意义。4、A组术前、术后HHS膝关节功能评分比较P小于0.01,差异有统计学意义。B组术前、术后HHS膝关节功能评分比较P小于0.01,差异有统计学意义。结论在关节镜行伸膝装置黏连松解术的伸直型膝关节僵硬患者,采用多模式疼痛管理能明显减轻患者术后48h的疼痛程度,提高总体满意度且能明显改善在关节镜行伸膝装置黏连松解术的伸直型膝关节僵硬患者术后2d、14d的膝关节活动度(ROM),增加患者康复的信心。但对1、3、6个月后膝关节主动活动度及HHS膝关节功能评分无改善。
[Abstract]:Objective to investigate the analgesic effect and curative effect of different pain management models in patients with extensional knee joint stiffness under knee arthroscopy. Methods from January 2012 to September 2016, 41 patients with ankylosis were divided into two groups according to their different analgesic modes. Among them, 21 knee patients who took celecoxib as postoperative analgesic regimen were selected as group A, and 20 knee patients who were treated with preoperative oral celecoxib and intraoperative "cocktail" multi-mode pain management as postoperative analgesic regimen were selected as group B. The therapeutic effect was analyzed retrospectively and followed up for 6 months. The postoperative analgesic effect was evaluated by visual pain analogue scale (VSA). Knee function improvement was evaluated 1 month, 3 months and 6 months after operation by knee flexion angle and knee joint score (HHS) in special surgery hospital. Results 1. At 12 hours, 1 day, 2 days after operation, the VAS score of knee joint in group B was smaller than that in group A (P < 0.05). The VAS score of knee joint in group B was as large as that in group A (P > 0.05). There was no significant difference between group B and group A (P > 0.05). 2, 2 days and 3 days after operation, the VAS score of knee joint in group B was smaller than that in group A. P < 0.05, the difference was statistically significant. At 1 week after operation, the VAS score of knee joint in group B was as large as that in group A (P > 0.05). There was no significant difference between group B and group A (P > 0.05). 2 and 14 days after operation, the flexion angle of knee joint in group B was larger than that in group A. P < 0.05, the difference was statistically significant. After 1 month, 3 months, 6 months after operation, the flexion angle of group B and group A was equal to that of group A. there was no significant difference between group A and group A before operation. Postoperative HHS knee joint function score P < 0.01, the difference was statistically significant, group B before and after HHS knee joint function score P < 0.01, the difference was statistically significant. Conclusion Multi-mode pain management can significantly reduce the degree of pain 48 hours after arthroscopy in patients with extensional knee stiffness treated with knee extension device and loosening. Increasing overall satisfaction and significantly improving the (ROM), of knee motion in patients with extensional knee stiffness treated with arthroscopic extension device and loosening increased the patients' confidence in rehabilitation. But there was no improvement in knee active motion and HHS knee function score after 1: 3 and 6 months.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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