本文關(guān)鍵詞： 骨質(zhì)疏松 髖關(guān)節(jié)置換 疼痛　出處：《安徽醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討抗骨質(zhì)疏松治療對骨質(zhì)疏松患者髖關(guān)節(jié)置換術(shù)后早期疼痛的治療效果。 方法：選取2011年9月至2012年12月期間在我科行髖關(guān)節(jié)置換術(shù)伴有骨質(zhì)疏松的80例患者為研究對象，將8O例患者分為治療組、對照組各4O例，同一組人員對患者在全麻下后外側(cè)入路行髖關(guān)節(jié)置換術(shù)，對于體弱的老年患者原則上是以最小的創(chuàng)傷、盡快恢復(fù)功能為目的，所以多選用半髖關(guān)節(jié)置換術(shù)，假體均為骨水泥型，術(shù)中監(jiān)測血壓，預(yù)防“骨水泥危象”。術(shù)后行常規(guī)預(yù)防感染、抗凝、功能鍛煉治療，兩組患者術(shù)后48小時內(nèi)使用鎮(zhèn)痛泵緩解疼痛。為避免麻醉及術(shù)后全身應(yīng)激反應(yīng)的影響，研究從術(shù)后第3天開始。治療組用鮭魚降鈣素50IU肌注，第l周每天1次，聯(lián)合維D鈣咀嚼片兩片睡前嚼服。第2周隔日1次，同時配合飲食調(diào)整、術(shù)后康復(fù)訓(xùn)練，對照組未予抗骨質(zhì)疏松治療。疼痛明顯時，予鹽酸曲馬多緩釋片0.05mg（半片）臨時口服止痛,用視覺模擬評分(VAS)和Harris髖關(guān)節(jié)功能評分比較觀察兩組術(shù)后情況。記錄時間為每天早上及傍晚各做一次評分，將結(jié)果用平均分進(jìn)行統(tǒng)計分析，資料運用SPSS進(jìn)行處理所有數(shù)據(jù)均為x±s表示，各數(shù)據(jù)求樣本均數(shù)，組間比較行差異性檢驗(運用t檢驗)，P 0.05為差異有顯著性意義。 結(jié)果：所有患者均獲隨訪，治療前均有明顯疼痛，治療組用藥后其疼痛評分下降，對照組疼痛雖然也有所下降，但明顯不及治療組，其中治療組三位患者出現(xiàn)面色潮紅及胃部不適，未予特殊處理，自行消退。治療組和對照組術(shù)后第3天視覺模擬評分（VAS）未見明顯差異，治療組術(shù)后第7天VAS評分為6.05±1.40，對照組為7.13±0.99，行差異性檢驗(t檢驗)，P為0.026。治療組術(shù)后第10天VAS評分為3.53±1.01，對照組為4.28±1.36，行差異性檢驗(t檢驗)，P為0.006，治療組術(shù)后第14天VAS評分為2.93±1.10，，對照組為3.60±3.37，行差異性檢驗(t檢驗)，P為0.017，差異均具有統(tǒng)計學(xué)意義。治療組術(shù)后第1周髖關(guān)節(jié)Harris評為74.75±6.66，對照組為69.93±8.57，行差異性檢驗(t檢驗)，P為0.006，治療組術(shù)后第2周髖關(guān)節(jié)Harris評為80.63±5.47，對照組為77.03±6.11，行差異性檢驗(t檢驗)，P為0.007，差異也均具有統(tǒng)計學(xué)意義。 結(jié)論：抗骨質(zhì)疏松治療對髖關(guān)節(jié)置換術(shù)后早期疼痛的治療效果滿意，能有效緩解術(shù)后早期疼痛，從長遠(yuǎn)看可達(dá)到有效預(yù)防假體周圍松動,假體周圍或其他部位再骨折等后遺癥的發(fā)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 鹵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 鹵1.40 on the 7th day after operation in the treatment group and 7.13 鹵0.99 in the control group. The VAS score was 3.53 鹵1.01 on the 10th day after operation in the treatment group and 4.28 鹵1.36 in the control group. The VAS score was 2.93 鹵1.10 on the 14th day after operation in the treatment group and 3.60 鹵3.37 in the control group. The difference was statistically significant. The Harris of hip joint was 74.75 鹵6.66 in the treatment group and 69.93 鹵8.57 in the control group at the first week after operation. P = 0.006. The Harris of hip joint was 80.63 鹵5.47 in the treatment group and 77.03 鹵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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R687.4

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