本文關(guān)鍵詞： 人工全膝關(guān)節(jié)置換術(shù) 局部關(guān)節(jié)周圍注射 鎮(zhèn)痛 功能康復(fù)　出處：《山東大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景： 骨性關(guān)節(jié)炎(osteoarthritis,OA),又稱為退變性關(guān)節(jié)炎,是一種可累及全身各個(gè)關(guān)節(jié)的,以關(guān)節(jié)軟骨退變及骨質(zhì)增生為主要特征的中老年人常見的骨科疾患,其中膝關(guān)節(jié)骨性關(guān)節(jié)炎尤為常見。由于炎癥對膝關(guān)節(jié)面造成的持續(xù)損傷,病人從輕度疼痛逐漸發(fā)展為行走、爬樓梯、膝關(guān)節(jié)屈伸時(shí)都會出現(xiàn)劇烈的疼痛,病人膝關(guān)節(jié)功能喪失,生活質(zhì)量下降。隨著生物力學(xué)以及材料學(xué)的發(fā)展,人工全膝關(guān)節(jié)置換術(shù)(total knee arthroplasty, TKA)已成為治療骨性關(guān)節(jié)炎所致膝關(guān)節(jié)疼痛、畸形及功能障礙的有效方法,極大地改善了膝關(guān)節(jié)退行性變患者的生活質(zhì)量。但由于全膝關(guān)節(jié)置換術(shù)需要大范圍的組織松解和大量截骨,術(shù)后功能鍛煉要求嚴(yán)格,因而術(shù)后存在較嚴(yán)重的急性疼痛,導(dǎo)致早期功能恢復(fù)不佳而影響手術(shù)效果。目前有多種圍手術(shù)期鎮(zhèn)痛模式,其中關(guān)節(jié)周圍注射復(fù)合鎮(zhèn)痛藥物可以使藥物直接作用于局部,同時(shí)又避免了術(shù)后早期靜脈內(nèi)系統(tǒng)使用阿片類藥物和非甾體類藥物的的不良反應(yīng),顯示出了了良好的應(yīng)用前景。 目的： 比較接受術(shù)中關(guān)節(jié)周圍混合藥物注射者與不接受混合注藥者,在其他鎮(zhèn)痛方法相同的情況下,術(shù)后疼痛、功能鍛煉情況的差異,對局部關(guān)節(jié)周圍注射在膝關(guān)節(jié)置換術(shù)后的鎮(zhèn)痛效果及其早期功能恢復(fù)的作用進(jìn)行評估。 方法： 將2013年6月至2014年3月在山東省立醫(yī)院關(guān)節(jié)外科40例膝關(guān)節(jié)骨性關(guān)節(jié)炎擬行人工全膝關(guān)節(jié)表面置換術(shù)的患者隨機(jī)分為2組,由同一組手術(shù)醫(yī)師進(jìn)行手術(shù),實(shí)驗(yàn)組(n=20)在關(guān)節(jié)周圍注射復(fù)合麻醉藥物(羅哌卡因75mg+嗎啡10mg+50ml生理鹽水混合均勻)；對照組(n=20)術(shù)中關(guān)節(jié)內(nèi)不注射任何藥物。術(shù)后2組均給予病人自控鎮(zhèn)痛(PCA),48h后撤除,對于疼痛難以耐受者,依情況給予奇曼丁(曲馬多)100mg。評估手術(shù)后患膝靜止和活動時(shí)的視覺模擬疼痛評分(VAS)及活動范圍,記錄術(shù)后2周內(nèi)奇曼丁用量和主動直腿抬高時(shí)間,觀察兩組術(shù)后不良反應(yīng)的情況,比較兩組術(shù)后早鎮(zhèn)痛效果及早期功能恢復(fù)情況。 結(jié)果： 1.實(shí)驗(yàn)組術(shù)后12、24h患膝靜息時(shí)VAS評分均小于對照組組(P＜0.05)；實(shí)驗(yàn)組術(shù)后24h、48h患膝活動后VAS評分明顯小于對照組(P＜0.05)；實(shí)驗(yàn)組患者術(shù)后48h靜息痛和72h活動后疼痛VAS評分與對照組無顯著性差異(P＜0.05)。 2.實(shí)驗(yàn)組術(shù)后前3天的膝關(guān)節(jié)活動度明顯大于對照組(P＜0.05)；術(shù)后7天及術(shù)后14天的膝關(guān)節(jié)活動度與對照組無顯著性差異(P＜0.05)；實(shí)驗(yàn)組主動直腿抬高時(shí)間明顯低于對照組(P＜0.05)。 3.實(shí)驗(yàn)組術(shù)后2周內(nèi)注射奇曼丁總量明顯小于對照組(P＜0.05)。 4.在術(shù)后不良反應(yīng)及并發(fā)癥方面,包括上消化道不適癥狀、呼吸抑制、尿儲留、深靜脈血刷等兩組之間差異無統(tǒng)計(jì)學(xué)差異。 結(jié)論： 1.局部關(guān)節(jié)周圍注射復(fù)合麻醉藥物可減輕骨關(guān)節(jié)炎患者行全膝關(guān)節(jié)置換術(shù)后的早期疼痛,而在住院的中、后期,局部關(guān)節(jié)周圍注射的鎮(zhèn)痛效果已不明顯。 2.接受局部關(guān)節(jié)周圍注射鎮(zhèn)痛的患者早期的功能鍛煉進(jìn)度快于不接受注射者,但在功能鍛煉的中后期,兩者的進(jìn)度已無明顯差異。 3.局部關(guān)節(jié)周圍注射可以明顯減少術(shù)后止痛藥物的用量,使因術(shù)后使用鎮(zhèn)痛藥物而引發(fā)嚴(yán)重并發(fā)癥的風(fēng)險(xiǎn)降低。 4.局部關(guān)節(jié)周圍注射不會增加術(shù)后的不良反應(yīng),是一種安全有效的早期鎮(zhèn)痛方法。
[Abstract]:Research background:
Osteoarthritis (osteoarthritis, OA), also known as degenerative arthritis, is a systemic involvement of each joint, common to the degeneration of articular cartilage and bone hyperplasia is the main feature of the elderly in the Department of orthopedics disease, including osteoarthritis of the knee are particularly common. Due to the ongoing inflammatory injury of the knee joint surface caused by the the patient from mild pain, gradually developed into a walk, climb stairs, knee flexion will appear severe pain, loss of knee joint function of patients, decreased quality of life. With the development of material science, biomechanics, total knee arthroplasty (total knee, arthroplasty, TKA) has become the treatment of osteoarthritis of the knee. The effective method of joint pain, deformity and dysfunction, and greatly improve the knee joint degeneration. But because of the quality of life of patients with total knee arthroplasty needs a wide range of tissue lysis and a large number of Osteotomy, postoperative functional exercise strict, and postoperative acute pain is serious, resulting in poor early functional recovery and thus affect the operation effect. At present, there are a variety of perioperative analgesia mode, of which around the joint injection of compound analgesic drugs can make the drug directly to the local, but also avoids the adverse reactions of opioids and NSAIDs use intravenous system early after surgery, showing a good prospect.
Objective:
Accept the intraoperative periarticular injection of mixed drug and do not accept mixed injection compared to other analgesia methods under the same condition, postoperative pain, differences in functional exercises, to evaluate the analgesic effect of total knee arthroplasty and early functional recovery effect on local injection around the joint.
Method錛，

本文編號：1522135