本文關(guān)鍵詞： 膝關(guān)節(jié)鏡手術(shù) 并發(fā)癥 切口痛 封閉 防治　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:(1)觀察膝關(guān)節(jié)鏡手術(shù)后切口痛的發(fā)生情況及其自然轉(zhuǎn)歸;(2)分析膝關(guān)節(jié)鏡手術(shù)后切口痛的發(fā)生原因及相關(guān)因素;(3)觀察早期切口局部封閉治療對(duì)預(yù)防發(fā)生膝關(guān)節(jié)鏡手術(shù)后切口痛的療效。方法:選擇自2015年9月至2016年8月間就診于山西大醫(yī)院并行膝關(guān)節(jié)鏡手術(shù)的患者作為研究對(duì)象。根據(jù)以下納入標(biāo)準(zhǔn)進(jìn)行病例篩選。納入標(biāo)準(zhǔn):(1)入院后術(shù)前癥狀、體征及MRI檢查符合半月板損傷、滑膜皺襞綜合征、關(guān)節(jié)內(nèi)游離體形成等膝關(guān)節(jié)鏡檢手術(shù)適應(yīng)證,且無關(guān)節(jié)鏡手術(shù)常規(guī)切口位置疼痛;(2)術(shù)中診斷與術(shù)前診斷相符;(3)術(shù)后無明顯腫脹及切口感染、滑膜疝等其他切口相關(guān)并發(fā)癥;(4)認(rèn)知功能正常,能夠按照要求完成隨訪。最終選出68例患者作為研究對(duì)象,將所選病例隨機(jī)分為兩組,即觀察組和治療組,每組34例。(1)研究膝關(guān)節(jié)鏡手術(shù)后切口痛的發(fā)生情況及自然轉(zhuǎn)歸:采用視覺模擬評(píng)分法(visual analogue scale,VAS)隨訪觀察觀察組患者術(shù)后2周、4周、8周膝關(guān)節(jié)鏡手術(shù)后膝前內(nèi)及前外側(cè)切口痛的發(fā)生情況,切口痛陽性病例繼續(xù)隨訪至切口痛轉(zhuǎn)陰性,并記錄隨訪時(shí)間;(2)觀察手術(shù)時(shí)間對(duì)膝關(guān)節(jié)鏡手術(shù)切口痛發(fā)生率的影響:根據(jù)觀察組患者的手術(shù)時(shí)間不同分為3組(45分鐘組、45~60分鐘組、60分鐘組)。采用視覺模擬評(píng)分法(VAS)隨訪觀察各組患者術(shù)后4周時(shí)膝關(guān)節(jié)鏡手術(shù)切口痛的發(fā)生情況;(3)觀察年齡對(duì)膝關(guān)節(jié)鏡手術(shù)切口痛發(fā)生率的影響:根據(jù)觀察組患者的年齡分為3組(15歲組、15~50歲組、50歲組)。采用視覺模擬評(píng)分法(vas)隨訪觀察各組患者術(shù)后4周時(shí)膝關(guān)節(jié)鏡手術(shù)切口痛的發(fā)生情況;(4)觀察早期封閉治療對(duì)預(yù)防膝關(guān)節(jié)鏡手術(shù)切口痛的療效:對(duì)治療組患者在術(shù)后即予膝前內(nèi)及前外側(cè)入口皮下封閉注射(醋酸曲安奈德0.5ml+2%利多卡因2ml),觀察組患者不予封閉注射。采用視覺模擬評(píng)分法(vas)隨訪觀察記錄各組患者術(shù)后4周時(shí)膝關(guān)節(jié)鏡手術(shù)切口痛的發(fā)生情況。本研究所得計(jì)量資料的比較用方差分析,計(jì)數(shù)資料的比較采用c2檢驗(yàn),多因素分析使用logistic回歸分析進(jìn)行統(tǒng)計(jì)學(xué)分析,檢驗(yàn)結(jié)果以p0.05為差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果:(1)膝關(guān)節(jié)鏡手術(shù)切口痛的發(fā)生率觀察組患者術(shù)后2周、4周、8周膝前內(nèi)側(cè)切口痛陽性發(fā)生率分別為47.05%、23.53%、3.03%,術(shù)后10周膝前內(nèi)側(cè)切口痛陽性發(fā)生率為0%;說明膝關(guān)節(jié)鏡術(shù)后膝前內(nèi)側(cè)切口痛的發(fā)生率自術(shù)后2周、4周、8周漸低,至術(shù)后10周已自行緩解。(2)切口側(cè)別因素術(shù)后4周觀察組患者膝前內(nèi)側(cè)切口痛陽性發(fā)生率為23.53%(8/34),膝前外側(cè)切口痛陽性發(fā)生率為8.82%(3/34),二者差異有統(tǒng)計(jì)學(xué)意義(p0.05),說明膝關(guān)節(jié)鏡術(shù)后切口痛主要發(fā)生在前內(nèi)側(cè)切口。(3)手術(shù)時(shí)間因素各組(45分鐘組、45~60分鐘組、60分鐘組)術(shù)后4周膝前內(nèi)側(cè)切口痛陽性發(fā)生率分別為0%、11.76%、50%,手術(shù)時(shí)間與膝關(guān)節(jié)鏡手術(shù)后4周膝前內(nèi)側(cè)切口痛陽性發(fā)生率之間具有顯著相關(guān)關(guān)系,差異具有統(tǒng)計(jì)學(xué)意義(p0.05);說明手術(shù)時(shí)間越長,越易發(fā)生切口痛。(4)年齡因素各組(15歲組、15~50歲組、50歲組)術(shù)后4周膝前內(nèi)側(cè)切口痛陽性發(fā)生率分別為0%、25%、26.67%,年齡與膝關(guān)節(jié)鏡手術(shù)后4周膝前內(nèi)側(cè)切口痛陽性發(fā)生率之間不存在顯著相關(guān)關(guān)系,差異無統(tǒng)計(jì)學(xué)意義(p0.05);說明患者年齡與切口痛的發(fā)生無明顯相關(guān)性。(5)封閉治療效果觀察組與治療組患者術(shù)后4周膝前內(nèi)側(cè)切口痛陽性發(fā)生率分別為23.53%、2.94%,兩組患者術(shù)后4周膝前內(nèi)側(cè)切口痛陽性發(fā)生率差異有統(tǒng)計(jì)學(xué)意義(均p0.05);說明切口局部封閉注射能減少膝前內(nèi)側(cè)切口痛的發(fā)生。結(jié)論:(1)膝關(guān)節(jié)鏡手術(shù)后膝前內(nèi)側(cè)切口痛較前外側(cè)切口痛的發(fā)生率高;切口痛陽性患者,大部分于術(shù)后10周內(nèi)自然緩解;(2)患者年齡與切口痛的發(fā)生無明顯相關(guān)性;手術(shù)時(shí)間與切口痛的發(fā)生成正相關(guān),即手術(shù)時(shí)間越長,越易發(fā)生切口痛;(3)早期封閉注射能有效預(yù)防膝關(guān)節(jié)鏡手術(shù)后切口痛的發(fā)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″鎰忎箟.緇撴灉:(1)鑶濆叧鑺傞暅鎵嬫湳鍒囧彛鐥涚殑鍙戠敓鐜囪瀵熺粍鎮(zhèn)ｈ，

本文編號(hào)：1445271