【摘要】：目的探討不同疼痛管理模式對(duì)膝關(guān)節(jié)鏡下行伸膝裝置黏連松解的伸直型膝關(guān)節(jié)僵硬患者術(shù)后鎮(zhèn)痛效果及療效分析。方法將于2012年1月至2016年9月在廣西醫(yī)科大學(xué)一附院創(chuàng)傷骨科手外科同一治療小組膝關(guān)節(jié)鏡下行伸膝裝置黏連松解術(shù)的41例伸直型膝關(guān)節(jié)僵硬患者按其不同鎮(zhèn)痛模式分為2組,其中將術(shù)后口服塞來昔布為術(shù)后鎮(zhèn)痛方案的21膝患者為A組,將術(shù)前口服塞來昔布及聯(lián)合術(shù)中關(guān)節(jié)腔注射“雞尾酒”多模式疼痛管理為術(shù)后鎮(zhèn)痛方案的20膝患者為B組,回顧性分析其治療效果,隨訪時(shí)間6個(gè)月,以視覺疼痛模擬評(píng)分量表(VSA)評(píng)價(jià)患者術(shù)后鎮(zhèn)痛效果,以膝關(guān)節(jié)屈曲改變角度及外科特種醫(yī)院膝關(guān)節(jié)評(píng)分(HHS)評(píng)估患者術(shù)后1個(gè)月、3個(gè)月、6個(gè)月患膝功能改善情況。結(jié)果1、術(shù)后12小時(shí)、1天、2天,靜息狀態(tài)下,患膝關(guān)節(jié)VAS評(píng)分B組比A組小,P小于0.05,差異有統(tǒng)計(jì)學(xué)意義。術(shù)后3天、4天,靜息狀態(tài)下,患膝關(guān)節(jié)VAS評(píng)分B組與A組大至相當(dāng),P大于0.05,差異無統(tǒng)計(jì)學(xué)意義。2、術(shù)后2天、3天,被動(dòng)活動(dòng)時(shí)患膝關(guān)節(jié)VAS評(píng)分B組比A組小,P小于0.05,差異有統(tǒng)計(jì)學(xué)意義。術(shù)后1周,被動(dòng)活動(dòng)時(shí),患膝關(guān)節(jié)VAS評(píng)分B組與A組大至相當(dāng),P大于0.05,差異無統(tǒng)計(jì)學(xué)意義。3、術(shù)后2天、14天,主動(dòng)活動(dòng)時(shí)患膝關(guān)節(jié)屈曲角度B組比A組大,P小于0.05,差異有統(tǒng)計(jì)學(xué)意義,術(shù)后1個(gè)月、3個(gè)月、6個(gè)月,主動(dòng)活動(dòng)時(shí),B組與A組屈曲角度大至相當(dāng),P大于0.05,差異無統(tǒng)計(jì)學(xué)意義。4、A組術(shù)前、術(shù)后HHS膝關(guān)節(jié)功能評(píng)分比較P小于0.01,差異有統(tǒng)計(jì)學(xué)意義。B組術(shù)前、術(shù)后HHS膝關(guān)節(jié)功能評(píng)分比較P小于0.01,差異有統(tǒng)計(jì)學(xué)意義。結(jié)論在關(guān)節(jié)鏡行伸膝裝置黏連松解術(shù)的伸直型膝關(guān)節(jié)僵硬患者,采用多模式疼痛管理能明顯減輕患者術(shù)后48h的疼痛程度,提高總體滿意度且能明顯改善在關(guān)節(jié)鏡行伸膝裝置黏連松解術(shù)的伸直型膝關(guān)節(jié)僵硬患者術(shù)后2d、14d的膝關(guān)節(jié)活動(dòng)度(ROM),增加患者康復(fù)的信心。但對(duì)1、3、6個(gè)月后膝關(guān)節(jié)主動(dòng)活動(dòng)度及HHS膝關(guān)節(jié)功能評(píng)分無改善。
[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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.4

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