[1]孙志璞,崔明达,张天吉,等.术前激素应用对单侧全膝关节置换患者术后快速康复的影响[J].新乡医学院学报,2019,36(5):455-458.[doi:10.7683/xxyxyxb.2019.05.013]
　SUN Zhi-pu,CUI Ming-da,ZHANG Tian-ji,et al.Effect of preoperative hormone application on postoperative rapid recovery in patients with unilateral total knee arthroplasty[J].Journal of Xinxiang Medical University,2019,36(5):455-458.[doi:10.7683/xxyxyxb.2019.05.013]
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术前激素应用对单侧全膝关节置换患者术后快速康复的影响
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
36
期数:
2019年5
页码:
455-458
栏目:
临床研究
出版日期:
2019-05-05

文章信息/Info

Title:
Effect of preoperative hormone application on postoperative rapid recovery in patients with unilateral total knee arthroplasty
作者:
孙志璞; 崔明达; 张天吉; 刘晓潭; 王宏伟
（新乡医学院第三附属医院骨科，河南　新乡　453003）
Author(s):
SUN Zhi-pu; CUI Ming-da; ZHANG Tian-ji; LIU Xiao-tan; WANG Hong-wei
（Department of Orthopedics Surgery，the Third Affiliated Hospital of Xinxiang Medical University，Xinxiang 453003，Henan Province，China）
关键词:
激素; 全膝关节置换; 镇痛; 快速康复
Keywords:
glucocorticoid; total knee arthroplasty; analgesia; fast track
分类号:
R687.4
DOI:
10.7683/xxyxyxb.2019.05.013
文献标志码:
A
摘要:
目的　观察术前单次应用甲强尼龙琥珀酸钠对单侧全膝关节置换患者术后镇痛效果及术后快速康复的影响。方法　选择新乡医学院第三附属医院骨科2016年7月至2018年6月收治的36例首次行单侧全膝关节置换术患者，根据术前是否应用甲泼尼龙琥珀酸钠将患者分为观察组和对照组，每组18例。观察组患者术前静脉注射甲泼尼龙琥珀酸钠125 mg，对照组患者给予等量生理盐水。分别于术前和术后第1天采用免疫比浊法检测2组患者血清C-反应蛋白（CRP）水平，术后6、12、24、36、48、60、72 h采用视觉模拟评分法评估2组患者静息状态和活动状态下的疼痛情况，记录并比较2组患者术后3 d氨酚羟考酮使用情况、术后7 d患者膝关节活动度及住院时间。结果　术前2组患者血清CRP水平比较差异无统计学意义（P>0.05）；2组患者术后第1天血清CRP水平均高于术前（P<0.05）；术后第1天，观察组患者血清CRP水平显著低于对照组（P<0.05）。术后6、72 h，2组患者静息状态下VAS评分比较差异无统计学意义（P>0.05）；术后12、24、36、48、60 h，观察组患者静息状态下VAS评分均低于对照组（P<0.05）。术后6、60 h，2组患者活动状态下VAS评分比较差异无统计学意义（P>0.05）；术后12、24、36、48、72 h，观察组患者活动状态下VAS评分均低于对照组（P<0.05）。观察组患者术后第1、2天氨酚羟考酮使用量和术后3 d的使用总量均低于对照组（P<0.05）；2组患者术后第3天氨酚羟考酮使用量比较差异无统计学意义（P>0.05）。术后 1～7 d，观察组患者膝关节活动度均显著大于对照组（P<0.05）。2组患者住院时间比较差异无统计学意义（P>0.05）。结论　单侧全膝关节置换患者术前应用甲泼尼龙琥珀酸钠可有效减轻患者术后炎症反应，减轻患者疼痛，减少术后阿片类镇痛药物的使用量，有利于患者进行早期功能锻炼。
Abstract:
Objective　To observe the effect of single application of methylprednisolone before operation on postoperative analgesia and rapid recovery after unilateral total knee arthroplasty.Methods　Thirty-six patients who underwent the first unilateral total knee arthroplasty in the Third Affiliated Hospital of Xinxiang Medical University from July 2016 to June 2018 were selected and divided into observation group and control group according to whether the methylprednisolone was used before operation，with 18 patients in each group.The patients in the observation group were injected intravenously methylprednisolone 125 mg before surgery，the patients in the control group were given the same volume of normal saline.The level of C-reactive protein （CRP） in serum of patients in the two groups were detected by immunoturbidimetric assay before operation and at the first day after operation.At 6，12，24，36，48，60，72 h after operation，the pain of patients in resting and active states was evaluated by visual analog scores（VAS） in the two groups.The application amount of oxycodone and acetaminophen at 1-3 days after operation and the total application amount of oxycodone and acetaminophen in the three days after operation were recorded and compared，the motion of knee joint after operation and the length of hospital stay of patients in the two groups were recorded and compared.Results　There was no significant difference in the serum level of CRP between the two groups before operation （P>0.05）；the serum levels of CRP of patients at the first day after operation were significantly higher than those before operation in the two groups（P<0.05）；at the first day after operation，the serum level of CRP of patients in the observation group was significantly lower than that in the control group（P<0.05）.There was no statistic difference in the VAS score in resting state between the two groups at 6，72 h after operation（P>0.05）；at 12，24，36，48，60 h after operation，the VAS score in resting state of patients in the observation group was significantly lower than that in the control group（P<0.05）.There was no statistic difference in the VAS score in active state between the two groups at 6，60 h after operation（P>0.05）；the VAS score in active state of patients in the observation group was significantly lower than that in the control group at 12，24，36，48，72 h after operation（P<0.05）.The application amount of oxycodone and acetaminophen at the 1st，2ed day after operation and the total application amount in the three days after operation of patients in the observation group was significantly lower than that in the control group（P<0.05）；there was no statistic difference in the application amount of oxycodone and acetaminophen at the 3rd day after operation between the two groups（P>0.05）.The range of motion of knee joint of patients in the observation group was significantly greater than that in the control group（P<0.05）in 1-7 d after operation（P<0.05）.There was no significant difference in the length of hospital stay between the two groups（P>0.05）.Conclusion　Preoperative application of methylprednisolone in patients who undergo unilateral total knee arthroplasty can effectively alleviate inflammation reaction，relieve pain，reduce the application amount of opioid analgesics after surgery，and facilitate the early functional exercise.

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[2]明海武,董卫兵,黄媛霞,等.数字化技术在膝关节置换术中的应用[J].新乡医学院学报,2017,34(8):772.[doi:10.7683/xxyxyxb.2017.08.030]

更新日期/Last Update: 2019-05-05