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中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (06) : 673 -679. doi: 10.3877/cma.j.issn.1674-134X.2021.06.004

临床论著

鸡尾酒疗法在全膝关节置换术中不同注射方式的疗效比较
旷世达1, 赵鑫1, 苏超1, 刘伟杰1, 高曙光2,()   
  1. 1. 410008 长沙,中南大学湘雅医院骨科
    2. 410008 长沙,中南大学湘雅医院骨科;410008 长沙,国家老年疾病临床医学研究中心
  • 收稿日期:2020-10-20 出版日期:2021-12-01
  • 通信作者: 高曙光
  • 基金资助:
    湖南省自然基金面上项目(2021JJ30040); 国家老年疾病临床医学中心临床研究基金(2021KFJJ06)

Outcomes comparison in cocktail injection different methods in total knee arthroplasty

Shida Kuang1, Xin Zhao1, Chao Su1, Weijie Liu1, Shuguang Gao2,()   

  1. 1. Department of Orthopedics, Xiangya Hospital of Central South University, Changsha 410008, China
    2. Department of Orthopedics, Xiangya Hospital of Central South University, Changsha 410008, China; National Clinical Research Center of Geriatric Disorders, Changsha 410008, China
  • Received:2020-10-20 Published:2021-12-01
  • Corresponding author: Shuguang Gao
引用本文:

旷世达, 赵鑫, 苏超, 刘伟杰, 高曙光. 鸡尾酒疗法在全膝关节置换术中不同注射方式的疗效比较[J/OL]. 中华关节外科杂志(电子版), 2021, 15(06): 673-679.

Shida Kuang, Xin Zhao, Chao Su, Weijie Liu, Shuguang Gao. Outcomes comparison in cocktail injection different methods in total knee arthroplasty[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(06): 673-679.

目的

该研究旨在比较鸡尾酒关节腔注射与关节周围注射对全膝关节置换(TKA)术后疼痛及活动度的影响差别。

方法

2019年4月至2020年1月,从中南大学湘雅医院因膝骨关节炎需行单侧TKA的患者中纳入患者作为队列研究。纳入标准:初次行单侧TKA患者;术前血小板、凝血功能、双下肢静脉彩超未见异常;依从性良好者。排除标准:患肢有神经性疼痛,感觉障碍者;服用抗凝药或阿司匹林停药不足1周;明确对曲安奈德、罗哌卡因或氨甲环酸过敏或有使用禁忌;严重肝肾功能不全;血栓形成高危患者;住院期间改行双侧TKA。共90例患者根据注射方式被分为关节腔组47例,关节周围组43例。在手术时关节腔组予以关节腔注射鸡尾酒,周围组予以关节周围注射鸡尾酒。记录患者一般信息,疼痛程度采用视觉模拟疼痛评分(VAS)评估,运动功能恢复采用关节活动度(ROM)、主动直腿抬高(SLR)时间和膝关节屈曲90°时间来评估。结果用独立样本t检验、重复测量方差分析和卡方检验进行分析。

结果

关节腔组和关节周围组在术前、术后的静态VAS(F=0.120,P>0.05)、动态VAS(F=0.321,P>0.05)上差异无统计学意义;关节腔组与关节周围组在术前、术后ROM(F=0.688,P>0.05)的差异无统计学意义。术后SLR(t=0.755,P>0.05)与术后屈曲90°时间(t=-1.234,P>0.05)差异无统计学意义。

结论

关节置换术后鸡尾酒关节腔注射与关节周围注射在术后2周内镇痛和运动康复效果上没有明显区别。

Objective

To compare the effects of intra-articular cocktail injection and periarticular injection on pain and knee movement after total knee arthroplasty (TKA).

Methods

From April 2019 to January 2020 in Xiangya Hospital, Central South University, the patients who needed unilateral TKA due to osteoarthritis were evaluated as study cohort. Inclusion criteria: patients undergoing unilateral TKA for the first time; no abnormality was found in preoperative platelet, coagulation function and venous ultrasound of both lower limbs; good compliance. Exclusion criteria: patients with neuropathic pain and sensory disorders; stop taking anticoagulant or aspirin for less than one week; definite allergy or contraindication to triamcinolone, ropivacaine or tranexamic acid; severe hepatic and renal insufficiency; high risk of thrombosis; bilateral TKA was performed during hospitalization. Ninety patients were enrolled and divided into the intra-articular group (n=47) and the peri-articular group (n=43). During the operation, cocktail injections were given into the articular cavity in the intra-articular group and around the joints in the peri-articular group. The general information of the patients was recorded; the degree of pain was evaluated by visual analogue scale (VAS) of pain and the recovery of motor function was evaluated by joint range of motion (ROM), the time of active straight leg raising (SLR) and the time of 90° knee flexion. The results were analyzed by independent sample t test, repeated measures anova and chi-square test.

Results

There was no statistically significant difference in rest VAS(F=0.120, P>0.05) and activity VAS(F=0.321, P>0.05) between the two groups before and after operation, and there was no statistically significant difference in ROM(F=0.688, P>0.05) between the two groups before operation and after operation. There was no statistically significant difference between postoperative SLR(t=0.755, P>0.05) and postoperative 90° knee flexion time(t=-1.234, P>0.05) in both groups.

Conclusion

There is no statistically significant difference in early postoperative analgesia and motor rehabilitation outcomes between the cocktail of intra-articular injection and peri-articular injection after total knee arthroplasty within two weeks.

图1 研究流程图注:A组-关节腔组;B组-关节周围组
表1 两组一般信息比较
表2 两组不同时间点静态VAS比较(±s)
表3 两组不同时间点动态VAS比较(±s)
表4 两组不同时间点活动度比较[°,(±s)]
表5 两组SLR与屈曲90°时间比较[d,(±s)]
表6 两组术后不良反应和额外药物使用比较[例(%)]
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