Osteoarthritis(OA)is a complex"whole joint"disease pursued by inflammatory mediators,rather than purely a process of"wear and tear".Besides cartilage degradation,synovitis,subchondral bone remodeli...Osteoarthritis(OA)is a complex"whole joint"disease pursued by inflammatory mediators,rather than purely a process of"wear and tear".Besides cartilage degradation,synovitis,subchondral bone remodeling,degeneration of ligaments and menisci,and hypertrophy of the joint capsule take parts in the pathogenesis.Pain is the hallmark symptom of OA,but the extent to which structural pathology in OA contributes to the pain experience is still not well known.For the knee OA,intraarticular(IA)injection(corticosteroids,viscosupplements,blood-derived products)is preferred as the last nonoperative modality,if the other conservative treatment modalities are ineffective.IA corticosteroid injections provide short term reduction in OA pain and can be considered as an adjunct to core treatment for the relief of moderate to severe pain in people with OA.IA hyaluronic acid(HA)injections might have efficacy and might provide pain reduction in mild OA of knee up to 24 wk.But for HA injections,the costeffectiveness is an important concern that patients must be informed about the efficacy of these preparations.Although more high-quality evidence is needed,recent studies indicate that IA platelet rich plasma injections are promising for relieving pain,improving knee function and quality of life,especially in younger patients,and in mild OA cases.The current literature and our experience indicate that IA injections are safe and have positive effects for patient satisfaction.But,there is no data that any of the IA injections will cause osteophytes to regress or cartilage and meniscus to regenerate in patients with substantial and irreversible bone and cartilage damage.展开更多
[目的]探讨全髋关节置换术(total hip arthroplasty,THA)关节腔灌注止血麻药激素药物混合液的作用。[方法]回顾性分析2022年10月—2024年3月初次单侧THA的92例患者的临床资料。依据术前医患沟通结果,46例患者为药物组,THA完成后给予关节...[目的]探讨全髋关节置换术(total hip arthroplasty,THA)关节腔灌注止血麻药激素药物混合液的作用。[方法]回顾性分析2022年10月—2024年3月初次单侧THA的92例患者的临床资料。依据术前医患沟通结果,46例患者为药物组,THA完成后给予关节内120 m L混合药物灌注;另外46例患者为对照组,关节内未使用药物。比较两组患者围手术期临床与检验资料。[结果]患者均顺利完成手术,无神经及血管损伤的并发症。两组在手术时间、切口长度、术中出血量和切口愈合等级的差异均无统计学意义(P>0.05)。但是,药物组的术后引流量[(216.3±32.4) mL vs (387.4±45.9) mL,P<0.001]和总显性失血量[(451.6±54.1) mL vs (625.5±63.3) mL,P<0.001]均显著低于对照组。此外,药物组术后DVT的发生率显著低于对照组(2.2%vs15.2%,P=0.026)。随术后时间推移,两组患者VAS评分均显著下降(P<0.05),而6 min步行距离均显著增加(P<0.05)。术后1 d和2 d,药物组的VAS评分显著低于对照组[(4.0±1.3) vs (6.7±1.4),P<0.001;(4.1±1.2) vs (7.3±1.3),P<0.001]。术后3 d和7 d,药物组6 min步行距离均显著大于对照组[(53.4±7.2) m vs (36.7±2.5) m,P<0.001;(154.0±14.1) m vs (124.8±14.0) m,P<0.001]。检验方面,术前两组Hct和D-D的差异均无统计学意义(P>0.05)。与术前比较,术后3 d两组的Hct均显著降低(P<0.05),而两组的D-D均显著升高(P<0.05)。术后3 d,药物组的Hct显著高于对照组[(38.1±1.3)%vs (36.2±0.5)%,P<0.001],而药物组的D-D显著低于对照组[(325.8±42.9)μg/L vs (377.8±53.3)μg/L,P<0.001]。[结论]关节腔灌注氨甲环酸联合罗哌卡因、地塞米松混合液能减轻THA术后疼痛,降低术后失血量,减少DVT的发生,有利于患肢功能恢复。展开更多
目的:比较连续股神经阻滞(continuous femoral nerve block,CFNB)和CFNB联合关节周围浸润镇痛(periarticular local infiltration analgesia,PLIA)对膝关节置换术后镇痛及早期功能恢复的影响。方法:选择择期行膝关节置换手术患者100例,...目的:比较连续股神经阻滞(continuous femoral nerve block,CFNB)和CFNB联合关节周围浸润镇痛(periarticular local infiltration analgesia,PLIA)对膝关节置换术后镇痛及早期功能恢复的影响。方法:选择择期行膝关节置换手术患者100例,随机分为CFNB组(n=50)和CFNB联合PLIA组(简称PLIA组,n=50),以视觉模拟评分(visual analogue score,VAS)评价患者疼痛程度,在术后各时点记录静息及被动运动时患侧膝关节前、后部VAS评分。记录术后患者被动屈膝90°时间、主动直腿抬高时间,记录患者术前及术后72 h美国特种外科医院膝关节评分(hospital for special surgery knee score,HSS)。结果:术后静息时膝关节前部VAS评分在各时点两组间差异均无统计学意义(P>0.05),但膝关节后部VAS评分在术后4、8、12、24 h时PLIA组明显低于CFNB组(P<0.05)。被动运动时PLIA组膝关节前部VAS评分在术后24 h明显低于CFNB组(P<0.05),膝关节后部VAS评分在术后12、24 h明显低于CFNB组(P<0.05)。两组术前及术后72 h HSS评分差异无统计学意义(P>0.05)。与CFNB组比较,PLIA组被动屈膝90°时间和主动直腿抬高时间均明显缩短(P<0.05)。结论:CFNB联合PLIA镇痛可以降低术后膝关节后部疼痛评分,减少被动运动疼痛,缩短被动屈膝90°时间,改善患者术后早期康复效果。展开更多
文摘Osteoarthritis(OA)is a complex"whole joint"disease pursued by inflammatory mediators,rather than purely a process of"wear and tear".Besides cartilage degradation,synovitis,subchondral bone remodeling,degeneration of ligaments and menisci,and hypertrophy of the joint capsule take parts in the pathogenesis.Pain is the hallmark symptom of OA,but the extent to which structural pathology in OA contributes to the pain experience is still not well known.For the knee OA,intraarticular(IA)injection(corticosteroids,viscosupplements,blood-derived products)is preferred as the last nonoperative modality,if the other conservative treatment modalities are ineffective.IA corticosteroid injections provide short term reduction in OA pain and can be considered as an adjunct to core treatment for the relief of moderate to severe pain in people with OA.IA hyaluronic acid(HA)injections might have efficacy and might provide pain reduction in mild OA of knee up to 24 wk.But for HA injections,the costeffectiveness is an important concern that patients must be informed about the efficacy of these preparations.Although more high-quality evidence is needed,recent studies indicate that IA platelet rich plasma injections are promising for relieving pain,improving knee function and quality of life,especially in younger patients,and in mild OA cases.The current literature and our experience indicate that IA injections are safe and have positive effects for patient satisfaction.But,there is no data that any of the IA injections will cause osteophytes to regress or cartilage and meniscus to regenerate in patients with substantial and irreversible bone and cartilage damage.
文摘[目的]探讨全髋关节置换术(total hip arthroplasty,THA)关节腔灌注止血麻药激素药物混合液的作用。[方法]回顾性分析2022年10月—2024年3月初次单侧THA的92例患者的临床资料。依据术前医患沟通结果,46例患者为药物组,THA完成后给予关节内120 m L混合药物灌注;另外46例患者为对照组,关节内未使用药物。比较两组患者围手术期临床与检验资料。[结果]患者均顺利完成手术,无神经及血管损伤的并发症。两组在手术时间、切口长度、术中出血量和切口愈合等级的差异均无统计学意义(P>0.05)。但是,药物组的术后引流量[(216.3±32.4) mL vs (387.4±45.9) mL,P<0.001]和总显性失血量[(451.6±54.1) mL vs (625.5±63.3) mL,P<0.001]均显著低于对照组。此外,药物组术后DVT的发生率显著低于对照组(2.2%vs15.2%,P=0.026)。随术后时间推移,两组患者VAS评分均显著下降(P<0.05),而6 min步行距离均显著增加(P<0.05)。术后1 d和2 d,药物组的VAS评分显著低于对照组[(4.0±1.3) vs (6.7±1.4),P<0.001;(4.1±1.2) vs (7.3±1.3),P<0.001]。术后3 d和7 d,药物组6 min步行距离均显著大于对照组[(53.4±7.2) m vs (36.7±2.5) m,P<0.001;(154.0±14.1) m vs (124.8±14.0) m,P<0.001]。检验方面,术前两组Hct和D-D的差异均无统计学意义(P>0.05)。与术前比较,术后3 d两组的Hct均显著降低(P<0.05),而两组的D-D均显著升高(P<0.05)。术后3 d,药物组的Hct显著高于对照组[(38.1±1.3)%vs (36.2±0.5)%,P<0.001],而药物组的D-D显著低于对照组[(325.8±42.9)μg/L vs (377.8±53.3)μg/L,P<0.001]。[结论]关节腔灌注氨甲环酸联合罗哌卡因、地塞米松混合液能减轻THA术后疼痛,降低术后失血量,减少DVT的发生,有利于患肢功能恢复。
文摘目的:比较连续股神经阻滞(continuous femoral nerve block,CFNB)和CFNB联合关节周围浸润镇痛(periarticular local infiltration analgesia,PLIA)对膝关节置换术后镇痛及早期功能恢复的影响。方法:选择择期行膝关节置换手术患者100例,随机分为CFNB组(n=50)和CFNB联合PLIA组(简称PLIA组,n=50),以视觉模拟评分(visual analogue score,VAS)评价患者疼痛程度,在术后各时点记录静息及被动运动时患侧膝关节前、后部VAS评分。记录术后患者被动屈膝90°时间、主动直腿抬高时间,记录患者术前及术后72 h美国特种外科医院膝关节评分(hospital for special surgery knee score,HSS)。结果:术后静息时膝关节前部VAS评分在各时点两组间差异均无统计学意义(P>0.05),但膝关节后部VAS评分在术后4、8、12、24 h时PLIA组明显低于CFNB组(P<0.05)。被动运动时PLIA组膝关节前部VAS评分在术后24 h明显低于CFNB组(P<0.05),膝关节后部VAS评分在术后12、24 h明显低于CFNB组(P<0.05)。两组术前及术后72 h HSS评分差异无统计学意义(P>0.05)。与CFNB组比较,PLIA组被动屈膝90°时间和主动直腿抬高时间均明显缩短(P<0.05)。结论:CFNB联合PLIA镇痛可以降低术后膝关节后部疼痛评分,减少被动运动疼痛,缩短被动屈膝90°时间,改善患者术后早期康复效果。
