甲泼尼龙激素对膝关节置换术后早期临床效果的影响

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摘要目的探讨多模式鸡尾酒关节周围注射(multimodal cocktail periarticular injection，MCPI)疗法中添加甲泼尼龙激素对膝关节置换术后早期临床效果的影响。方法采用前瞻性随机对照研究，自2018年1月至2018年6月共招募60例患者进行随机对照试验，每组30例，分别接受含甲泼尼龙激素及不含甲泼尼龙激素的混合药物来控制术后疼痛。采用视觉模拟评分(visual analogue scale，VAS)评估术后静息、活动状态下的疼痛情况，观察患者术后膝关节肿胀程度，测量不同时间段膝关节主动活动范围。结果研究结果显示，MCPI中添加甲泼尼龙激素能减少术后早期(24 h内)关节疼痛和肿胀程度，提前主动直腿抬高时间，差异有统计学意义(P＜0.05)，其余数据之间差异无统计学意义(P＞0.05)。同时，类固醇激素没有增加术后伤口感染的风险，也没有出现肌腱断裂的情况。结论在MCPI中加入甲泼尼龙激素可提高全膝关节置换术后早期(24 h内)止痛效果，提前主动直腿抬高时间，减轻关节肿胀程度，且无明显并发症，但对术后早期膝关节活动度无明显影响。

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关键词 ：全膝关节置换术, 鸡尾酒, 术后镇痛, 类固醇激素

Abstract：Objective To investigation the effect of methyl prednisolone on the early clinical effect after knee arthroplasty with multimode cocktail periarticular injection (MCPI).Methods A prospective randomized controlled trial was conducted in 60 patients from January 2018 to June 2018 with 30 patients in each group.The patients received a combination of methylprednisolone and no methylprednisolone to control postoperative pain.Visual analogue score (VAS) was used to evaluate the pain at rest and activity after operation.The swelling degree of knee joint was observed and the active range of knee motion was measured at different time intervals.Results The results showed that adding methylprednisolone to MCPI could reduce the degree of joint pain and swelling in the early stage (within 24 hours) after operation，and increase the time of active straight leg elevation in advance (P＜0.05)，there was a significant difference between the two groups (P＜0.05).There was no significant difference between the other data (P＞0.05).Steroid hormones also did not increase the risk of postoperative wound infection or tendon rupture.Conclusion Adding methylprednisolone to MCPI can improve the pain relief effect in the early stage (within 24 hours) after total knee replacement，advance the time of raising straight leg，reduce the degree of joint swelling，and have no obvious complications.However，there is no significant effect on the motion of knee joint in the early stage after operation.

Key words： total knee arthroplasty cocktail postoperative analgesia steroid hormone

作者简介: 张权(1990－ )，男，研究生在读，山西医科大学，030001。

引用本文:

张权 1，任广宗 1，任伟平 2，王智勇 2，张志强 2. 甲泼尼龙激素对膝关节置换术后早期临床效果的影响[J]. 实用骨科杂志, 2019, 25(4): 305-309.
Zhang Quan 1，Ren Guangzong 1，Ren Weiping 2，et al. Effect of Methylprednisolone on the Early Clinical Effect of Knee Arthroplasty. sygkzz, 2019, 25(4): 305-309.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2019/V25/I4/305

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