初次全膝关节置换术后静脉应用糖皮质激素治疗效果观察

doi:10.3969/j.issn.1006-7795.2019.05.016

摘要/Abstract

摘要： 目的探讨初次全膝关节置换术后短期静脉使用糖皮质类激素-甲基泼尼松龙的临床治疗效果，并对其使用的安全性进行评估。方法选择2016年3月至2018年3月在首都医科大学附属北京朝阳医院进行初次全膝关节置换的病例，符纳入合标准的患者共348例（496膝），根据患者是否在术后前3 d静脉使用糖皮质类激素-甲基泼尼松龙（40 mg/d），将其分为常规组（186例，266膝）及激素组（162例，230膝）。观察指标包括：术后1~7 d的视觉模拟评分（visual analogue scale，VAS）、术后3~7 d膝关节活动度（range of motion，ROM）及术后第7天患者的美国特种外科医院膝关节评分（hospital for special surgery knee score，HSS），另外记录患者出现恶心、呕吐、切口愈合不良及关节感染的发生率。结果患者术后1~7 d的VAS及3~7 d的膝关节活动度激素组均明显优于常规组，差异有统计学意义（P<0.05）；患者术后第7天的HSS评分激素组也明显优于常规组，差异有统计学意义（P<0.05）；从术后合并症来看，激素组恶心、呕吐的发生率要明显低于常规组，而切口愈合不良及感染的发生率差异无统计学意义（P>0.05）。结论初次全膝关节置换术后短期静脉应用糖皮质类激素能够明显减轻患者术后疼痛，减少术后恶心、呕吐，促进膝关节功能恢复，同时并未增加置换后伤口愈合不良、关节感染等合并症的发生。

关键词: 关节成形术, 置换, 膝, 糖皮质激素

Abstract: Objective To investigate the clinical efficacy of the short-term intravenous glucocorticoid after primary total knee arthroplasty and to evaluate the security of the patients. Methods From March 2016 to March 2018,348 cases (496 knees) who met the inclusion criteria had received primary total knee arthroplasty (TKA) in our hospital. All of the patients were divided into two groups according to whether glucocorticoid was used after operation-regular group (186 patients,266 knees) and hormone group (162 cases,230 knees). Observation indexes include:visual analogue scale (VAS) and range of motion 1 to 7days after the operation,hospital for special surgery scores at the first week after the operation and the postoperative complications rate,include nausea,vomiting,wound healing and joint infection. Results The VAS and range of motion (ROM) after surgery of the Hormone group was significantly better than the normal group,also relate to the HSS score,with significant difference between these two groups. Furthermore,the incidence of nausea and vomiting in the hormone group was significantly lower than that in the normal group,and there was no significant difference in the incidence of wound healing and infection. Conclusion Short-term intravenous application of glucocorticoid hormones can significantly reduce postoperative pain patients,reduce postoperative nausea and vomiting,promote the knee function recovery,at the same time does not increase complications such as poor wound healing,infection of joint after replacement.

Key words: arthroplasty, replacement, knee, glucocorticoids

中图分类号:

R658

张博, 王进军, 王志为, 任世祥, 林源. 初次全膝关节置换术后静脉应用糖皮质激素治疗效果观察[J]. 首都医科大学学报, 2019, 40(5): 749-753.

Zhang Bo, Wang Jinjun, Wang Zhiwei, Ren Shixiang, Lin Yuan. Clinical effects of postoperative application of glucocorticoids in total knee arthroplasty[J]. Journal of Capital Medical University, 2019, 40(5): 749-753.

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