早期超前镇痛对膝关节镜术后患者关节功能活动度的影响

The Effect of Early Pre-Emptive Analgesia on Postoperative Range of Motion in Patients Undergoing Knee Arthroscopy

摘要: 目的：术前关节活动度恢复程度对膝关节镜患者的术后功能有重要影响，但患者由于肢体疼痛通常无法进行有效术前功能锻炼。超前镇痛虽有助于康复锻炼，但其临床用药可能引起严重不良反应。本文作者研究术前早期超前镇痛对膝关节镜手术患者术后关节活动度恢复的影响，评估其是否具有临床应用意义。方法：34例患者分为早期超前镇痛组和非超前镇痛组，均于全麻下接受膝关节镜下半月板部分切除术，分别于住院期间手术前、出院后术后第4周和第12周门诊随访测量患者手术侧肢体膝关节活动度恢复情况，结果进行统计分析。结果：术后全部患者均可正常伸直膝关节，无过伸异常。患者术前及随访4周时早期超前镇痛组平均活动度屈膝角度恢复大于非早期镇痛组，差异有统计学意义(p < 0.01)；至术后第12周早期超前镇痛组活动度仍大于非早期镇痛组，两组间差异无统计学意义(p > 0.05)。结论：对接受膝关节镜下半月板部分切除手术的患者进行早期超前镇痛干预，与未采用超前镇痛的传统治疗模式相比，有助于加快患者膝关节活动度的恢复进程。

Abstract: Objective: Preoperative rehabilitation of the range of motion has a great impact on the postopera-tive joint functions in patients undergoing knee arthroscopies, but effective functional exercise may not be practicable due to severe pain. Although early pre-emptive analgesia may provide sufficient pain control, controversies still exist regarding related severe adverse effects caused by the analgesics. The aim of this study was to investigate the effectiveness of early pre-emptive analgesia on postoperative joint range of motion in patients undergoing arthroscopy. Methods: Thirty four patients undergoing arthroscopic partial menisectomy were divided into two groups: the early pre-emptive analgesia group and the non-pre-emptive analgesia group. Knee range of motion was measure before surgery and at the 4th and 12th postoperative weeks. Results: All patients regained full extension of the knee before discharge. The knee flexion angles of patients in the analgesic group were higher than those of patients in the non-analgesic group before surgery and at 4 weeks postoperatively. There was no statistical difference in flexion angles between two groups at the 12th postoperative week. Conclusion: Early pre-emptive analgesia could accelerate the rehabilitation of range of motion in patients undergoing arthroscopic menisectomy.