改良硬膜外镇痛用于预防膝周围骨折术后膝关节僵硬的临床研究

目的 探讨长时间硬膜外镇痛辅助术后膝关节功能锻炼对康复效果的影响. 方法 将100例膝周围骨折术后患者采用双盲法随机分为两组：传统组50例,术后连续硬膜外镇痛2d,其后以口服药镇痛;改良组50例,皮下埋置硬膜外导管,术后连续硬膜外镇痛10 d.采用相同的功能锻炼方法,观察两组不同时点的VAS疼痛评分和下肢运动阻滞评分,追加口服或肌注镇痛药的比例,不同时点患肢被动活动度（PROM）、自主活动度（AROM）情况,自主活动度（AROM）达到90°,110°,130°的比例,评价两组膝关节功能康复效果. 结果 术后1 d VAS疼痛评分两组间差异无统计学意义,术后3,4,6,8,10 d改良组显著低于传统组（P＜ 0.01）;两组均无明显下肢运动阻滞;追加口服或者肌注镇痛药的比例改良组显著低于传统组（P＜0.01）;术后6,8,10,15,30 d时被动活动度（PROM）及自主活动度（AROM）改良组均明显高于传统组（P＜0.05或P＜0.01）;术后8,10,15,30 d时患肢自主活动度（AROM）达到90°,110°,130°比例改良组均显著高于传统组（P＜0.05或P＜0.01）.结论 改良硬膜外镇痛模式,辅助膝关节功能锻炼,能显著提高锻炼效果,加快康复进程,有效预防膝关节僵硬.

Clinical study on improved epidural analgesia in prevention of postoperative stiff knees in patients with fractures around the

Objective To explore the effect of knee joint function exercise on knee rehabilitation after operation under the long-term epidural analgesia.Methods One hundred postoperative patients with fractures around the knee were randomly divided into two groups.Fifty patients in traditional group were treated by epidural analgesia in first two days and then given oral painkiller in the next eight days.Fifty patients in observation group were treated by epidural analgesia in ten days with subcutaneous implantation of epidural catheter.All patients in two groups were treated by the same functional exercise.The VAS and Bromage score,the incidence of asking for the extra pain medicine,the passive range of motion（PROM） and autonomic range of motion（AROM） of affected limb,the ratios of AROM up to 90°,110°,130° at the different time were observed and recorded.,and the rehabilitation effect of knee joint functional were compared between two groups.Results The scores of VAS had no significant difference between two groups at 1 d after surgery,but the VAS scores were significantly lower in observation group than in traditional group at 3,4,6,8,10 d after operation （P ＜ 0.01）.No obvious motor block was found in two groups.The incidence of asking for the extra pain medicine was significantly lower in observation group than in traditional group.PROM and AROM in observation group were significantly higher than those in traditional group at 6,8,10,15,30 d after operation（P ＜0.05 or P ＜0.01）.The ratios of AROM up to 90°,110°,130° were significantly higher in observation group than in traditional group at 8,10,15,30 d after operation（P ＜ 0.05 or P ＜ 0.01）.Conclusion Improved epidural analgesia could extend the time of function exercise to improve the effect,speed up the recovery process,and effectively prevent the stiffness of knee joint.