CAJ | 학술논문

背景：全膝关节置换为严重膝关节疾病患者解决了极大的痛苦，临床疗效已得到公认。临床上双膝关节置换的患者，两次手术临床镇痛方案的制定尚缺乏临床循证医学证据的支持。 　　目的：比较分期双侧全膝关节置换中初次与二次手术后早期疼痛的差异，为临床镇痛方案提供证据。 　　方法：选择2009年1月至2013年1月进行分期双侧全膝关节置换的87例患者进行回顾性分析。比较分期双侧膝关节置换患者初次与二次手术后24，48，72 h的目测类比评分，包括休息位和最大屈曲位；另外还比较了两次手术间隔时间为6个月以内、6-12个月、12个月以上3个时间段二次手术与初次手术后早期疼痛评分差值的差异。 　　结果与结论：二次全膝关节置换在术后24，48 h的休息位和最大屈曲位目测类比评分均显著高于初次置换。而术后72 h休息位与最大屈曲位目测类比评分则没有明显差异。两次手术时间间隔在6个月以内的患者第二次全膝关节置换后24 h休息位和最大屈曲位目测类比评分均显著高于6-12个月组和12个月以上组；而6-12个月组与12个月以上组的休息位和屈曲位目测类比评分的差值均未见明显差异。提示分期双侧全膝关节置换后48 h内二次手术的疼痛程度明显高于初次手术，这为适当加强双膝关节置换二次手术后的镇痛方案提供了有效的临床证据；而两次手术的时间间隔长短也可影响二次手术后早期疼痛的改变程度，从术后患者疼痛角度出发，可建议双侧分期置换的间隔时间可以大于6个月，以减少二次手术后疼痛，提高患者满意度，加快恢复速度。
배경：전슬관절치환위엄중슬관절질병환자해결료겁대적통고，림상료효이득도공인。림상상쌍슬관절치환적환자，량차수술림상진통방안적제정상결핍림상순증의학증거적지지。 　　목적：비교분기쌍측전슬관절치환중초차여이차수술후조기동통적차이，위림상진통방안제공증거。 　　방법：선택2009년1월지2013년1월진행분기쌍측전슬관절치환적87례환자진행회고성분석。비교분기쌍측슬관절치환환자초차여이차수술후24，48，72 h적목측류비평분，포괄휴식위화최대굴곡위；령외환비교료량차수술간격시간위6개월이내、6-12개월、12개월이상3개시간단이차수술여초차수술후조기동통평분차치적차이。 　　결과여결론：이차전슬관절치환재술후24，48 h적휴식위화최대굴곡위목측류비평분균현저고우초차치환。이술후72 h휴식위여최대굴곡위목측류비평분칙몰유명현차이。량차수술시간간격재6개월이내적환자제이차전슬관절치환후24 h휴식위화최대굴곡위목측류비평분균현저고우6-12개월조화12개월이상조；이6-12개월조여12개월이상조적휴식위화굴곡위목측류비평분적차치균미견명현차이。제시분기쌍측전슬관절치환후48 h내이차수술적동통정도명현고우초차수술，저위괄당가강쌍슬관절치환이차수술후적진통방안제공료유효적림상증거；이량차수술적시간간격장단야가영향이차수술후조기동통적개변정도，종술후환자동통각도출발，가건의쌍측분기치환적간격시간가이대우6개월，이감소이차수술후동통，제고환자만의도，가쾌회복속도。
BACKGROUND:Total knee arthroplasty solves a great pain for patients with severe knee joint disease, and its clinical curative effects have been general y accepted. In the clinic, the formulation of clinical analgesic program of the two surgeries in patients undergoing double knee prosthesis lacks of the support of evidence-based medicine. OBJECTIVE:To compare the differences in pain during early stage of primary and secondary surgeries in bilateral total knee arthroplasty, and to provide evidence for clinical analgesic programs. METHODS:A total of 87 patients receiving staged bilateral total knee arthroplasty from January 2009 to January 2013 were retrospectively analyzed. Visual analogue scale was compared at 24, 48 and 72 hours after first and second staged total knee arthroplasty, including seating and maximum flexion position. In addition, the difference in early pain score was compared between second and first total knee arthroplasty in different intervals (less than 6 months, 6-12 months, more than 12 months). RESULTS AND CONCLUSION:The visual analogue scale scores at seating and maximum flexion position at 24 and 48 hours after second total knee arthroplasty were significantly higher than the first surgery. No significant difference in visual analogue scale scores was detected between 72-hour seating and maximum flexion position. Visual analogue scale scores were significantly higher in the interval of less than 6 months than in the 6-12 month group and more than 12 month group in the 24-hour seating and maximum flexion position after second total knee arthroplasty. No significant difference in visual analogue scale scores was detected between the 6-12 month group and more than 12 month group at seating and maximum flexion position. Results suggested that the pain of second surgery was obviously higher than the first surgery within 48 hours after staged bilateral total knee arthroplasty, and this can provide a clinical evidence to enhance the analgesic strategy in the second staged bilateral total knee arthroplasty. The interval between two surgeries also affected the early pain after second surgery. Considered the aspect of postoperative pain, it is better to suggest the interval between first and second surgeries in staged total knee arthroplasty should be more than 6 months. This can reduce pain after second surgery, elevate patient’s satisfaction and accelerate the speed of recovery.