目的 观察盐酸氨基葡萄糖治疗膝骨关节炎（KOA）的临床疗效。 方法 2010年5月－2012年7月将130例经膝关节镜清理术后的KOA患者随机分成A、B两组，每组65例。A组联合口服盐酸氨基葡萄糖胶囊750 mg，2次/d，6周为1个疗程，治疗3个疗程；B组联合口服尼美舒利胶囊0.1 g，2次/d，服用12周。采用Lequesne指数作为疗效评定指标，观察治疗前后膝关节体征及症状变化，休息痛、运动痛、压痛、肿胀、晨僵和行走能力的改善情况。 结果 B组患者在治疗早期症状改善优于同期A组，且在第3个月有统计学意义（P＜0.05），随着治疗时间的延长，A组患者总有效率在1、3、6个月分别为70.8%、76.9%和92.3%，均呈逐渐上升趋势，且第6个月疗效较前2个时间点差异有统计学意义（P＜0.05）。分别停药后继续随访至1年，两组患者总有效率均有所下降，但A组疗效仍优于B组，且有统计学意义（P＜0.05）。A组出现不良反应2例，B组4例，均较轻微，无严重不良事件发生。 结论 盐酸氨基葡萄糖在改善OA患者膝关节症状等方面效果肯定，且疗效较稳定，安全性良好；但远期疗效仍需随访观察。
【摘要】 目的 比较单次股神经阻滞和关节腔内单次注射罗哌卡因对膝关节镜检术后镇痛效果，为临床应用提供试验依据。 方法 2009年1月-2010年7月，选择美国麻醉医师协会（ASA）Ⅰ～Ⅱ级、年龄18~65岁、拟行择期单侧下肢膝关节镜手术患者180例，随机分为股神经阻滞组和关节腔内用药组，每组90例，分别于术前1 h行股神经阻滞（0.15%罗哌卡因20 mL）和手术结束时在膝关节腔内注入0.6%罗哌卡因20 mL。于术后4、8、24 h采用视觉模拟评分法（visual analog scale，VAS）行静止和运动时疼痛评分，记录术后患者满意度、不良反应发生率，术后使用镇痛药物情况。 结果 关节腔内用药组术后镇痛药物使用率（41.11%）明显高于股神经阻滞组（20.00%）（Plt;0.005）。两组患者术后24 h静止时及术后8、24 h运动时的VAS评分关节腔内用药组均明显高于股神经阻滞组（Plt;0.001），其余各时点差异无统计学意义（Pgt;0.05）。 结论 股神经阻滞可提供更加有效的术后镇痛效果，并且用药量小，安全系数高，值得临床推广。【Abstract】 Objective To compare the effect of single-injection femoral nerve block and local anesthetic intraarticular injection for analgesia after knee arthroscopy, in order to provide the experimental base for clinical application. Methods From January 2009 to July 2010, 180 American Society of Anesthesiologists (ASA) physical status I-II patients, aged from 18 to 65 years old, and scheduled for elective single knee arthroscopy were randomly divided into two groups: femoral nerve block group and local anesthetic intraarticular injection group with 90 patients in each group. For the patients in the former group, 20 mL of 0.15% ropivacaine was injected 1 hour before operation. For the latter group, 20 mL of 0.6% ropivacaine was injected into the articular cavity after operation. Pain intension scores at rest and in motion were measured 4, 8, and 24 hours after operation by visual analog scale (VAS). The degree of patients’ satisfaction, adverse reaction incidence rate and information of taking pain-killers were also recorded. Results The rate of using pain-killers in the intraarticular injection group (41.11%) was dramatically higher than the femoral nerve block group (20.00%) (Plt;0.005). The VAS scores of patients in the intraarticular injection group at rest 24 hours after operation and in motion 8 hours and 24 hours after operation were significantly higher than the femoral nerve block group (Plt;0.001), while there was no significant difference at other points between the two groups. Conclusions Femoral nerve block is more efficient for analgesia after knee arthroscopy compared with local anesthetic intraarticular injection. It is a safe procedure requiring only a relatively small dose of medicine, and is worth being popularized.
ObjectiveTo investigate the effect of arthroscopic debridement combined with oral glucosamine hydrochloride tablets in the treatment of knee osteoarthritis. MethodsSixty-two patients with knee osteoarthritis treated between January 2013 and April 2015 were chosen to be our research subjects. They were randomly divided into trial group (n=31) and control group (n=31). The control group was treated with arthroscopic debridement, and the trial group was given glucosamine hydrochloride tablets for treatment, apart from arthroscopic debridement. We evaluated the clinical effects by visual analogue scale (VAS) score and Lysholm knee joint function score before, and 1 week, 4 weeks, 3 months and 6 months after surgery. ResultsOne week after surgery, the VAS score and Lysholm knee joint function score were not significantly different between the two groups (P>0.05). Four weeks, 3 months and 6 months after surgery, the VAS score of the trial group was respectively 3.08±0.91, 2.46±0.87, and 1.45±0.66, and was 5.47±1.02, 3.55±1.20, and 2.37±0.53 in the control group; the Lysholm score of the trial group was 80.55±2.24, 85.35±1.79, and 89.74±4.58, respectively, and of the control group was 72.55±4.47, 74.68±2.94, and 76.69±5.63. The VAS score and the Lysholm score of the trial group were both better than those of the control group (P<0.05). ConclusionArthroscopic debridement can alleviate the symptoms of knee osteoarthritis, and oral administration of glucosamine hydrochloride tablets after surgery has obvious effects.
Objective To explore the feasibility and safety of early feeding after arthroscopic surgery with general anesthesia. Methods One hundred patients undergoing arthroscopic surgery with general anesthesia between January and December 2017 were randomly divided into the routine feeding group and the early feeding group, with 50 cases in each group. In the routine feeding group, patients were feeding after anus gas passage or 6 hours after surgery. Under full assessment, patients in the early feeding group could drink or eat when recovered from anesthesia. The nausea, vomiting, abdominal distension, and thirst incidences and the comfort degree 6 hours after surgery, the time of first stand up on foot, and the length of hospital stay between the two groups were compared. Results There was no statistical difference (P>0.05) in the incidence of disgusting (10.0%vs. 22.0%), vomiting (6.0% vs. 16.0%), abdominal distention (4.0% vs. 12.0%) or length of hospital stay [(6.44±2.28) vs. (6.34±0.94) days]. The difference in the incidence of postoperative thirst (14.0% vs. 40.0%), the comfort degree 6 hours after surgery (2.36±1.21 vs. 4.14±1.53), the time of the first stand up on foot [(17.30±10.32) vs. (20.84±3.92) hours] were statistically significant (P<0.05). Conclusions Early feeding is safe and feasible for the postoperiative arthroscopic surgery after general anesthesia, and can improve the patients’ comfort degree.
Objective To investigate the relative factors of sleep disorders in patients after arthroscopic knee surgery.MethodsThe clinical data of 155 patients undergoing arthroscopic knee surgery in West China Hospital of Sichuan University from October 1st 2017 to April 1st 2018 were analyzed. The sleep quality index was assessed by the Pittsburgh Sleep Quality Index. According to the scores, the patients were divided into two groups: the sleep disorder group and the non-sleep disorder group. Mindfulness level were evaluated by Mindful Attention Awareness Scale (MAAS). The binary logistic regression was used to assess the relationship between MAAS and sleep disorders.ResultsAmong the enrolled cases, there were 135 males and 20 females, with an average age of (34.12±12.13) years; 64 patients had poor sleep quality. The results of univariate analysis showed that the payment method, single or bilateral lesions, and MAAS score were the factors affecting sleep (P<0.05). The results of multivariate analysis indicated that with medical insurance [odds ratio (OR)=0.118, 95% confidence interval (CI) (0.021, 0.671), P=0.016], postoperative pain [OR=3.379, 95%CI (1.164, 9.812), P=0.025], bilateral lesions [OR=3.842, 95%CI (1.040, 14.191), P=0.044], and MAAS score ≥68 [OR=0.046, 95%CI (0.018, 0.121), P<0.001] were independent predictive factors for sleep disorders (P<0.05). Conclusion Postoperative pain reduction and mindfulness training may improve the patients’ sleep quality and reduce the incidence of sleep disorders.
ObjectivesTo systematically review the complications of knee arthroscopic surgeries in China.MethodsWe searched PubMed, EMbase, CNKI, WanFang Data and VIP databases to collect cross-sectional studies on the complications of knee arthroscopic surgeries in China from inception to March 1st, 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 36 studies involving 20 740 cases were included. The results of meta-analysis showed the incidence rate of complication in knee arthroscopic surgeries in China was 9.71% (95%CI 8.20% to 11.23%). Subgroup analysis showed that the complication incidence rates in the eastern, central and western regions were 10.04% (95%CI 8.00% to 12.14%), 9.67% (95%CI 6.57% to 12.76%) and 7.47% (95%CI 6.20% to 8.73%). The complication incidence rates in the upper first-class and non-upper first-class hospitals were 9.50% (95%CI 7.83% to 11.17%) and 10.95% (95%CI 6.75% to 15.14%). The top 3 complication types with highest incidence rate included joint effusion［2.16% (95%CI 1.44% to 2.87%)］, accidental injury of native structures［1.49% (95%CI 0.96% to 2.03%)］ and hemorrhage［1.43% (95%CI 1.01% to 1.84%)］. Other severe complications including neurovascular injury, thrombosis diseases and infection were 0.06% (95%CI 0.02% to 0.11%), 0.33% (95%CI 0.19% to 0.48%) and 0.08% (95%CI 0.03% to 0.13%).ConclusionsCurrent evidence shows that the complication incidence rate of arthroscopic surgeries in China is relatively high and the complication type is complex and varied. Due to the quantity and quality of the included studies, more high-quality studies are required to verify the above conclusions in future.
ObjectiveTo investigate the effect of different saline irrigation volume under arthroscopy on early postoperative pain and swelling of the knee.MethodsThe clinical data of 539 patients with meniscus injury treated by arthroscopic menisci reformation who met the selection criteria between July 2016 and February 2020 were retrospectively analyzed. They were divided into three groups according to the continuous saline irrigation volume during the operation: 176 patients in the non-irrigation group (group A), 183 patients in the 1 liter-irrigation group (group B), and 180 patients in the 3 liters-irrigation group (group C). There was no significant difference in gender, age, cause of injury, sides of injury, body mass index, disease duration, smoking history, and classification of meniscus injury among 3 groups (P>0.05). At 6, 12, 24, 48, and 72 hours after operation, the patient’s pain level was evaluated by the visual analogue scale (VAS) score, and the knee swelling situation was evaluated by the swelling ratings (the difference between both sides in circumference of the 2 cm upper patella of the knee). Knee skin temperature (the difference of the skin temperature between both sides) and the C-reactive protein (CRP) level in serum were measured at the 1st and 3rd days after operation. Range of motion of the knee was measured at the 1st, 3rd, and 5th days after operation.ResultsAll incisions healed by first intention without any complication after operation. The VAS scores of each group showed a slow increase trend after operation, and gradually decreased to less than the VAS score of 6 hours at 48 hours after operation. There was no significant difference in VAS scores among the 3 groups at each time point after operation (P>0.05). The swelling ratings of the knee in each group showed a gradually decrease trend after operation. There was no significant difference in the swelling ratings of the knee among the 3 groups at each time point after operation (P>0.05). The skin temperature of the knee in each group decreased at the 3rd day after operation than the 1st day, and there was no significant difference in the skin temperature of the knee among the 3 groups at each time point after operation (P>0.05). There was no significant difference in CRP level within the group and among the 3 groups at each time point after operation (P>0.05). Range of motion of the knee in each group increased gradually at the 1st, 3rd, and 5th days after operation, and there was no significant difference among the 3 groups at each time point after operation (P>0.05).ConclusionThe different continuous saline irrigation volume would not affect the early postoperative pain, swelling, and inflammation of the knee during the arthroscopic menisci plasty.