摘要
目的评价老年骨质疏松性胫骨平台骨折围手术期疼痛管理联合抗骨质疏松治疗的临床效果,为老年骨质疏松性胫骨平台骨折围手术期镇痛处理及抗骨质疏松治疗提供参考方案。方法回顾性研究2014年1月至2016年2月天津医科大学总医院两院区骨科,60岁以上骨质疏松性骨折住院病人中胫骨平台骨折Schatzker分型为Ⅱ型或Ⅲ型患者,排除合并严重内科基础疾病以及精神类疾病患者;风湿性关节炎或其他影响关节活动的疾病;双下肢有血栓形成者;对本实验药物过敏者,共纳入符合条件的患者108例,每组36例。A组单纯静脉滴注帕瑞昔布即为帕瑞昔布组,B组静脉滴注帕瑞昔布同时口服洛索洛芬钠即帕瑞昔布联合洛索洛芬钠组,C组静脉滴注帕瑞昔布同时口服洛索洛芬钠并在治疗全程应用抗骨质疏松药物即帕瑞昔布联合洛索洛芬钠及抗骨质疏松剂组。分别于术前、术后第1天和第5天分别对3组患者进行疼痛评分,并于术后2周采用美国特种外科医院膝关节评分(HSS评分)对3组患者的膝关节功能进行评分。计量资料用方差分析及q检验,计数资料用卡方检验。通过对比围手术期3组患者疼痛评分及术后膝关节HSS评分评估围手术期镇痛处理联合抗骨质疏松治疗的临床效果。结果帕瑞昔布联合洛索洛芬钠及抗骨质疏松剂组术后视觉模拟评分法(VAS)低于帕瑞昔布组和帕瑞昔布联合洛索洛芬钠组(F=8.08,P<0.05),且术后膝关节HSS评分优良率高于帕瑞昔布和帕瑞昔布联合洛索洛芬钠组。帕瑞昔布联合洛索洛芬钠组术后疼痛评分低于帕瑞昔布静脉滴注组(2=4.237,P<0.05),两组术后膝关节功能活动评分无显著统计学差异。结论帕瑞昔布联合洛索洛芬钠及抗骨质疏松剂能有效缓解老年骨质疏松性胫骨平台骨折围手术期疼痛,并能有效提高术后膝关节功能,值得临床推广。
Objective To evaluate the efficacy of perioperative analgesia combined with anti-osteoporosis therapy on aged osteoporotic tibial plateau fractures and to provide a reference for perioperative analgesic and osteoporosis treatment of osteoporotic tibial plateau fractures in the elderly .Methods A total of 108 patients over 60 years old with osteoporotic fractures in tibial plateau （ Schatzker classification type ⅡorⅢ） were selected from orthopedic department of Tianjin Medical University General Hospital and divided into three groups,36 patients each.The exclusion criteria were as follows： severe physical diseases,mental diseases,rheumatic arthritis,thromboembolism in lower limbs ,and allergic to the drugs in this study.The patients in group A received parecoxib by intravenous drip .With the same treatment as group A,the patients in group B took loxoprofen sodium as oral medicine simultaneously .The patients in group C not only took loxoprofen sodium but also received the intramuscular injection of salmon calcitonin . Pain score were evaluated in three groups before the operation ,on day 1 and day 5 post-operatively .The knee joint function of the three groups was evaluated by hospital for special surgery （ HSS） scoring system two weeks after the operation .The clinical efficacy was analyzed prior and after treatment respectively ,and the improvement rate of the symptom was compared before and after treatment in each groups . The measurement data were analyzed by variance analysis and q-test,and the counting data were tested by chi-square test.The efficacy of perioperative pain management combined with anti-osteoporosis treatment of the tibial plateau in elderly was assessed according to the comparison between the three groups .Results The VAS scores before the operation had no significant difference among the three groups .The VAS scores in group C were lower than group A and group B （F=8.08,P〈0.05） after the operation,and the good and excellent rate of the postoperative knee function in gourp
出处
《中华关节外科杂志（电子版）》
CAS
2017年第6期606-611,共6页
Chinese Journal of Joint Surgery(Electronic Edition)
关键词
胫骨
膝关节
骨质疏松骨折
手术期间
镇痛
Tibia
Knee joint
Osteoporotic fractures
Perioperative period
Analgesia
